Rule Proposal

​​​VOLUME 49, ISSUE 17
ISSUE DATE: SEPTEMBER 5, 2017
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS​
NEW JERSEY STATE BOARD OF CHIROPRACTIC EXAMINERS

Proposed Amendments:N.J.A.C. 13:44E-1A.6, 2.1, 2.2, and 2.7

Proposed New Rules: N.J.A.C. 13:44E-1.2 and 4

Definitions; Malpractice Insurance; Advertising; Patient Records; Delegable Tasks or Functions of Chiropractic Aides and Licensed Chiropractic Assistants; Licensed Chiropractic Assistants
 
Authorized By: New Jersey State Board of Chiropractic Examiners, Lisa Tadeo, Executive Director.
 
Authority: N.J.S.A. 45:9-41.23.
 
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
 
Proposal Number: PRN 2017-232.
 
Submit comments by November 4, 2017, to:
 
   Lisa Tadeo, Executive Director
   New Jersey State Board of Chiropractic Examiners
   124 Halsey Street
   P.O. Box 45004
   Newark, NJ 07101
   or electronically at: http://www.njconsumeraffairs.gov/Proposals/Pages/default.aspx.
 
Summary

Under the authority of the New Jersey Board of Chiropractic Examiners (Board), P.L. 2015, c. 283 (N.J.S.A. 45:9-41 et seq.) creates a new class of licensee known as licensed chiropractic assistants and controls their scope of practice. The law became effective on July 17, 2016. The Board is proposing amendments to the rules set forth in N.J.A.C. 13:44E governing chiropractors and proposes creating a new Subchapter 4 to establish the rules for licensed chiropractic assistants.

A summary of the amendments to N.J.A.C. 13:44E and the proposed new rules follow. The Board is proposing new N.J.A.C. 13:44E-1.2, which provides a definition for the term "licensee." The Board believes this definition is necessary to distinguish which class of licensees is being discussed in Subchapters 1, 1A, 2, and 3 of the rules, since P.L. 2015, c. 283 established a new set of licensees. The new rule provides that "licensee" in the rules in Subchapters 1, 1A, 2, and 3 shall only mean a licensed chiropractor. The Board is also proposing to amend the heading of Subchapter 1 to refer to this new definition.

Subchapter 1A establishes requirements for the licensure of chiropractors. P.L. 2015, c. 283 requires licensed chiropractic assistants to be covered by the malpractice insurance policies of chiropractors. The Board proposes to amend N.J.A.C. 13:44E-1A.6, which concerns malpractice insurance, to include a new subsection (c) that requires all New Jersey-licensed chiropractic assistants working for a chiropractor licensed in the State to be covered by that examiner's malpractice insurance. Existing subsection (c) is proposed to be recodified as subsection (d) with amendment. Currently, the rule provides that it is professional misconduct for a licensed chiropractor to practice in the State without malpractice insurance. The proposed amendment to new N.J.A.C. 13:44E-1A.6(d) provides that it is professional misconduct if a licensed chiropractor practicing in the State does not have malpractice insurance for either themselves or licensed assistants employed by the practice.

Subchapter 2 addresses general rules of practice. N.J.A.C. 13:44E-2.1 concerns advertising. The Board proposes an amendment to N.J.A.C. 13:44E-2.1(b) to allow chiropractors to include licensed chiropractic assistants as part of their advertisements and to use the "L.C.A." abbreviation in those advertisements. The Board also proposes an amendment to N.J.A.C. 13:44E-2.1(c)3 to stipulate that it is professional misconduct to advertise a service that is beyond the abilities of the chiropractor or other staff to perform. N.J.A.C. 13:44E-2.2 concerns [page=2900] patient records. The Board proposes an amendment to N.J.A.C. 13:44E-2.2(a) to state that information collected by a licensed chiropractic assistant is part of a patient's permanent record that is to be prepared and maintained by a chiropractor.

N.J.A.C. 13:44E-2.7 addresses delegable tasks. Existing N.J.A.C. 13:44E-2.7 sets forth the tasks that may be performed by unlicensed assistants. The Board is proposing various amendments to this section to clarify what tasks may be delegated to licensed chiropractic assistants, and those tasks that may continue to be delegated to individuals that are not licensed. In order to avoid confusion, the Board is proposing to change all references to "unlicensed assistants" to "chiropractic aides" throughout the rule. N.J.A.C. 13:44E-2.7(a) defines the terms pertinent to the performance of delegable tasks. The Board proposes an amendment to N.J.A.C. 13:44E-2.7(a) to remove the definition of "direct supervision." In its place, the Board is proposing a definition for the term "supervision," consistent with the provisions of P.L. 2015, c. 283, which is defined as the oversight provided by a licensed chiropractor of the clinical services performed by a licensed assistant, and for which the chiropractor shall be on the premises at all times and readily available to instruct the licensed assistant. The Board proposes to further amend N.J.A.C. 13:44E-2.7(a) to include definitions for the terms "plan of care," and "licensed chiropractic assistant."

N.J.A.C. 13:44E-2.7(b) lists delegable tasks. The Board is proposing to amend subsection (b) to provide that under supervision, a licensed chiropractic assistant may perform the existing tasks delineated in (b)1 through 10. Those tasks remain unchanged. The Board proposes new N.J.A.C. 13:44E-2.7(b)11 and 12 to add two additional tasks that may be performed by licensed assistants pursuant to P.L. 2015, c. 283. Proposed new N.J.A.C. 13:44E-2.7(b)11 allows licensed chiropractic assistants to administer thermal, sound, light, mechanical, and electrical modalities and hydrotherapy, and proposed new N.J.A.C. 13:44E-2.7(b)12 allows them to instruct and monitor prescribed rehabilitative exercises.

The Board proposes new subsection (c) to provide that chiropractic aides may perform the delegable tasks listed in N.J.A.C. 13:44E-2.7(b)1 through 10, which they are currently authorized to perform, but may not perform the tasks in (b)11 through 12 since those are only to be performed by licensed chiropractic assistants pursuant to P.L. 2015, c. 283. The proposed amendments to subsection (c) provide further that if a licensed chiropractor employs a chiropractic aide, supervision of the aide shall require the chiropractor to be on the premises at all times, and shall entail regular consultation, guidance, and instruction with respect to the tasks and functions performed by the aide.

The Board proposes new subsection (d) to list the specific tasks and functions a chiropractor may not allow either a licensed chiropractic assistant or a chiropractic aide to perform. Such activities are delineated in existing subsection (c). The Board proposes to recodify the requirements in existing subsection (d) to new subsection (e) to list the responsibilities of a chiropractor employing chiropractic aides and licensed chiropractic assistants. The requirements in existing subsection (e) are proposed to be recodified with amendments at N.J.A.C. 13:44E-2.7(f). New subsection (f) provides that the chiropractor is to write in the plan of care the instructions for chiropractic aides and licensed chiropractic assistants and to make the plan available at all times. "Plan of care" replaces existing language that stipulates that a "patient's chart" is where instructions are to be listed. "Plan of care" makes the location of instructions more specific. The requirements from existing subsection (f) are proposed to be recodifed at new subsection (g). The rule requires a chiropractic aide or licensed chiropractic assistant to determine if a patient's status has materially changed since the patient's prior visit. If it has, the assistant or aide may not perform their delegable tasks until a chiropractor has reexamined the patient and authorized the tasks to be performed. The Board is proposing a new subsection (h), which provides that, notwithstanding the requirements of the rule concerning licensed assistants and chiropractic aides, nothing in the rule is intended to prohibit a student enrolled in a chiropractic or chiropractic assistance program approved by the Board from performing clinical services under the supervision of a licensed chiropractor.

