No. 32753 (Amendment): R156-73. Chiropractic Physician Practice Act Rules

DAR File No.: 32753
Filed: 06/25/2009, 10:40
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this filing is to clarify terms used in the governing statute, Title 58, Chapter 73, to address current practices which may be hazardous to the public safety or welfare, to add additional unprofessional conduct definitions, and to make technical corrections and clarifications that have been reviewed by the Division and the Chiropractic Physician Licensing Board.

Summary of the rule or change:

Throughout the rule, the term "rules" has been replaced with "rule" where applicable. In Section R156-73-102, added a definition for "joint mobilization". Section R156-73-302 is being added to provide guidelines for the licensing qualification of "good moral character". In Section R156-73-303b, amendments are proposed to clarify standards for sponsorship of required continuing education. In Section R156-73-303, the proposed amendment provides that a temporary license may only be issued for a period of not more than six months. In Section R156-73-501, added unprofessional conduct definitions to clarify the responsibilities of a chiropractic physician with regard to safety and welfare of the public. In Section R156-73-502, added the administration of injections per Subsection R156-73-501(14) cannot be delegated to a chiropractic assistant by a chiropractic physician. In Section R156-73-601, the name of section is updated to correctly reflect the requirements of the section. Section R156-73-605 is being added to provide a new licensee may be requested to meet with the Chiropractic Physicians Licensing Board.

State statutory or constitutional authorization for this rule:

Section 58-73-101 and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $75 to print the rule and distribute it once the proposed amendments are made effective. Division investigators should not require additional training as a result of the proposed amendments. A possible increase in compliance costs to the Division may occur if an increased number of complaints resulting from the proposed amendments are reported to the Division. Any costs incurred will be absorbed in the Division's current budget.

local governments:

Proposed amendments only apply to licensed chiropractic physicians and applicants for licensure in that classification. As a result, the proposed amendments do not apply to local governments.

small businesses and persons other than businesses:

The proposed amendments only apply to licensed chiropractic physicians and applicants for licensure in that classification. A licensed chiropractic physician's office may qualify as a small business. Such an office, or small clinic employing a chiropractic physician, should not be impacted by the proposed amendments. The proposed amendments may result in a possible savings for the public and insurance carriers due to the clarification of terms and responsibilities of a chiropractic physician. There may be unknown costs if a licensed chiropractic physician engages in any of the unprofessional conduct definitions which are being added and if an administrative proceeding is initiated as a result of any violation committed by the licensee. However, if a licensee does not engage in the unprofessional conduct behavior, no costs will be incurred.

Compliance costs for affected persons:

The proposed amendments only apply to licensed chiropractic physicians and applicants for licensure in that classification. The proposed amendments may result in a possible savings for the public and insurance carriers due to the clarification of terms and responsibilities of a chiropractic physician. There may be unknown costs if a licensed chiropractic physician engages in any of the unprofessional conduct definitions which are being added and if an administrative proceeding is initiated as a result of any violation committed by the licensee. However, if a licensee does not engage in the unprofessional conduct behavior, no costs will be incurred.

Comments by the department head on the fiscal impact the rule may have on businesses:

This filing places into rule the standards used to determine good moral character, sets additional standards for professional conduct, and makes other clarifying amendments. It is expected that the public and licensees will benefit from such clarification and adoption of standards. No fiscal impact to businesses is anticipated. Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Sally Stewart at the above address, by phone at 801-530-6179, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/14/2009

Interested persons may attend a public hearing regarding this rule:

7/16/2009 at 9:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 401 (fourth floor), Salt Lake City, UT

This rule may become effective on:

08/21/2009

Authorized by:

Mark B. Steinagel, Director

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-73. Chiropractic Physician Practice Act Rule[s].

R156-73-101. Title.

[These rules are]This rule is known as the "Chiropractic Physician Practice Act Rule[s]".

 

R156-73-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 73, as used in Title 58, Chapters 1 and 73, or [these]this rule[s]:

(1) "Clinical acupuncture" means the application of mechanical, thermal, manual, and/or electrical stimulation of acupuncture points and meridians, including the insertion of needles, by a chiropractic physician that has demonstrated competency and training by completing a recognized course that is sponsored by an institution or organization approved to sponsor continuing education, as defined in Section R156-73-303b.

(2) "Distance learning" means the acquisition of knowledge and skills through information and instruction encompassing all technologies and other forms of learning at a distance, including internet, audio/visual recordings, mail or other correspondence.

(3) "FCLB" means the Federation of Chiropractic Licensing Boards.

(4) "Indirect supervision" means the supervising licensed chiropractic physician shall be available for immediate voice contact by telephone, radio, or other means and shall provide daily face to face consultation and review of cases at the chiropractic facility for the chiropractic intern, temporarily licensed or unlicensed person being supervised.

(5) "Joint mobilization", as used in Subsection 58-73-601(2)(c)(ii)(B) means passive movements done by another person, applied as a series of stretches or repetitive movements to individual or combinations of joints, not to exceed the end range of motion and stopping short of the articular elastic barrier.

