2 PROPOSED ADMINISTRATIVE RULES

 

SOAHR 2009-039 DEPARTMENT OF COMMUNITY HEALTH

DIRECTOR’S OFFICE

 

CHIROPRACTIC - GENERAL RULES

Proposed November 10, 2010

 

Filed with the Secretary of State on

 

These rules become effective immediately upon filing with the Secretary of State unless adopted under section 33, 44, or 45a(6) of 1969 PA 306. Rules adopted under these sections become effective 7 days after filing with the Secretary of State.

 

(By authority conferred on the director of the department of community health by sections 16145(3), and 16401, 16423, and 16431(3) of 1978 PA 368, MCL 333.16145(3), and MCL

333.16401, 333.16423, and 333.16431(3) et seq. and Executive Reorganization Order Nos. 1996-1, 1996-2, and 2003-1, MCL 333.3101, MCL 445.2001 and MCL 445.2011)

 

R 338.12001, R 338.12003, R 338.12004, R 338.12005, R 338.12006, R 338.12008, R

338.12008a, R 338.12009, R 338.12010, R 338.12011, R 338.12014, and R 338.12015 of the

Michigan Administrative Code are amended, and R 338.12008b, R 338.12011a, and R 338.12011b are added to the Code, and R 338.12002 of the Code is rescinded, as follows:

 

R 338.12001  Definitions. Rule 1. As used in these rules:

(a)     "Adjustment apparatus" means a tool or device used to apply a mechanical force to correct or reduce a subluxations, or misalignments, and joint dysfunctions. of the vertebral column or related bones and tissues for the establishment of neural integrity.

(b)     "Analytical instruments" means instruments which monitor the body's physiology used in the detection and diagnosis of human conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions, or to assist the chiropractor in offering advice to seek treatment from other health professionals in order to restore and maintain health. for the purpose of determining subluxated or misaligned vertebrae or related bones and tissues.

(c)     "Code" means 1978 PA 368, MCL 333.1101 et seq.

(d)     “Nationally recognized standards” means that which is taught in a chiropractic educational program or postgraduate educational program that is accredited by the council on chiropractic education, commission on accreditation.

(e)     “Physical measures” means procedures or techniques used to correct or reduce subluxations, misalignments, and joint dysfunctions.

(d)(f) "Rehabilitative exercises" means the coordination of a patient's exercise program,; the performance, ordering and use of tests; and the performance of measurements,; instruction and consultation,; supervision of personnel,; and the use of exercise and rehabilitative

 

 

procedures, with or without assistive devices, for the purpose of correcting or preventing a subluxated or misaligned vertebrae of the vertebral column subluxations, misalignments, and joint dysfunctions.

(g)  “Test” means a procedure that is ordered or performed for the purpose of detecting and diagnosing human conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions, or to assist the chiropractor in offering advice to seek treatment from other health professionals in order to restore and maintain health.

 

R 338.12002   Licensure; application Rescinded.

Rule 2. (1) An applicant for licensure shall apply on forms provided by the department.

  (2)  An applicant shall submit application fees established by the legislature with the application.

 

R 338.12003  Licensure by examination; requirements.

Rule 3. (1) An applicant for licensure a chiropractic license by examination shall submit the required fee and a completed application on a form provided by the department. , together with the requisite fee. In addition to meeting the requirements of the code and these rules, an applicant for licensure by examination shall meet both of the following provisions requirements:

(a)     Have graduated from a program or institution of chiropractic that meets the educational standards in R 338.12006 and have final, official transcripts provided to the department from the educational institution.

(b)     Shall meet 1 of the following: Have passed parts I, II, III, and IV of the national board examination that is conducted and scored by the national board of chiropractic examiners. (i)  For applications filed on or before December 31, 2000, an applicant shall have achieved either of the following:

(A) A passing score on the state examination which is approved by the Michigan board of chiropractic and which is administered by the department of community health under the provisions of R 338.12005(1).