N.J.A.C. 13:44E-4 is a proposed new subchapter that sets forth the requirements necessary to become a licensed chiropractic assistant and the obligations once licensed. Proposed new N.J.A.C. 13:44E-4.1 explains the purpose and scope of the rules. In order to ensure that applicants for licensure as chiropractic assistants will have adequate time to obtain the required education and training established pursuant to the proposed new rules, the Board is proposing a delayed operative date for the requirements in Subchapter 4. Proposed new N.J.A.C. 13:44E-4.1(b) provides that the new rules will not become operative until 12 months following the effective date of the rules in the new subchapter.

Proposed new N.J.A.C. 13:44E-4.2 sets forth definitions for terms used throughout the new subchapter, including, "chiropractic assistance," "licensed chiropractic assistant," and "supervision." The terms are defined consistent with the definition of such terms in P.L. 2015, c. 283. "Plan of care" is also defined, and means a documented treatment plan designed by the licensed chiropractor for the treatment of patients. The Board anticipates that the plan of care will provide guidance to licensed assistants when performing their work.

Proposed new N.J.A.C. 13:44E-4.3 explains the scope of practice for licensed chiropractic assistants and the activities that fall outside that scope of practice. Consistent with the provisions of P.L. 2015, c. 283, the proposed new rule provides that the scope of practice for licensed chiropractic assistants includes the collection of general heath data; the application of thermal, sound, light, mechanical, and electrical modalities and hydrotherapy; and instructing and monitoring prescribed rehabilitative activities. The scope of practice for licensed chiropractic assistants does not include performing non-clinical administrative work, chiropractic adjustments, manual therapy, nutritional instruction, and counseling. A licensed assistant may also not perform any other therapeutic services or procedures that require additional licensure.

Proposed new N.J.A.C. 13:44E-4.4 incorporates the requirements from P.L. 2015, c. 283 that must be satisfied in order to obtain a license as a chiropractic assistant. Specifically, the new rule requires an applicant for a license to be at least 18 years of age, be of good moral character, and have successfully completed high school. In addition, an applicant must have completed specific educational and clinical requirements set forth in proposed new N.J.A.C. 13:44E-4.6 and must have successfully passed a Board-approved competency examination. Proposed new N.J.A.C. 13:44E-4.5(a) establishes that someone can only refer to themselves as a chiropractic assistant or allude to performing chiropractic assistance if they are licensed by the State. However, proposed new N.J.A.C. 13:44E-4.5(b) provides that a student enrolled in a program to become a licensed chiropractic assistant may provide clinical services under a chiropractor's supervision in order to gain the necessary experience to graduate.

The Board proposes new N.J.A.C. 13:44E-4.6 to establish the education requirements that must be satisfied in order to become a licensed chiropractic assistant. Proposed new N.J.A.C. 13:44E-4.6(a) requires an applicant to have obtained the required education from a chiropractic institution accredited pursuant to N.J.S.A. 45:9-41.6, which requires schools for chiropractic education to be accredited by the Council of Chiropractic Education, the Straight Chiropractic Academic Standards Association, or other accrediting agency approved by the U.S. Department of Education. An applicant for licensure as a chiropractic assistant must complete, pursuant to proposed new N.J.A.C. 13:44E-4.6(a)1, a 120-hour didactic education curriculum, which may be obtained through live and recorded webinars and live classroom instruction in the subject areas delineated in the rule, and, pursuant to proposed new N.J.A.C. 13:44E-4.6(a)2, 380 hours of clinical training in the subject areas set forth in the rule. Proposed new N.J.A.C. 13:44E-4.6(a)3 requires applicants to sit for and pass the Board-administered examination on New Jersey jurisprudence. The Board believes that the proposed 500 hours of training and passage of a New Jersey jurisprudence examination are necessary to ensure that applicants for licensure as chiropractic assistants are appropriately trained to safely perform the services within the scope of practice of licensed chiropractic assistants, and will help to ensure the health, safety, and welfare of patients receiving chiropractic care in the State.

Proposed new N.J.A.C. 13:44E-4.7 sets forth the information and documents that must be submitted with an application for licensure, which include official transcripts demonstrating completion of the required education and proof of successful completion of the Board-approved competency examination. The Board proposes new N.J.A.C. [page=2901] 13:44E-4.8 to establish how licenses are both issued and renewed. The proposed new rule provides that a license to practice as a chiropractic assistant, when issued, will be good for a period of two years. It then must be renewed biennially. A licensee must submit a renewal application and renewal fee prior to the license expiration. A license that is not renewed within 30 days of the expiration date shall expire. An assistant that continues to practice with an expired license shall be deemed to be engaging in unlicensed practice. The Board notes that the requirements set forth in proposed new N.J.A.C. 13:44E-4.7 and 4.8 are consistent with the requirements imposed on chiropractors for licensure application and renewal in existing N.J.A.C. 13:44E-1A.2 and 1A.4.

Proposed new N.J.A.C. 13:44E-4.9 addresses continuing education requirements that a licensed chiropractic assistant must complete. Proposed new N.J.A.C. 13:44E-4.9(b) requires licensed chiropractic assistants to complete 15 credit hours of continuing education each biennial licensing period, consistent with the requirements of P.L. 2015, c. 283. Proposed new N.J.A.C. 13:44E-4.9(b) also specifies that two credits on State laws and rules on the ethics of chiropractic assistance or recordkeeping and documentation need to be completed every biennial licensure period. The Board proposes new N.J.A.C. 13:44E-4.9(c), which provides that continuing education courses may include subject matter and content of study that is taught at accredited chiropractic schools or colleges and universities, or in a subject matter tested for licensure. Proposed new N.J.A.C. 13:44E-4.9(d) prohibits earning continuing education credits for taking basic, foundational courses. A licensed chiropractic assistant taking courses to earn continuing education must enroll in courses designed to build up the assistant's knowledge and update him or her on matters related to chiropractic assistance. Proposed new N.J.A.C. 13:44E-4.9(e) states that the Board can accredit educational programs offered by professional organizations and societies to provide continuing education courses so long as other programs at these societies or organizations have significant or practical impact on licensed chiropractic assistants. Proposed new N.J.A.C. 13:44E-4.9(f) allows the Board to approve equivalent options to educational programs that would provide a licensed assistant with the ability to earn continuing education credits by, among other things, producing a scientific paper or article for a professional publication, conducting an independent study, or teaching.

Proposed new N.J.A.C. 13:44E-4.9(g) sets forth the manner by which continuing education credits are calculated. It also sets forth the approved methods of obtaining continuing education credit hours. This includes credit hours earned through distance-learning programs, teaching, published works, research, and scientific presentations. Proposed new N.J.A.C. 13:44E-4.9(h) stipulates that a licensed chiropractic assistant cannot earn more than six credits through asynchronous distance learning courses or more than five credits for classes that take place in one calendar day.

