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VOLUME 46, ISSUE 2
ISSUE DATE: JANUARY 21, 2014
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF CHIROPRACTIC EXAMINERS

46 N.J.R. 163(a)

Proposed Readoption with Amendments: N.J.A.C. 13:44E

State Board of Chiropractic Examiners Rules
 
Authorized By: State Board of Chiropractic Examiners, Lisa Tadeo, Executive Director.
 
Authority: N.J.S.A. 45:1-3.2, 45:9-14.5 et seq., and 45:9-41.23.
 
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
 
Proposal Number: PRN 2014-015.
 
Submit comments by March 22, 2014, to:
 
   Lisa Tadeo, Executive Director
   State Board of Chiropractic Examiners
   124 Halsey Street
   P.O. Box 45004
   Newark, NJ 07101
 
Summary

The State Board of Chiropractic Examiners (the Board) is proposing to readopt N.J.A.C. 13:44E with amendments. Pursuant to Executive Order No. 66 (1978) and N.J.S.A. 52:14B-5.1.b, these rules are scheduled to expire on December 22, 2013. As the Board has filed this notice of readoption with the Office of Administrative Law on or prior to that date, the expiration date is extended 180 days to June 20, 2014, pursuant to N.J.S.A. 52:14B-5.1.c(2). In compliance with the Executive Order, the Board undertook a thorough review of the existing provisions of N.J.A.C. 13:44E in order to delete unnecessary rules and clarify existing provisions. The Board believes that the rules proposed for readoption, as amended, are necessary, reasonable, understandable, and responsive to the purpose for which they were promulgated. The following is a summary of the rules that the Board proposes to readopt, as well as a summary of the proposed amendments.

The Board proposes to readopt without change Subchapter 1, which sets forth the chiropractor's scope of practice, including requirements for commencing chiropractic care, permitted diagnostic and analytical procedures, other services permitted within the scope of practice, and conditions on the use of the title "doctor."

Subchapter 1A sets forth the rules for licensure.

Specifically, N.J.A.C. 13:44E-1A.1 sets forth the requirements for licensing as a chiropractor.

N.J.A.C. 13:44E-1A.2 sets forth the application requirements for chiropractic licensure in New Jersey.

N.J.A.C. 13:44E-1A.3 sets forth the requirements for licensure in New Jersey of applicants licensed in other states.

N.J.A.C. 13:44E-1A.4 addresses the biennial license renewal requirements for chiropractors, including the requirements for reinstatement of licenses that have been inactive or expired for less than five years and for more than five years. The Board proposes to readopt the rule with a technical amendment to paragraph (j)1 to correct an incorrect cross-reference in the rule text.

[page=164] N.J.A.C. 13:44E-1A.5 sets forth the requirements for chiropractic continuing education. The Board has specified the number of continuing education credits a licensee must complete prior to each biennial renewal period, the subject matter that may be studied, the methods through which continuing education credits may be earned, approval procedures to be followed by continuing education sponsors seeking approval for their programs and by licensees seeking continuing education credit for courses that have not been otherwise approved by the Board, documentation retention and reporting requirements for sponsors and licensees, and continuing education exemption and waiver provisions. Subsection (c) sets forth the time frame for earning continuing education credits prior to the biennial renewal period beginning September 1, 2013, and the number of credits that must be earned. The Board proposes to amend subsection (b) to the extent that it references subsection (c), and to delete subsection (c) in its entirety, because the time frame referenced in subsection (c) has elapsed. The Board proposes to add new subsection (l) to require that the Board preapprove all courses required for the performance of electrodiagnostic tests and special examinations at least 90 days prior to date that the course begins. This will let licensees know whether a particular course is appropriate before the licensee has invested the time and money in the course. Preapproval may be sought by either the course provider or the licensee.

N.J.A.C. 13:44E-1A.6 requires licensees to maintain chiropractic malpractice insurance.

Subchapter 2 contains the general rules of practice.

N.J.A.C. 13:44E-2.1 contains the requirements for licensee advertising.

N.J.A.C. 13:44E-2.2 sets forth the information to be placed in patient records, rules relating to the release of patient records, confidentiality requirements, and rules relating to the disposition of records upon cessation of the chiropractor's practice for a period of longer than three months.

N.J.A.C. 13:44E-2.3 contains the Board's sexual misconduct rules. The rules prohibit a licensee from engaging in sexual contact with patients with whom the licensee has had a patient-chiropractor relationship unless the professional relationship has been terminated under the circumstances set forth in the rules. The rule also prohibits licensees from engaging in sexual discussions with patients that are unrelated to treatment, and from the sexual harassment of patients.

N.J.A.C. 13:44E-2.4 requires that every chiropractic facility have a chiropractor of record and that patients' records reflect the identity of the licensee performing the services. The section also sets forth the chiropractor of record's other recordkeeping responsibilities. Additionally, the section requires that any licensee found to have rendered services in violation of N.J.S.A. 45:1-21 shall be responsible for restitution ordered by the Board together with the owner of the facility in which the services were rendered.

N.J.A.C. 13:44E-2.5 contains the Board's fee schedule.

N.J.A.C. 13:44E-2.6 prohibits the payment or receipt of fees for patient referral, but allows the division of fees among licensees in specified business relationships.