(B) Passing scores on parts I and II of the national board examination. The scores and verification shall be sent directly from the national board office to the chiropractic board office.

  (ii)  For an application filed on or after January 1, 2001, an applicant shall have passed parts I, II, and III of the national board examination that is conducted and scored by the national board of chiropractic examiners.

(iii)  For an application filed on or after January 1, 2007, an applicant shall have passed parts I, II, III and IV of the national board of examination that is conducted and scored by the national board of chiropractic examiners.

 

R 338.12004   Licensure by endorsement; requirements.

Rule 4. (1)  An applicant for a chiropractic license by endorsement shall submit the required fee and a completed application on a form provided by the department. , together with the requisite fee. In addition to meeting the requirements of the code and these rules, an applicant shall satisfy who satisfies the requirements of this rule, as applicable, shall meet the requirements of section 16186 of the code.

(2)     If an applicant was first licensed in another state before January 1, 2001, and has been engaged in the practice of chiropractic for a minimum of 5 years or more before immediately preceding the

 

 

(3)     If an applicant does not meet the requirements of subrule (2) of this rule was first licensed in another state for less than 5 years immediately preceding the date of filing an application for a Michigan chiropractic license, then the applicant, in addition to meeting the requirements of the code, shall establish that the applicant have been licensed in another state and establish having passed the examination specified in R 338.12003 passed parts I, II, III, and IV of the national board examination that is conducted and scored by the national board of chiropractic examiners.

(4)  In addition to meeting the requirements of subrule (1) and either subrule (2) or (3) of this rule, an applicant’s license shall be verified, on a form supplied by the department, by the licensing agency of any state of the United States in which the applicant holds a current license or ever held a license as a chiropractor. Verification includes, but is not limited to, showing proof of any disciplinary action taken or pending against the applicant.

 

 

R 338.12005   Examination; adoption and approval; passing score.

Rule 5.  The board approves and adopts the national board examination in chiropractic that is conducted and scored by the national board of chiropractic examiners. The board adopts the passing score recommended by the national board of chiropractic examiners for the national board examination parts I, II, III, and IV. shall be a converted score of not less than 75.

 

R 338.12006  Adoption of educational Educational program standards; adoption by reference. Rule 6. (1) The board adopts by reference the standards of the council on chiropractic education, commission on accreditation, as specified in the publication entitled, "Standards for Doctor of

Chiropractic Programs and Requirements for Institutional Status" January 2004 2007. The standards are available from The Council on Chiropractic Education, 8049 N. 85th Way, Scottsdale, Arizona 85258 - 4321, or at the council’s website at http://www.cce-usa.org at no cost. Copies of the standards are available for inspection and distribution at cost from the Board of Chiropractic, Bureau of Health Professions, Department of Community Health, 611 West Ottawa Street, P. O. Box 30670, Lansing, Michigan 48909.

(2)     Any chiropractic educational program that is accredited by the council on chiropractic education, commission on accreditation, qualifies as a chiropractic educational program approved by the board.

 

R 338.12008   License renewal; and relicensure continuing education.

Rule 8. (1)  An applicant for renewal of a license to practice chiropractic shall have completed, in the 2-year period immediately preceding the application, 30 hours of continuing education in programs approved by the board.

(a)     An applicant for renewal of a license to practice chiropractic under section 16201(2) of the code shall have completed in each renewal period, as part of the required hours of continuing education, all of the following: 1 continuing education hour on sexual boundaries, 1 continuing education hour on ethics, and 1 continuing education hour on pain and symptom management.

(i)     One continuing education hour on sexual boundaries.

(ii)     One continuing education hour on ethics.

(iii)     One continuing education hour on pain and symptom management.

 

 

(iv)     Two continuing education hours on physical measures under MCL 333.16431(3). The continuing education hours required on physical measures shall be completed by attending a live, in-person program.

(v)     Two continuing education hours on the performance and ordering of tests under MCL 333.16431(3). The continuing education hours required on the performance and ordering of tests shall be completed by attending a live, in-person program.