([5]6) "NBCE" means the National Board of Chiropractic Examiners.

([6]7) "PACE" means Providers of Approved Continuing Education sponsored by the Federation of Chiropractic Licensing Boards.

([7]8) "Preceptor" means a licensed chiropractic physician who is a supervisor of interns and externs in the professional practice of chiropractic.

([8]9) "Preceptorship" means a supervised training program established by a written contract between a chiropractic college or university whose program or institution is accredited by the Council on Chiropractic Education, Inc., and a licensee for the purpose of providing chiropractic training to a student enrolled in the chiropractic college or university while under the supervision of a licensee.

([9]10) "Unprofessional conduct", as defined in Title 58, Chapters 1 and 73, is further defined in accordance with Subsection 58-1-203(5), in Section R156-73-501.

 

R156-73-103. Authority - Purpose.

[These rules are]This rule is adopted by the division under the authority of Subsection 58-1-106(1)(a) to enable the division to administer Title 58, Chapter 73.

 

R156-73-302. Good Moral Character - Disqualifying Convictions.

(1) When reviewing an application to determine the good moral character of an applicant as set forth in Section 58-73-302 and whether the applicant has been involved in unprofessional conduct as set forth in Subsection 58-1-501(2)(c), the Division and the Board shall consider the applicant's criminal record as follows:

(a) a criminal conviction for a sex offense as defined in Title 76, Chapter 5, Part 4 and Chapter 5a, and Title 76, Chapter 10, Parts 12 and 13, shall disqualify an applicant from becoming licensed; or

(b) a criminal conviction for the following crimes may disqualify an applicant from becoming licensed:

(i) crimes against a person as defined in Title 76, Chapter 5, Parts 1, 2 and 3;

(ii) crimes against property as defined in Title 76, Chapter 6, Parts 1 through 6;

(iii) any offense involving controlled dangerous substances; or

(iv) conspiracy to commit or any attempt to commit any of the above offenses.

(2) An applicant who has a criminal conviction for a felony crime of violence may be considered ineligible for licensure for a period of seven years from the termination of parole, probation, judicial proceeding or date of incident, whichever is later.

(3) An applicant who has a criminal conviction for a felony involving a controlled substance may be considered ineligible for licensure for a period of five years from the termination of parole, probation, judicial proceeding or date of incident, whichever is later.

(4) An applicant who has a criminal conviction for any misdemeanor crime of violence or the use of a controlled substance may be considered ineligible for licensure for a period of three years from the termination of parole, probation, judicial proceeding or date of incident, whichever is later.

(5) Each application for licensure or renewal of licensure shall be considered in accordance with the requirements of Section R156-1-302.

 

R156-73-303b. Continuing Education - Standards.

(1) The standards for continuing education are as follows:

(a) the content must be relevant to chiropractic practice and consistent with the laws and rules of this state;

(b) the course must be under the sponsorship of or approved by:

(i) a chiropractic college or university whose doctor of chiropractic program is accredited by the Council on Chiropractic Education, Inc.;

(ii) a professional [association ]or nonprofit organization or association representing a licensed profession that has open membership and election of officers whose program objectives relate to the practice of chiropractic;

(iii) the licensing agency of Utah or another state; or

(iv) PACE;

(c) learning objectives must be reasonably and clearly stated;

(d) teaching methods must be clearly stated and appropriate;

(e) faculty must be qualified, both in experience and in teaching expertise;

(f) documentation of attendance must be provided;

(g) there shall be no more than four clock hours related to chiropractic practice marketing or practice building;

(h) no more than 10 hours of continuing education, in each two year period of licensure, may be by distance learning.

(2) A licensee shall be responsible for maintaining competent records of completed continuing education for a period of two years after close of the two year period to which the records pertain.

(3) The board may, after review, waive the continuing education requirements for a licensee presenting sufficient evidence of hardship or illness or other reason making it impossible or highly impractical for the licensee to attend or have attended a sufficient number of continuing education classes.

(4) As part of the 40 continuing education hours required every two years, a chiropractic physician, who provides acupuncture services as a part of their practice, shall complete 10 hours of acupuncture related continuing education.

 

R156-73-303. Temporary License.

In accordance with Subsections 58-1-303(1)(a) and 58-73-302(2), an endorsement applicant may be issued a temporary license for a period of not more than six months under the following conditions:

(1) The licensee shall work under the indirect supervision of a chiropractic physician approved by the division.

(2) The supervising chiropractic physician shall:

(a) be available at all times to provide advice, instruction and consultation;

(b) assume responsibility for all chiropractic activities and services performed by the temporary licensee; and

(c) supervise no more than two persons at any given time.

(3) The temporary license may not be renewed or extended for any purpose.

(4) Any change in supervising chiropractic physician shall be preapproved by the division.

 

R156-73-308. Renewal Cycle - Procedures.