Proposed new N.J.A.C. 13:44E-4.9(i) establishes the process continuing education providers need to follow to obtain approval by the Board to offer courses to licensed chiropractic assistants. This includes the submission of an application, which details the course and program descriptions, instructor qualifications, locations, dates, and times of courses, and additional information the Board may require. Proposed new N.J.A.C. 13:44E-4.9(j) provides that a licensed chiropractic assistant may submit course and program descriptions, instructor qualifications, locations, dates, and times of the course, number of continuing education courses being sought, and additional information to obtain credit to attend a class that has not yet been approved by the Board. The Board is to notify the licensed assistant in writing of its decision. Proposed new N.J.A.C. 13:44E-4.9(k) states that a licensed chiropractic assistant who completed an accredited graduate chiropractic assistant program within 12 months of the start of a biennial license registration period shall not be required to fulfill the continuing education requirement for that biennial period. Proposed new N.J.A.C. 13:44E-4.9(l) directs a licensed chiropractic assistant to certify on his or her application for renewal that he or she has completed the continuing education requirement for that period. The Board proposes new N.J.A.C. 13:44E-4.9(m) to allow no more than three credits to apply to the next biennial renewal period should a licensed assistant exceed the required 15 credit hours in the previous period. Proposed new N.J.A.C. 13:44E-4.9(n) states that a licensed chiropractic assistant holding an inactive or retired license is exempt from the continuing education requirement unless he or she wants to resume practice. If an inactive or retired licensed chiropractic assistant, as well as a licensed assistant with a suspended or revoked license, desires to resume practice, he or she must show proof of completing the continuing education requirement during each biennial period for which they were inactive or retired. A list of the classes taken must be submitted to the Board. The Board has the right to require further instruction on a subject should the Board find a deficiency in an application. Proposed new N.J.A.C. 13:44E-4.9(o) discusses the process for reporting continuing education credit earned and retaining documentation to show the requirement was fulfilled. Proposed new N.J.A.C. 13:44E-4.9(p) stipulates that the Board may extend the amount of time a licensed chiropractic assistant has to complete his or her continuing education requirement or may waive the requirement due to hardship and explains the process for such a request. Proposed new N.J.A.C. 13:44E-4.9(q) states that a licensed chiropractic assistant must provide verification and proof that he or she met the continuing education requirement. Proposed new N.J.A.C. 13:44E-4.9(r) provides that a licensed chiropractic assistant's second or subsequent failure to comply with the continuing education requirement can be considered professional misconduct and lead to a license suspension or revocation. The Board notes that the requirements set forth in proposed new N.J.A.C. 13:44E-4.9 are consistent with the continuing education requirements imposed upon chiropractors, with the exception of the required number of credits, which, as noted above, is established by P.L. 2015, c. 283.

Proposed new N.J.A.C. 13:44E-4.10 stipulates that a licensed chiropractic assistant must display his or her license and current renewal certificate conspicuously in the principal place of employment where he or she performs work as a licensed chiropractic assistant. Proposed new N.J.A.C. 13:44E-4.11 requires a licensed chiropractic assistant to notify the Board in writing of a change of address from the address currently on file with the Board within 10 days of the change. Service of process or other Board-initiated process at the address on file with the Board will be deemed adequate notice under the Uniform Administrative Procedure Rules at N.J.A.C. 1:1-7.1 and considered the commencement of any disciplinary proceeding. Proposed new N.J.A.C. 13:44E-4.12 provides that a licensed chiropractic assistant will be granted an opportunity to be heard prior to the suspension, revocation, or refusal to renew a license. Proposed new N.J.A.C. 13:44E-4.13 addresses supervision. The rule provides that a licensed assistant may only initiate treatment when a supervising licensed chiropractor is on the premises. Proposed new N.J.A.C. 13:44E-4.13(b) provides that should a practice have more than one licensed chiropractor, a supervisor is to be designated in the office. Should the designee be absent, another licensed chiropractor is to take over as the supervisor until the original supervisor returns. Proposed new N.J.A.C. 13:44E-4.14 requires the licensed chiropractic assistant to follow the plan of care when working with a patient. Proposed new N.J.A.C. 13:44E-4.14(b) requires the licensed chiropractic assistant to make contemporaneous, permanent entries in the patient's treatment record that accurately reflect the treatment or services rendered as part of the plan of care.

Proposed new N.J.A.C. 13:44E-4.15 concerns sexual misconduct. Proposed new N.J.A.C. 13:44E-4.15(b) includes definitions for the terms "licensee," "patient," "patient-chiropractic assistant relationship," "sexual contact," "sexual harassment," and "spouse." Pursuant to proposed new N.J.A.C. 13:44E-4.15(c) and (d), a licensed chiropractic assistant may not engage in, or seek to engage in, or solicit, sexual contact with a patient with whom they have a patient-licensed chiropractic assistant relationship. Proposed new N.J.A.C. 13:44E-4.15(e) prohibits discussion of an intimate sexual nature between a licensed chiropractic assistant and a patient unless it is related to legitimate patient needs. Proposed new N.J.A.C. 13:44E-4.15(f) requires privacy and specific conditions to prevent the exposure of the unclothed body of the patient unless it is necessary to the work of a licensed chiropractic assistant. Proposed new N.J.A.C. 13:44E-4.15(g) bars a licensed chiropractic assistant from engaging in sexual harassment while performing in a professional capacity. Proposed new N.J.A.C. 13:44E-4.15(h) bans other activity that could lead a reasonable person to believe [page=2902] that the activity speaks to the licensed chiropractic assistant's prurient interests or is for the assistant's sexual arousal. Proposed new N.J.A.C. 13:44E-4.15(i) provides that violations of any of these prohibitions will be deemed professional misconduct. Proposed new N.J.A.C. 13:44E-4.15(j) provides that it will not be a defense to claim that a patient solicited sexual contact or that the licensed chiropractic assistant was in love with or had affection for a patient. The Board notes that the prohibitions in proposed new N.J.A.C. 13:44E-4.15 are consistent with requirements imposed on licensed chiropractors pursuant to existing N.J.A.C. 13:44E-2.3.

Proposed new N.J.A.C. 13:44E-4.16 establishes the fees an applicant will have to pay for licensure as a chiropractic assistant, including the fee for an application, initial licensure, and renewal. Under the statutory authority set forth in N.J.S.A. 45:1-3.2, a professional board's fees must be established in an amount necessary to defray proper expenses incurred in performing its duties, but fees which raise revenues in excess of estimated expenses are prohibited. Following a fiscal assessment conducted by the Division of Consumer Affairs, the Board has determined that the fees set forth in the proposed new rule, including the application fee of $ 125.00, and an initial license fee of $ 150.00, are necessary to defray the anticipated costs associated with the licensure and regulation of chiropractic assistants.

The Board has provided a 60-day comment period for this notice of proposal. Therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.
 
Social Impact

The Board believes that the proposed amendments and new rules will have a positive impact on consumers by increasing the number of licensed individuals who will be permitted to provide certain chiropractic treatments to patients. Consequently, the time patients have to wait for treatment may decrease, and there may be less interruption in patient care.

The proposed amendments and new rules may also have a positive impact on chiropractic practices to the extent that they may offer practices greater flexibility in providing treatment to patients, and may lead to an increase in the number of patients treated. The practice operations may change slightly as a result of the proposed amendments and new rules since a chiropractor employing a chiropractic aide and a licensed chiropractic assistant may have to supervise additional staff, but the supervision requirements imposed under the proposed amendments and new rules are consistent with current supervision requirements.

The proposed amendments and new rules may have a positive impact on individuals interested in becoming a licensed chiropractic assistant or those currently employed as a chiropractic aide seeking to be licensed. The proposed amendments and new rules provide direction to such individuals as to the requirements to obtain that licensure.
 