(b)     Of the required hours of continuing education, not more than 6 15 continuing education hours may be in board-approved online computer distance learning programs. For the purposes of this subrule, distance learning means any of the following:

(i)     Approved continuing education courses, programs, or activities where the instructor and participant are apart and not able to immediately interact. Instruction takes place through media including, but not limited to, journal articles, manuals, CDs, DVDs, audio and video tapes, research projects, and Internet courses.

(ii)     Approved continuing education courses where the instructor and participant are apart but are able to immediately interact and participant attendance is verified by the provider. This type of distance learning includes, but is not limited to, instruction presented through teleseminars and webinars.

(c)  The board shall not approve for continuing education credit a distance learning program in which a participant performs a chiropractic manipulation or adjustment on another individual as part of the program.

(c)(d)  This subrule does not apply to licensees who have obtained their initial chiropractic license within the 2-year period immediately preceding the expiration date of the initial license.

  (2)  An applicant for relicensure under the provisions of section 16201(3) of the code shall comply with either of the following requirements:

  (a)  Have completed, in the 3-year period immediately preceding the application for relicensure, 42 hours of continuing education in programs approved by the board with not less than 24 hours in courses on chiropractic adjusting techniques.  The following also apply:

  (i) Have completed as part of the required hours of continuing education, 1 continuing education hour in sexual boundaries, 1 continuing education hour in ethics, and 1 continuing education hour in pain and symptom management.

  (ii)  Have completed as part of the required hours of continuing education, not more than 6 continuing education hours in board-approved online computer programs.

  (b)  Have been continuously licensed and engaged in the practice of chiropractic in another state during the 3-year period immediately preceding the application for relicensure.

(2)  Submission of an application for renewal shall constitute the applicant’s certification of compliance with this rule. An applicant for renewal shall retain documentation of meeting this rule for a period of 3 years from the date of applying for license renewal. Failure to comply with this rule shall be a violation of section 16221(h) of the code.

 

R 338.12008a   Continuing education; approval of programs; acceptable and unacceptable programs. Rule 8a.(1)  The board shall consider as board-approved continuing education, the successful completion of a course or courses offered for academic credit in a chiropractic school approved by the board under R 338.12006.

(2)     The board shall consider both of the following as continuing education:

(a)     Successful completion of a continuing education program offered by a chiropractic school approved by the board under R 338.12006.  The school shall annually provide the department with the names of the programs as well as dates and times that the programs were offered, and the

 

 

locations of the training offered in Michigan. Effective June 1, 2012, a chiropractic school shall comply with the all of the following:

(i)     Submit to the department the names, dates, and times of the programs that will be offered and the locations of the programs offered in this state. The school shall submit the information prior to the start of the academic year.

(ii)     Submit any continuing education programs added after the beginning of the academic year to the department at least 90 days prior to the continuing education program being held.

(iii)     Submit any additional information requested by the department or the board to ensure compliance with this rule.

(b)     One The board may grant 1 continuing education contact hour may be granted for each 50 to 60 minutes of program attendance, without limitation, at a continuing education program, which has been granted approval by another state state’s board of chiropractic.

(3)     If a chiropractic school fails to comply with the requirements of subrule 2(a) of this rule, the board may require approval of continuing education programs under subrule (4) of this rule.

(3)(4)  The board shall consider requests for approval of continuing education programs by sponsors who submit applications on a form provided by the department. For purposes of this rule, 1 hour of continuing education is defined as 50 to 60 minutes of program attendance or participation in an activity. The board shall evaluate applications for approval based upon all of the following:

(a)     Programs shall have content outlines and schedules.

(b)     Sponsors shall provide a listing of program materials.

(c)     Sponsors shall provide information relative to the method for monitoring attendance, if applicable, or verifying completion of an activity.

(d)    Sponsors shall furnish evidence of program attendance to attendees or completion of an activity to participants.

(e)     Program instructors, or presenters, developers, or authors shall demonstrate qualifications and knowledge in the subject matter.