(1) In accordance with Subsection 58-1-308(1), the renewal date for the two-year renewal cycle applicable to licensees under Title 58, Chapter 73, is established by rule in Section R156-1-308a.

(2) Renewal procedures shall be in accordance with Section R156-1-308c.

 

R156-73-501. Unprofessional Conduct.

"Unprofessional conduct" includes:

(1) keeping the office, instruments, laboratory, equipment, appliances or supplies in an unsafe or unsanitary condition;

(2) engaging in advertising which is misleading because of omission of necessary material information, which contains false or misleading statements, or which otherwise operates to deceive;

(3) engaging in or abetting deceptive or fraudulent billing practices;

(4) engaging in sexual contact with a patient, with or without patient consent, within 12 months of last treatment;

(5) engaging in sexual activities or contact with a former patient, with or without consent, after 12 months of last treatment if there is a risk of exploitation or potential harm to the former patient;

(6) engaging in behaviors in a patient/doctor relationship, including verbal, intended to sexually arouse any person or encourage sexual activity;

(7) failing to keep the division informed of a current address and telephone number;

(8) advertising acupuncture services or practicing clinical acupuncture techniques beyond the scope of the certification held;[ and]

(9) advertising as an "acupuncturist" either verbally or in print;

(10) failing to maintain responsibility for care, billing and documentation in a group practice, multidisciplinary practice or third-party ownership practice;

(11) engaging in any act or practice in a professional capacity which the licensee is not competent to perform through education or training;

(12) administering injections through the skin, limited to subcutaneous or intramuscular administration, of any substances other than non-prescription drugs as defined in Subsections 58-17b-102(39) or non-controlled substances as defined in Subsection 58-37-2(f)(ii);

(13) administering injections of non-prescription drugs or non-controlled substances without sufficient competency and training as demonstrated by the following:

(a) completion of a recognized course on injectables and their administration, under the sponsorship of or approved by an institution, organization or association meeting the continuing education standards as defined in Section R156-73-303b; and

(b) receiving a passing score on a certifying examination; and

(14) delegating the administration of injections to a chiropractic assistant.

 

R156-73-502. Chiropractic Assistant.

In accordance with Subsection 58-73-102(3), a chiropractic assistant may perform activities related to the practice of chiropractic in accordance with the following:

(1) The supervising chiropractic physician shall:

(a) be currently licensed in Utah;

(b) be responsible for the chiropractic activities and services performed by the assistant; and

(c) always be available to provide advice, instruction and consultation.

(2) The supervising chiropractic physician shall never delegate the following to a chiropractic assistant:

(a) adjustment of the articulation of the spinal column;

(b) diagnosis of the articulation of the spinal column;

(c) manipulation of the articulation of the spinal column;[ and]

(d) therapeutic positioning of the articulation of the spinal column; and

(e) administration of injections per Subsection R156-73-501(14).

 

R156-73-601. [Scope of Practice]Competency Requirements to Perform Acupuncture.

The requirements to demonstrate competency and training to perform clinical acupuncture include:

(1) Licensees who provided acupuncture services as a part of their practice prior to January 1, 2002 are not required to meet the requirements of Subsections (2) or (3), but are required to complete a recognized clinical acupuncture course sponsored by an institution or organization approved to sponsor continuing education, as defined in Section R156-73-303b, consisting of at least 100 classroom hours of instruction and passing a certifying examination in order to continue to provide clinical acupuncture as a part of their practice after January 1, 2002.

(2) Licensees who begin providing clinical acupuncture as a part of their practice on or after January 1, 2002 and prior to January 1, 2005 shall:

(a) complete a recognized clinical acupuncture course sponsored by an institution or organization approved to sponsor continuing education, as defined in Section R156-73-303b, consisting of at least 200 classroom hours of instruction and passing a certifying examination; or

(b) complete a recognized clinical acupuncture course sponsored by an institution or organization approved to sponsor continuing education, as defined in Section R156-73-303b, consisting of at least 100 classroom hours of instruction, passing a certifying examination, and completing 100 hours of clinical experience under the indirect supervision of a licensed health care provider who has met the requirements in Subsection (1) or (2)(a), and has practiced clinical acupuncture for at least two years.

(3) Licensees who begin providing clinical acupuncture as a part of their practice on or after January 1, 2005 shall:

(a) meet the requirements to take and receive a passing score on the NBCE Acupuncture Examination; or

(b) meet the requirements to take and receive a passing score on the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Examination.

 

R156-73-605. Review of Applicant's Qualification for Licensure.

All new licensees may be requested to attend a regularly scheduled Board meeting within six months of license activation at which time their qualifications may be reviewed.

 

KEY: chiropractors, licensing, chiropractic physician

Date of Enactment or Last Substantive Amendment: [October 18, 2004]2009

Notice of Continuation: June 19, 2006

Authorizing, and Implemented or Interpreted Law: 58-73-101; 58-1-106(1)(a); 58-1-202(1)(a)