Economic Impact

The Board believes that the proposed amendments and new rules may have an economic impact on applicants seeking to be licensed as chiropractic assistants. Applicants may incur costs associated with completing the required education and training and passing the required examination. Applicants will also incur costs associated with submitting the required application and remitting the license and renewal fees imposed under the rules. The proposed amendments and new rules may also have an economic impact on chiropractors if they employ licensed chiropractic assistants in place of, or in addition to, unlicensed aides, since licensed assistants may command a higher salary than chiropractic aides because of their additional training and expanded scope of practice. Chiropractors may also incur costs to ensure that the licensed chiropractic assistants they employed are covered under the practice's malpractice policy. This economic impact may be offset given the potential to increase the number of patients treated by a chiropractor whose practice employs a licensed assistant.
 
Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments and new rules are governed by N.J.S.A. 45:9-41 et seq., and, therefore, are not subject to any Federal standards or requirements.
 
Jobs Impact

The number of jobs in the State could increase as a result of the proposed amendments and new rules. New Jersey is the first state to license chiropractic assistants. The Board cannot estimate how many positions will be created, but believes that some chiropractic offices may seek to employ newly licensed chiropractic assistants in addition to and/or in place of currently employed unlicensed chiropractic aides. The Board believes that the proposed amendments and new rules may cause applicants to come to the State for employment opportunities or motivate those already living in New Jersey to seek this licensure.
 
Agriculture Industry Impact

The proposed amendments and new rules will have no impact on the agriculture industry in the State.
 
Regulatory Flexibility Analysis

If, for the purposes of the Regulatory Flexibility Act (Act), N.J.S.A. 52:14B-16 et seq., the approximately 3,262 currently licensed chiropractors are considered "small businesses," then the following analysis applies.

The proposed amendments to N.J.A.C. 13:44E-1A.6, 2.1, 2.2, and 2.7 impose various reporting, recordkeeping, and compliance requirements upon licensed chiropractors, which are discussed in the Summary above.

A regulatory flexibility analysis is not required for proposed new N.J.A.C. 13:44E-1.2 and 4.1 through 4.16 because these proposed new rules apply only to applicants for licensure as chiropractic assistants who are not considered small businesses in this State because they do not yet have a license to actively engage in the provision of professional services and they cannot perform services as a licensed chiropractic assistant without the supervision of a licensed chiropractor.

No additional professional services will be needed to comply with the proposed amendments and new rules. The costs that may be incurred in complying with the proposed amendments and new rules are discussed in the Economic Impact statement above. The Board believes that the proposed amendments and new rules should be uniformly applied to all licensees in order to ensure the health, safety, and welfare of the general public in the provision of chiropractic services and, therefore, no differing compliance requirements for any licensees are provided based upon the size of the business.
 
Housing Affordability Impact Analysis

The proposed amendments and new rules will have an insignificant impact on the affordability of housing in New Jersey and there is an extreme unlikelihood that the regulations would evoke a change in the average costs associated with housing because the proposed amendments and new rules concern the licensure and regulation of chiropractic assistants.
 
Smart Growth Development Impact Analysis

The proposed amendments and new rules will have an insignificant impact on smart growth and there is an extreme unlikelihood that the regulations would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers, under the State Development and Redevelopment Plan in New Jersey because the proposed amendments and new rules concern the licensure and regulation of chiropractic assistants.
 
Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
 
SUBCHAPTER 1.    PURPOSE AND SCOPE; DEFINITIONS
 
13:44E-1.2        Definitions
 
Unless otherwise noted, any reference to "licensee" in Subchapters 1, 1A, 2, and 3 shall mean solely a chiropractor licensed and subject to regulation by the New Jersey State Board of Chiropractic Examiners.
 
SUBCHAPTER 1A.    LICENSURE
 
13:44E-1A.6    Malpractice insurance
 
(a)-(b) (No change.)
 
[page=2903] (c) All New Jersey-licensed chiropractic assistants working for a doctor of chiropractic as described in (b) above shall be covered by the malpractice insurance policy of that practice.
 
[(c)] (d) Violations of (b) and (c) above shall be deemed professional misconduct within the meaning of N.J.S.A. 45:1-21(e).
 
SUBCHAPTER 2.    GENERAL RULES OF PRACTICE
 
13:44E-2.1    Advertising
 
(a) (No change.)
 
(b) A licensed chiropractor who is actively engaged in the practice of chiropractic in the State of New Jersey may provide information to the public by advertising in print or electronic media. Advertisements may include references to licensed chiropractic assistants employed with a licensed chiropractor, provided the title "licensed chiropractic assistant" or the abbreviation "L.C.A." is included in the advertisement.
 
(c) A licensee who engages in the use of advertising [which] that contains the following shall be deemed to be engaged in professional misconduct:
 
1.-2. (No change.)
 
3. Promotion of a professional service [which] that the licensee knows or should know is beyond the licensee's ability to perform or beyond the ability of other staff to perform;
 
4.-10. (No change.)
 
(d)-(l) (No change.)
 
13:44E-2.2    Patient records
 
(a) A contemporaneous, permanent patient record shall be prepared and maintained by a licensee, which may include information collected by licensed chiropractic assistants, for each person seeking chiropractic services, regardless of whether any care is actually rendered or whether any fee is charged. Licensees also shall maintain records relating to billings made to patients and third party carriers for professional services. All patient records, bills, and claim forms shall accurately reflect the care or services rendered. Such records shall include, as a minimum:
 
1.-12. (No change.)
 
(b)-(g) (No change.)
 
13:44E-2.7    Delegable tasks or functions of [unlicensed] chiropractic aides and licensed chiropractic assistants
 
(a) The following words and terms, when used in this section, shall have the following meanings unless the context clearly indicates otherwise:
 
[1. "Direct supervision" means the ongoing process performed by a licensed chiropractor who monitors the performance of the unlicensed assistant and provides regular consultation, guidance and instruction with respect to the tasks and functions performed by the unlicensed assistant. Direct supervision requires that the licensed chiropractor be physically present on the premises from which chiropractic services are rendered at all times during which an unlicensed individual is engaged in delegated tasks or functions.]
 
[2.] 1. ["Unlicensed assistant"] "Chiropractic aide" means any person[, including a student or graduate of a chiropractic institution,] who does not hold a valid New Jersey chiropractic or chiropractic assistant license, or a license, certification, or registration issued pursuant to law that authorizes the performance of acts that, absent such authorization, would be unlawful.
 
2. "Licensed chiropractic assistant" means a person who is licensed pursuant to the provisions of sections 5 through 8 of P.L. 2015, c. 283 and the rules set forth in this subchapter and in N.J.A.C. 13:44E-4 to practice chiropractic assistance under the supervision of a licensed chiropractor.
 
3. "Plan of care" means a documented treatment plan designed by a licensed chiropractor for the treatment of a patient.
 
4. "Supervision" means the oversight provided by a licensed chiropractor of the clinical services performed by a licensed chiropractic assistant, and for which the chiropractor shall be on the premises at all times and readily available to instruct the licensed chiropractic assistant throughout the performance of the clinical services.
 
(b) Under the [direct] supervision of, and when delegated by, a licensed chiropractor, [an unlicensed assistant, including a graduate of a recognized program of study in chiropractic,] a licensed chiropractic assistant may perform tasks or functions including, but not limited to, the following:
 
1.-8. (No change.)
 