(f)    Programs shall relate to the general subject area of the practice of chiropractic.

(4)(5) Programs considered for approval under subrules (1) and (2) of this rule shall not receive credit for those portions of programs covering subject areas that include practice building, marketing, or financial advancement, with the exception of content that includes the laws, rules, regulations, or policies regarding insurance billing or documentation.

(6)     The board may disapprove programs offered by institutions and organizations if the board determines that the programs offered by those institutions or organizations fail to demonstrate compliance with the legislative intent to further educate licensees on subjects related to the practice of chiropractic.

(7)    A member of the board or his or her designee may attend a continuing education program and perform a random review to ensure compliance with this rule.

 

R 338.12008b   Relicensure; requirements.

Rule 8b. (1)  An applicant for relicensure may be relicensed under section 16201(3) and (4) of the code if the applicant meets either of the following requirements:

(a)    Have completed, in the 3-year period immediately preceding the application for relicensure, 45 hours of continuing education in programs approved by the board that include all of the following:

(i)     Twenty-four continuing education hours on chiropractic adjusting techniques.

 

 

(ii)     The required continuing education hours listed in paragraphs (i) to (v) of R 338.12008(1)(a).

(ii)  Not more than 15 continuing education hours in board-approved distance learning programs.

(b)    Have been licensed as a chiropractor in another state of the United States for the entire 3-year period immediately preceding the application for relicensure.

(2)     In addition to meeting the requirements of subrule (1) of this rule, an applicant’s license shall be verified, on a form supplied by the department, by the licensing agency of any state of the United States in which the applicant holds a current license or ever held a license as a chiropractor. Verification includes, but is not limited to, showing proof of any disciplinary action taken or pending against the applicant.

 

R 338.12009   Assessment of fine Factors in assessing fines.

Rule 9. (1)  When a fine has been designated as an available sanction for a violation of sections section 16221 to 16226 of the code, in the course of assessing a fine, a the board shall may take into consideration the following factors without limitation in assessing the fine:

(a)     The extent to which the licensee obtained financial benefit. from any conduct comprising part of the violation found by the board.

(b)     The willfulness of the conduct. found to be part of the violation determined by the board.

(c)     The public harm, actual or potential., caused by the violation found by the board.

(d)    The cost incurred in investigating and proceeding against the licensee.

(2)  A fine shall not exceed the sum of $10,000.00 for each violation found to have been committed by the licensee.

 

R 338.12010   Adjustment apparatus; criteria for board approval.

Rule 10.  In accordance with Under section 16423 of the code, the following criteria are established for any adjustment apparatus which approved by the board has been asked to approve shall satisfy all of the following requirements:

(a)  The apparatus shall be used for the practice of chiropractic as defined in section 16401(1)(e) of the code.

(1)(b)  The purpose of the apparatus is to restore or maintain alignment of vertebrae shall be used for the purpose of correcting or reducing subluxations, misalignments, and joint dysfunctions. The use of the apparatus may be included as, but not limited to, a part of a rehabilitative exercise program.

(2)(c)  The use of the apparatus applies a mechanical force to the spine or related bone and tissues shall be substantially equivalent to nationally recognized standards as defined in R 338.12001(d).

 

R 338.12011   Analytical instruments; criteria for board approval.

Rule 11.  In accordance with Under section 16423 of the code, the following criterion is established for any analytical instruments which approved by the board has been asked to approve shall satisfy all of the following requirements:

The purpose of the instrument is to monitor the body's physiology for the purpose of determining subluxated or misaligned vertebrae or related bones and tissues.

(a)     The instruments shall be used for the practice of chiropractic as defined in section 16401(1)(e) of the code.

 

 

(b)     The instruments shall be used for the purpose of detecting and diagnosing human conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions, or to assist the chiropractor in offering advice to seek treatment from other health professionals in order to restore and maintain health. The use of the instruments may be included as, but not limited to, a part of a rehabilitative exercise program.

(c)     The use of the instruments shall be substantially equivalent to nationally recognized standards as defined in R 338.12001(d).