9. Administering cryotherapy, hot packs, non-fulcrum mechanical traction without restraints (such as roller tables and roller chairs) and non-invasive surface screening; [and]
 
10. Setup and preparation of the patient for the administration of physical modalities[.];
 
11. Administering thermal, sound, light, mechanical, and electrical modalities and hydrotherapy, including, but not limited to, the following:
 
i. Ultraviolet (B and C bands) or electromagnetic rays including, but not limited to, deep heating agents, microwave diathermy, short-wave diathermy, and ultrasound;
 
ii. Electro-therapy devices powered by an alternating current or any interferential devices, as set forth in (a) above; or
 
iii. Decompression therapy devices or mechanical traction; and
 
12. Instructing and monitoring prescribed rehabilitative exercises.
 
(c) Under the supervision of, and when delegated by, a licensed chiropractor, a chiropractic aide, including a graduate of a recognized program of study in chiropractic, may perform tasks or functions including, but not limited to, those functions and tasks listed in (b)1 through 10 above. A licensed chiropractor shall not permit a chiropractic aide, including a graduate of a recognized program to study chiropractic, to perform the tasks listed in (b)11 and 12 above.
 
1. If a licensed chiropractor employs a chiropractic aide, the aide is to be supervised by a licensed chiropractor who shall be on the premises at all times and readily available. Such supervision shall entail regular consultation, guidance, and instruction with respect to the tasks and functions performed by the aide.
 
[(c)] (d) A [licensee] licensed chiropractor shall not permit [an unlicensed] a chiropractic aide or licensed chiropractic assistant to:
 
1. (No change.)
 
2. Notwithstanding [(a)2] (a)1 above, perform massage, unless licensed as a massage and bodywork therapist in this State by the Board of Massage and Bodywork Therapy pursuant to N.J.S.A. 45:11-53 to [79] 80.
 
3. (No change.)
 
4. Perform a chiropractic adjustment; or
 
[5. Administer the following physical modalities:
 
i. Ultraviolet (B and C bands) or electromagnetic rays including, but not limited to, deep heating agents, microwave diathermy, short-wave diathermy and ultrasound;
 
ii. Electro-therapy devices powered by an alternating current or any interferential devices, as set forth in N.J.A.C. 13:44E-2.7A; or
 
iii. Decompression therapy devices or mechanical traction, except non-fulcrum mechanical traction without restraints;
 
6. Administer therapeutic, rehabilitative or strengthening exercises; or]
 
[7.] 5. Perform any task or function for which the skill, training, and judgment of a licensed chiropractor is required to safely and competently perform such task or function.
 
[(d)] (e) A [licensee] licensed chiropractor who [permits] allows [an unlicensed] a chiropractic aide or licensed chiropractic assistant to perform any task or function incidental to the rendering of chiropractic care shall:
 
1. (No change.)
 
2. [Directly supervise the unlicensed] Supervise chiropractic aides and licensed chiropractic assistants; and
 
3. Ensure that such individual is competent to perform all delegated tasks or functions. The [licensee] licensed chiropractor shall provide any instruction or training necessary to ensure competence and shall make such inquiry as may be necessary to ensure that a satisfactory level [page=2904] of education exists so as to conclude that the [unlicensed individual] chiropractic aid and licensed chiropractic assistant may render any delegated tasks or functions with reasonable skill and safety.
 
[(e)] (f) [The licensee] A licensed chiropractor shall write all instructions for duties to be performed by [unlicensed] chiropractic aides and licensed chiropractic assistants [on] in the [patient's chart] plan of care and shall make the [chart] plan available at all times to the [unlicensed] chiropractic aide and licensed chiropractic assistant carrying out the instructions.
 
[(f)] (g) Prior to the performance of any delegated tasks or functions by [an unlicensed] a chiropractic aide or licensed chiropractic assistant, the [unlicensed] aide or assistant shall determine whether the patient's physical status has materially changed since the patient's prior office visit. In such event, the [unlicensed] chiropractic aide or licensed chiropractic assistant shall not proceed with the performance of any delegated tasks or functions until the [licensee] licensed chiropractor has reexamined the patient or authorized the performance of a delegated task or function.
 
(h) Notwithstanding the provisions of (a) through (g) above, a student enrolled in a chiropractic or chiropractic assistant program approved by the Board may perform clinical services under the supervision of a licensed chiropractor to gain the necessary practical clinical experiences.
 
SUBCHAPTER 4.              LICENSED CHIROPRACTIC ASSISTANTS
 
13:44E-4.1        Purpose and scope; effective date
 
(a) The rules in this subchapter implement the provisions of P.L. 2015, c. 283, concerning the licensure of chiropractic assistants.
 
(b) The provisions in this subchapter shall take effect on (12 months from the effective date this new rule).
 
13:44E-4.2        Definitions
 
As used in this subchapter, the following words and terms shall have the following meanings unless otherwise noted:
 
"Board" means the New Jersey State Board of Chiropractic Examiners.
 
"Chiropractic assistance" means assisting a licensed chiropractor by providing certain clinical procedures common and customary to the chiropractic setting pursuant to N.J.S.A. 45:9-41.19.c and N.J.A.C. 13:44E-4.3.
 
"Licensed chiropractic assistant" means a person holding a license issued by the New Jersey State Board of Chiropractic Examiners to practice chiropractic assistance under the supervision of a licensed chiropractor. A person licensed as a chiropractic assistant may use that full title or its abbreviation, "L.C.A."
 
"Plan of care" means a documented treatment plan designed by the licensed chiropractor for the treatment of a patient.
 
"Supervision" means the oversight provided by a licensed chiropractor of the clinical services performed by a licensed chiropractic assistant and for which the chiropractor shall be on the premises at all times and readily available to instruct the licensed chiropractic assistant throughout the performance of the clinical services.
 
13:44E-4.3        Scope of practice
 
(a) The scope of practice of a licensed chiropractic assistant includes, but is not limited to, the following:
 
1. Collection of general health data including:
 
i. Taking of an oral history or vital sign measurement;
 
ii. Performing manual muscle tests, general orthopedic and neurologic tests, and functionality and outcome assessment tests; and
 
iii. Other testing that qualifies as part of chiropractic assistance;
 
2. Application of thermal, sound, light, mechanical, and electrical modalities and hydrotherapy including, but not limited to, the following:
 
i. Ultraviolet (B and C bands) or electromagnetic rays including, but not limited to, deep heating agents, microwave diathermy, short-wave diathermy, and ultrasound;
 
ii. Electro-therapy devices powered by an alternating current or any interferential devices, as set forth in N.J.A.C. 13:44E-2.7A(a); and
 
iii. Decompression therapy devices or mechanical traction, including non-fulcrum mechanical traction without restraint;
 
3. Instructing and monitoring prescribed rehabilitative activities, including:
 
i. Recording a patient's response to treatment based on subjective and objective findings; and
 
ii. Reporting to the licensed chiropractor who developed the plan of care for treatment of the patient on:
 
A. Any response to or lack of progress with treatment; and
 
B. The need for program change, reassessment of treatment, or discontinuation of treatment.
 
(b) A licensed chiropractic assistant's work shall not include:
 
1. Non-clinical administrative work;
 
2. Chiropractic adjustment;
 
3. Manual therapy;
 
4. Nutritional instruction;
 
5. Counseling; and
 
6. Other therapeutic services or procedures requiring additional licensure.
 
13:44E-4.4        Licensing requirements
 
(a) To be eligible for licensure as a chiropractic assistant in New Jersey, an applicant shall:
 
1. Be at least 18 years of age;
 
2. Be of good moral character;
 
3. Have successfully completed high school or its equivalent;
 
4. Have successfully completed the education and clinical requirements set forth in N.J.A.C. 13:44E-4.6;
 
5. Submit a completed application;
 
6. Have successfully passed a Board-approved competency examination; and
 
7. Have paid the required fees pursuant to N.J.S.A. 45:9-41.34.d and N.J.A.C. 13:44E-4.16.
 
13:44E-4.5        Licensure eligibility; exceptions
 
(a) The term "chiropractic assistant" or any other title, designation, words, letters, abbreviations, or insignia indicating the practice of chiropractic assistance shall only be used by an individual if that person is licensed to practice chiropractic assistance under the provisions of N.J.S.A. 45:9-41.33 et seq. (P.L. 2015, c. 283).
 
(b) Students enrolled in an educational program, recognized by the Board, that leads to a degree or certification as a chiropractic assistant shall be permitted to provide clinical services under the supervision of a chiropractor to gain the necessary practical clinical experience.
 
13:44E-4.6        Education requirements
 
(a) An applicant for licensure as a chiropractic assistant shall satisfy the following educational requirements earned from a chiropractic institution accredited pursuant to N.J.S.A. 45:9-41.6:
 
1. 120 hours of didactic education, obtained through live and recorded webinars and live classroom instruction, to include the following:
 
i. Chiropractic philosophy and terminology;
 
ii. Functional anatomy of the spine, extremities, muscles, nerves, and landmarks;
 
iii. Management of common disorders;
 
iv. Rehabilitation;
 
v. Physiotherapy modalities including indications and contraindications;
 
vi. Professional behavior related to ethics, boundaries, and risk management;
 
vii. Documentation and recordkeeping; and
 
viii. Hygiene;
 
2. 380 hours of clinical training consisting of the following monitored activities:
 
i. Health data collection;
 
[page=2905] ii. Examination and testing procedures;
 
iii. Passive and active therapeutic interventions;
 
iv. Documentation and recordkeeping; and
 
v. Patient safety and office policies regarding emergency procedures; and
 
3. A Board-administered examination on New Jersey jurisprudence.
 
(b) The completion of the clinical training in (a)2 above shall be accompanied by documented attestation and notarization to demonstrate the satisfactory completion of clinical requirements under supervision of the licensed chiropractor.
 
13:44E-4.7        Application for licensure
 
(a) An applicant for licensure as a licensed chiropractic assistant in New Jersey shall submit the following to the Board:
 
1. A completed application form provided by the Board, which shall contain the applicant's name, address, Social Security number, academic qualifications, information from other states regarding licensure, certification or registration (if applicable), a resume, answers demonstrating moral character, confidential answers concerning the applicant's fitness to practice, and child support questions;
 
2. Official transcripts demonstrating completion of the educational requirements pursuant to N.J.A.C. 13:44E-4.6;
 
3. Proof of successful completion of a Board-approved competency exam pursuant to N.J.A.C. 13:44E-4.4(a)6;
 
4. The application fee set forth in N.J.A.C. 13:44E-4.16; and
 
5. A certification of authorization to perform and cooperate in a criminal history background check conducted pursuant to N.J.S.A. 45:1-28 et seq.
 
13:44E-4.8        Issuance of licenses; license renewals
 
(a) Licenses to practice chiropractic assistance shall be issued for a period of two years and be renewed biennially. A licensed assistant who seeks renewal of his or her license shall submit a license renewal application and the license renewal fee set forth in N.J.A.C. 13:44E-4.16 to the Board prior to the expiration of the current license.
 
(b) If a licensed assistant does not renew his or her license prior to its expiration date, they may renew the license within 30 days of its expiration by submitting a renewal application, a license renewal fee, and a late fee, as set forth in N.J.A.C. 13:44E-4.16.
 
(c) A license that is not renewed within 30 days of its expiration date shall expire. Any individual who continues to practice chiropractic assistance with an expired license after 30 days following the license expiration date shall be deemed to be engaged in unlicensed practice.
 
13:44E-4.9        Continuing education
 
(a) "Licensee," as used in this section, means a chiropractic assistant licensed and subject to regulation by the New Jersey State Board of Chiropractic Examiners.
 
(b) A licensee applying for biennial license renewal shall have completed, during the preceding biennial period, 15 continuing educational credits in order to qualify for the renewal of his or her license pursuant to N.J.S.A. 45:9-41.35. One credit is defined as 50 minutes of instruction. A minimum of two credits shall be completed in the study of State laws and rules governing professional ethics of chiropractic assistance or recordkeeping and documentation as it pertains to the practice of chiropractic assistance in this State.
 
(c) The continuing education courses may include, but not be limited to, subject matter and content of study that is taught by accredited chiropractic schools, colleges, institutions, and universities, or in a subject matter tested for licensure, that has been approved by the Board.
 
(d) The Board will not grant continuing education credit for completion of basic courses required for graduation from programs offering training as a licensed chiropractic assistant or for initial licensure. Continuing education credit shall be granted only for courses designed to build upon basic knowledge and/or to bring licensees up-to-date on new developments relating to the practice of chiropractic assistance.
 
(e) The Board may accredit other educational programs offered by professional organizations or societies, health care professions, schools, colleges, institutions, universities, or healthcare facilities as suitable for continuing education credits, so long as such other educational programs have significant intellectual or practical content, which deal primarily with matters directly related to the practice of chiropractic assistance or with the professional responsibilities or ethical obligations of licensees.
 
(f) The Board may accredit other equivalent options to educational programs including, but not limited to, examinations, scientific papers, professional publications, scientific presentations, residency programs, teaching and/or research appointments, advanced degree or certification program in related fields, scientific exhibits, independent study or research, self-study programs, or distance learning as suitable for continuing education credits, so long as such other equivalent options have significant intellectual or practical content, which deal primarily with matters directly related to the practice of chiropractic assistance or with the professional responsibilities or ethical obligations of licensees.
 
(g) Continuing education credit shall be calculated as follows:
 
1. Continuing professional education programs of national or State professional organizations: one credit hour for every 50 minutes of in-class participation;
 
2. Accredited university or college courses in the subjects set forth in (d) above:
 
i. Applicants shall receive 7.5 credit hours of continuing education credit for each semester or trimester credit hour earned; five credit hours of continuing education credit for each credit hour earned in a quarter; and
 
ii. Applicants attending noncredit courses shall be granted continuing education credit at the rate of one credit hour for every 50 minutes of in-class participation;
 
3. Distance learning programs and other independent study programs: the amount of credit to be allowed for approved distance and individual study programs, including taped study programs, shall be one credit hour for every 50 minutes of distance and individual self-study program participation;
 
4. Teaching or instruction of a course for the first time or teaching a course previously taught if substantial time was spent updating course material shall be instruction and preparation time: one continuing education credit for each hour of instruction or preparation.
 
i. The total number of continuing education credits that may be granted for service as a teacher or instructor shall not exceed six credits per biennial period.
 
ii. Requests for credit shall be accompanied by an outline of the instruction or course.
 
iii. A teacher or instructor that is employed as a teacher or instructor on a full-time basis shall not be eligible to obtain continuing education credits for such activities;
 
5. Scientific papers and professional publications: credit shall be given for each 50-minute period of preparation time on a self-declaration basis, not to exceed six credit hours per biennial period. A copy of the publication article shall be submitted to the Board with a request for continuing education credit.
 
i. Credit may be claimed for published articles and books by the authors of those works. These publications must contribute to the professional competency of chiropractors.
 
ii. In exceptional circumstances, a licensee may request additional credit by submitting the article or book to the Board with an explanation of the circumstances that he or she believes justifies an award of greater credit. When licensees request more than six continuing education credit hours earned through papers and publications during the biennial period, credit hours awarded shall be determined by the Board on a case-by-case basis. Factors such as complexity of the subject matter, length of publication, and the amount of preparation time shall be considered;
 
[page=2906] 6. Research and preparation of examinations or acting as an examiner for a clinical examination: one continuing education credit for each hour of research or time spent on the examination, not to exceed three continuing education credits per biennial period; and
 
7. Scientific presentations or exhibits: one continuing education credit for each hour of preparation or presentation, not to exceed six continuing education credits per biennial period.
 