 

 

R 338.12011a   Tests; performance or ordering; requirements.

Rule 11a.  Under section 16423 of the code, the performance, ordering or use of tests shall satisfy all of the following requirements:

(a)     The performance and ordering of tests shall be for the practice of chiropractic as defined in section 16401(1)(e) of the code.

(b)     The performance, ordering, or use of tests shall be for the purpose of detecting and diagnosing human conditions and disorders of the musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions, or to assist the chiropractor in offering advice to seek treatment from other health professionals in order to restore and maintain health. The performance and ordering of tests may be included as, but not limited to, a part of a rehabilitative exercise program.

(c)     The performance and ordering of tests shall be substantially equivalent to nationally recognized standards as defined in R 338.12001(d).

R 338.12011b   Performance of invasive procedure; requirements.

Rule 11b. Under sections 16401(2)(d) and 16423 of the code, a chiropractor may perform an invasive procedure if both of the following requirements are met:

(a)     The invasive procedure is limited to an examination of the ears, nose, and throat.

(b)     The purpose of the examination is to detect and diagnose human conditions and disorders of the musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions, or to assist the chiropractor in offering advice to seek treatment from other health professionals in order to restore and maintain health.

 

R 338.12014   Advertising.

Rule 14. (1)  All licensees practicing chiropractic in Michigan this state shall use the word "chiropractic" or "chiropractor" or the initials "D.C." in conjunction with their names on all signs, letterheads, business cards, or similar items of identification.

(2)     Any advertisement or advertising which that does any of the following is deemed considered

by the board to be fraudulent, false, deceptive, or misleading:

(a)     Contains a misrepresentation of facts.

(b)     Is misleading or deceiving in its content or context.

(c)     Creates false or unjustified expectations of beneficial treatment or successful cures.

(d)    Fails to conspicuously identify the chiropractor or chiropractors referred to in the advertising as a chiropractor or chiropractors.

(e)     Contains any representation which that identifies the chiropractic practice being advertised by a name which that does not include the term "chiropractor" or "chiropractic" or some easily recognizable derivative thereof the initials “D.C.”

 

 

(f)     Appears in any classified directory, listing, or compendium under a heading which, when considered together with the advertisement, has the capacity or tendency to be deceptive or misleading with respect to the profession or professional status of the chiropractor.

 

R 338.12015   Patient records.

Rule 15. (1)  A licensee practicing chiropractic in Michigan this state shall maintain a legible patient record for each patient, which accurately reflects the licensee’s evaluation and treatment of the patient.  Entries in the patient record shall be made in a timely fashion.

(2)    The patient record shall contain the patient’s full name, address, date of birth, sex, and other information sufficient to identify the patient; the date of every entry in the patient record; and, the name of the person making an entry if that person is not the licensee. all of the following:

(a)    The name of the attending chiropractor.

(b)    The patient’s full name, address, date of birth, sex, and other information sufficient to identify the patient.

(c)     The date of every entry in the patient record.

(d)     A patient record entry for an initial patient visit that includes all of the following:

(i)     History, including description of presenting condition.

(ii)     Physical evaluation.

(iii)     Diagnostic studies, if applicable.

(iv)     Diagnosis.

(v)     Treatment or care provided.

(e)    A patient record entry for subsequent evaluations, treatments, or care provided that includes all of the following:

(i)     Change in condition, if applicable.

(ii)     Physical evaluation.

(iii)     Treatment or care provided.

(f)    If applicable, a referral to another health care provider.

  (3)  The patient record shall contain sufficient information to document the chiropractic care rendered, ordered, or prescribed.

  (4)  A referral to another health care provider shall be reported in the patient record. (5)(3)  A licensee shall retain a patient record for at least 7 years from the date of the last

chiropractic service for which a patient record entry is required. A licensee shall retain the patient record for a minor patient until 1 year after the minor patient reaches 18 years of age, even if the licensee retains this results in the record being retained for more than 7 years.