(h) A licensee shall complete no more than six of the total continuing chiropractic assistance education credits by asynchronous distance learning courses where the instructor and the learner are not in direct, live communication during the course, approved by the Board; the remaining credits must be attained through live didactic learning experience, including synchronous distance learning activities where the instructor and learner are in direct live communication during the course. The Board shall not award more than five hours of continuing education credit for any program that takes place during the course of one calendar day.
 
(i) A provider seeking Board approval to sponsor programs for continuing education credit shall submit an application to the Board, which shall include course and program descriptions, instructor qualifications, locations, dates, and times of courses, and other information as required by the Board.
 
1. Qualified sponsors shall offer courses that meet the following criteria:
 
i. Be a formal course of learning, which contributes directly to the maintenance of professional competence of a licensee;
 
ii. Be at least one credit hour, 50-minute period, in length; however, additional credits in excess of one hour may be awarded in 1/2 hour increments;
 
iii. Be conducted by a qualified instructor or discussion leader; and
 
iv. Offer subjects enumerated in (c) above.
 
2. A continuing education sponsor may receive prior approval, valid for the current biennial licensing period in which the approval was issued, for a course of acceptable subject matter, as set forth in (c) above, and be assigned a designated number of continuing education credits by the Board if the program sponsor provides in writing information required by the Board to document the elements of (i)1 above, and in addition, certifies that the sponsor shall:
 
i. Maintain and retain accurate records of attendance for a five-year period;
 
ii. Retain a written outline of course materials for a five-year period; and
 
iii. Comply with the requirements of (i)4 below.
 
3. The Board will post on its website at http://www.njconsumeraffairs.gov/chi/Pages/continuingeducation.aspx, a list of all program sponsors that, pursuant to this section, have applied and been approved to sponsor courses for continuing education credit. Continuing education sponsors shall comply with the following additional requirements:
 
i. The program sponsor shall disclose in advance to prospective participants the objective, prerequisites, experience level, content, required advanced preparation, teaching method, and number of continuing education credits involved in the program;
 
ii. The program sponsor shall provide evidence to the Board that it has policies and procedures in place to verify and adequately monitor the attendance of course participants;
 
iii. The program sponsor shall be responsible for assuring that the number of participants and the physical facilities are consistent with the teaching methods to be utilized;
 
iv. The program sponsor shall select and assign qualified instructors for the continuing education program. Sponsors shall provide to the Board the curriculum vitae of all course instructors and certify to the Board that the sponsor has verified the credentials of all its instructors. Sponsors must notify the Board of any instructor change within 20 days of making the change;
 
v. The program sponsor shall evaluate the performance of its program instructors at the conclusion of each program to determine the instructors' suitability to continue to serve as instructors in the future;
 
vi. Program evaluation shall be in accordance with the following:
 
(1) The sponsor shall provide some means of program evaluation. Evaluations shall be solicited from both the participants and instructors. Programs shall be evaluated to determine whether:
 
(A) Objectives were met;
 
(B) Prerequisites were necessary or desirable;
 
(C) Facilities were satisfactory;
 
(D) The instructor was effective;
 
(E) Advanced preparation materials were satisfactory; and
 
(F) The program content was timely and effective; and
 
(2) Evaluations shall take the form of one or a combination of pre-tests for advanced preparation, post-tests for effectiveness of the program, questionnaires completed at the end of the program or later, or oral feedback to the instructor or sponsor. Instructors shall be informed of their performance and sponsors shall systematically review the evaluation process to insure its effectiveness; and
 
vii. The program sponsor shall be responsible for issuing certificates of satisfactory completion or other comparable documentation to program participants. Such certificates or documentation shall be printed with the following information:
 
(1) Dates attended;
 
(2) Credit hours earned;
 
(3) Course title and description of content, including the method of course delivery and subject area;
 
(4) Course sponsor name;
 
(5) Instructor name; and
 
(6) Course location.
 
4. A continuing education sponsor who has qualified as a sponsor, or has obtained prior Board approval, shall not alter, amend, update, or reconfigure the approved courses for continuing education credit without the permission of the Board. If a continuing education sponsor alters, amends, updates, or reconfigures a course, the continuing education sponsor must resubmit the course to the Board for approval.
 
(j) A licensee seeking Board approval of a program for continuing education credit, which has not been approved pursuant to (i) above, may submit an application on a form prescribed by the Board, which shall include course and program descriptions, instructor qualifications, locations, dates, and times of courses, number of continuing education credits, and other information as required by the Board. The Board shall notify the licensee, in writing, of its determination, which is based upon (d), (e), and (f) above.
 
(k) A new licensee who completed an accredited chiropractic assistant education program within 12 months of the commencement of the biennial registration period is not required to complete the continuing education requirements for the biennial period.
 
(l) A licensee shall certify on the application for biennial licensure renewal that he or she has completed the required number of continuing education credits. The Board may conduct random audits to determine licensee compliance with the continuing education requirements of this section.
 
(m) A licensee who completes more than 15 continuing chiropractic education credits required pursuant to this section may apply no more than three of the excess credits to the continuing chiropractic education requirements for the following biennial period only. The excess credits approved for a biennial period may be applied to the continuing education requirements for the next period whether or not approved for that period.
 
(n) Licensees holding an inactive or retired license shall be exempt from continuing education requirements, except that any licensee holding an inactive or retired license, or whose license is suspended or revoked, who applies to resume practice as a licensed chiropractic assistant shall provide proof of having completed the continuing chiropractic assistance education requirements for each biennial licensure period for which the licensee was on inactive or retired status. If the total credits required to become current exceeds 15, then 15 shall be the maximum number required. Any [page=2907] applicant seeking to resume practice shall submit to the Board a detailed list of all continuing education courses that the licensee has completed in order to become current. If the Board determines that there is a deficiency in a particular area of study, the Board may require the applicant to complete additional continuing education courses in the area of the deficiency before reinstating the license to active status.
 
(o) To report continuing chiropractic assistance education credits, a licensee shall:
 
1. Certify, on the application for biennial renewal, completion of the required number of continuing education credits; and
 
2. Maintain all evidence of completion of continuing education requirements for a period of not less than five years after satisfaction of the credits and submit such documentation to the Board upon request.
 
(p) The Board may extend the time period for completion of continuing education requirements or may waive continuing education requirements on an individual basis for reasons of hardship, such as severe illness, disability, or military service, consistent with the following:
 
1. A licensee seeking an extension or waiver of the continuing education requirements shall apply to the Board in writing setting forth the specific details for the reasons why an extension or a waiver is requested. The licensee shall submit all of the documentation that supports the request for the extension and/or waiver;
 
2. A licensee shall apply for an extension and/or a waiver prior to the expiration of the biennial renewal period. All requests shall be sent to the Board office, by certified mail, return receipt requested; and
 
3. An extension or waiver granted pursuant to this section shall become effective for the biennial licensure period in which the extension or waiver is granted. If the condition that necessitated the extension or waiver continues into the next biennial period, the licensee shall apply to the Board for the renewal of such extension or waiver for the new biennial period.
 
(q) A licensee shall provide verification and proof of compliance with continuing chiropractic education requirements. Non-compliance with the continuing education requirements shall provide cause for civil penalties pursuant to N.J.S.A. 45:9-41.32.
 
(r) A second or subsequent offense by a licensee for failure to comply with the continuing education requirements may be considered professional misconduct and would provide grounds for additional discipline including license suspension or revocation.
 
13:44E-4.10      Display of licensure
 
Each person holding a license to practice as a chiropractic assistant in the State of New Jersey shall display the license and a current renewal certificate in a conspicuous location in the principal place of business where he or she is employed as a licensed chiropractic assistant.
 
13:44E-4.11      Notification of change of address; service of process
 
(a) A licensed chiropractic assistant shall notify the Board in writing of any change of address from the address currently registered with the Board and shown on the most recently issued certificate. Such notice shall be sent to the Board by certified mail, return receipt requested, not later than 10 days following the change of address.
 
(b) Service of an administrative complaint or other Board-initiated process at a licensed assistant's address currently on file with the Board shall be deemed adequate notice for the purposes of N.J.A.C. 1:1-7.1 and the commencement of any disciplinary proceedings.
 
13:44E-4.12      Opportunity to be heard
 
Prior to any suspension, revocation, or refusal to renew a license, the licensed assistant shall have the opportunity to be heard pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and 52:14F-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.
 
13:44E-4.13      Supervision
 
(a) A licensed chiropractic assistant shall only initiate treatment when a supervising licensed chiropractor is on the premises.
 
(b) In a practice with more than one licensed chiropractor, a supervising licensed chiropractor is to be designated for that office. In his or her absence, a licensed chiropractor in that same practice shall be designated temporarily until the initial designee returns.
 
13:44E-4.14      Plan of care; recordkeeping
 
(a) A licensed chiropractic assistant shall follow the plan of care designed for a patient's treatment by a licensed chiropractor.
 
(b) Licensed chiropractic assistants shall make contemporaneous, permanent entries into professional treatment records that shall accurately reflect the treatment or service rendered as listed in the plan of care. To the extent applicable, professional treatment records shall reflect:
 
1. Dates and times of interaction with a patient;
 
2. Identifying and documenting specific elements of each physiotherapy modality provided, including:
 
i. Time or other details to be included in a plan of care;
 
ii. Equipment used during session or provided to the patient; and
 
iii. Length of time for each treatment relating to therapeutic modalities or rehabilitative care;
 
3. Care provided without the co-signature of the supervising chiropractor; and
 
4. Patient progress and status at discharge in the chiropractic record according to office policies.
 
13:44E-4.15      Sexual misconduct
 
(a) By this section, the New Jersey State Board of Chiropractic Examiners is identifying for licensed chiropractic assistants conduct that it shall deem to be violative of the law.
 
(b) As used in this section, the following terms have the following meanings unless the context indicates otherwise:
 
1. "Licensee" means any person licensed to engage in the practice of chiropractic assistance as regulated by the New Jersey State Board of Chiropractic Examiners.
 
2. "Patient" means any person who is the recipient of a professional service rendered by a licensee for the purposes of care relating to chiropractic assistance.
 
3. "Patient-chiropractor assistant relationship" means an association between a chiropractic assistant and patient wherein the licensee owes a continuing duty to the patient to be available to render professional services consistent with his or her chiropractic assistance training and experience. The performance of any professional chiropractic assistance includes, but is not limited to, any consultation and care provided by a licensee in furtherance of chiropractic assistance care.
 
4. "Sexual contact" means the knowing touching of a person's body directly or through clothing, where the circumstances surrounding the touching would be construed by a reasonable person to be motivated by the licensee's own prurient interest or for sexual arousal or gratification. "Sexual contact" includes, but is not limited to, the imposition of a part of the licensee's body upon a part of the patient's body, sexual penetration, or the insertion or imposition of any object or any part of a licensee or patient's body into or near the genital, anal, or other opening of the other person's body. "Sexual contact" does not include the touching of a patient's body that is necessary during the performance of a generally accepted and recognized chiropractic assistant technique.
 
5. "Sexual harassment" means solicitation of any sexual act, physical advances, or verbal or nonverbal conduct that is sexual in nature and which occurs in connection with a licensee's activities or role as a provider of chiropractic assistant services, and that either: is unwelcome, offensive to a reasonable person, or creates a hostile workplace environment, and the licensee knows, should know, or is told this; or is sufficiently severe or intense to be abusive to a reasonable person in that context. "Sexual harassment" may consist of a single extreme or severe act or of multiple acts and may include, but is not limited to, conduct of a licensee with a patient, co-worker, [page=2908] employee, or student whether or not such individual is in a subordinate position to the licensee.
 
6. "Spouse" means the husband, wife, or fiancee of the licensee or an individual involved in a long-term committed relationship with the licensee.
 
i. For purposes of this section, a long-term committed relationship means a relationship that is at least six months in duration.
 
(c) A licensee shall not engage in sexual contact with a patient with whom he or she has a patient-licensed chiropractic assistant relationship. That relationship is considered ongoing for purposes of this section, unless:
 
1. Professional services are terminated by written notice to the patient from the chiropractor working with the licensed assistant via certified mail return receipt requested and documentation in the patient record; and
 
2. Three months have elapsed since the last professional service was rendered.
 
(d) A licensee shall not seek or solicit sexual contact with a patient with whom he or she has a patient-chiropractic assistant relationship and shall not seek or solicit sexual contact with any person in exchange for professional services.
 
(e) A licensee shall not engage in any discussion of an intimate sexual nature with a patient, unless that discussion is related to legitimate patient needs. Such discussion shall not include disclosure by the licensee of his or her own intimate sexual relationships.
 
(f) A licensee shall provide privacy and conditions that prevent the exposure of the unclothed body of the patient unless necessary to the professional chiropractic assistant services being rendered.
 
(g) A licensee shall not engage in sexual harassment in a professional setting while performing in a professional capacity.
 
(h) A licensee shall not engage in any other activity that would lead a reasonable person to believe that the activity serves the licensee's personal prurient interests or is for the sexual arousal or sexual gratification of the licensee or patient or that constitutes an act of sexual abuse.
 
(i) Violation of any of the prohibitions or directives set forth at (c) through (h) above shall be deemed to constitute professional misconduct pursuant to N.J.S.A. 45:1-21.e.
 
(j) It shall not be a defense to any action under this section that:
 
1. The patient solicited or consented to sexual contact with the licensee; or
 
2. The licensee was in love with or had affection for the patient.
 
13:44E-4.16      Fee schedule
 
(a) The following fees shall be charged by the Board:
 
1. Application fee--$ 125.00;
 
2. Endorsement fee--$ 75.00;
 
3. Initial licensing fee:
 
i. During the first year of a biennial renewal period--$ 150.00; and
 
ii. During the second year of a biennial renewal period--$ 75.00;
 
4. Biennial license renewal fee--$ 150.00;
 
5. Duplicate license fee--$ 25.00;
 
6. Verification of licensure fee--$ 40.00;
 
7. Late renewal fee--$ 50.00;
 ​
8. Reinstatement fee--$ 125.00 (plus all past due license fees); and
 
9. Inactive license fee--$ 50.00.