N.J.A.C. 13:44E-2.6A sets forth requirements for patient record review and subsequent opinion based upon that review by a non-attending chiropractor for the purpose of evaluating prior chiropractic care, the need for continuing chiropractic care, the necessity for diagnostic testing and/or referrals, or consultation.

N.J.A.C. 13:44E-2.7 sets forth tests and functions that can be delegated by a chiropractor to an unlicensed assistant. The Board proposes several technical amendments to paragraph (c)2 to reflect amendments to N.J.S.A. 45:11-53 et seq., effective September 12, 2012, in P.L. 2007, c. 337, eliminating the Massage, Bodywork and Somatic Therapy Examination Committee of the New Jersey Board of Nursing and establishing the Board of Massage and Bodywork Therapy. Massage, bodywork, and somatic therapists are now massage and bodywork therapists, and are licensed, rather than certified.

N.J.A.C. 13:44E-2.7A sets forth the requirements for ordering electro-therapy devices for home use.

N.J.A.C. 13:44E-2.8 requires a licensee to notify the Board of any change of address. It also provides that service of notice of an administrative complaint to the address of record is considered adequate notice.

N.J.A.C. 13:44E-2.9 requires a licensee to display his or her license in a conspicuous place in the principal office or place of practice.

N.J.A.C. 13:44E-2.10 sets forth a licensee's right to a hearing before suspension, revocation, or refusal to renew a license by the Board.

N.J.A.C. 13:44E-2.11 prohibits excessive fees and overutilization.

N.J.A.C. 13:44E-2.12 sets forth the requirements for referring a patient to a physical therapist.

N.J.A.C. 13:44E-2.13 contains the chiropractic examination requirements. The Board proposes to delete the words "effective January 1, 2001," at the introduction to subsection (a), because they are no longer necessary.

N.J.A.C. 13:44E-2.14 sets forth requirements for chiropractors when performing an independent chiropractic examination. This section includes licensing, experience, and documentation requirements.

N.J.A.C. 13:44E-2.15 sets forth the permissible practice structures for licensees. The Board proposes to amend the phrase "Department of Health and Senior Services" to read "Department of Health" wherever it occurs in subsection (c) as the Department was reorganized and renamed effective June 29, 2012 (see P.L. 2012, c. 17).

Subchapter 3 addresses determinations with respect to the validity of certain diagnostic tests, special requirements for electrodiagnostic tests and other special examinations.

N.J.A.C. 13:44E-3.1 sets forth the definitions for this subchapter. The Board is proposing to amend the definition of "special examination" to include vestibulo-ocular nystagmus testing as another example of special examinations that chiropractors may perform. The Board has approved the performance of vestibulo-ocular nystagmus testing in the past, but continues to receive inquiries from licensees as to whether they may perform this test. The Board believes that by amending the definition of special examination to specifically include vestibulo-ocular nystagmus testing, the Board will clear up any confusion for licensees about the permissibility of this test.

N.J.A.C. 13:44E-3.2 requires that licensees performing diagnostic tests be appropriately educated and trained to perform and bill for them. In the case of electrodiagnostic tests or specialized tests, licensees must achieve a certificate of competency relating to the pertinent test. Subsection (b) sets forth the criteria and a list of diagnostic tests for which licensees may not bill patients or third party payors. Subsection (c) sets forth a list of tests for which licensees may bill patients or third-party payors, subject to certain limitations. Because the Board is proposing to amend N.J.A.C. 13:44E-3.1 to recognize that vestibulo-ocular nystagmus testing is a permissible specialized examination, the Board is proposing to amend subsection (c) to specifically permit licensees to bill patients and/or third-party payors for this procedure.

N.J.A.C. 13:44E-3.3 describes the tests that a chiropractor cannot perform but for which a patient may be referred to a medical doctor.

N.J.A.C. 13:44E-3.4 sets forth the basic pre-test prerequisites and standards for patient evaluation applicable to electrodiagnostic tests and special examinations.

N.J.A.C. 13:44E-3.5 sets forth the prerequisites that a licensee must satisfy in order to perform electrodiagnostic tests and special examinations. The Board is proposing to amend paragraph (a)2 to require that licensees who seek to perform electrodiagnostic tests or specific special examinations complete a course, preapproved by the Board, that consists of course work and practical, hands-on instruction and an examination that demonstrates that the licensee is capable of recognizing scientifically supportable and practical indications for the test; has knowledge in the proper administration of the test; possesses skill at proper interpretation of the test; and has obtained training in how to integrate the test results into management of the patient's condition. The Board believes that the trend in chiropractic education is for courses to be evaluated based on performance outcome, rather than on the number of hours of instruction. Paragraph (a)3 would require that a licensee apply to the Board for certification to perform electrodiagnostic tests or special examinations within 60 days after successful completion of an approved course. Upon receipt of the application, the Board would have 90 days to act.

[page=165] N.J.A.C. 13:44E-3.6(a) sets forth the informed consent rule relating to electrodiagnostic testing and special examinations. N.J.A.C. 13:44E-3.6(b) sets forth the requirements for using equipment in the performance of electrodiagnostic tests and special examinations. N.J.A.C. 13:44E-3.6(c) requires licensees performing electrodiagnostic tests or special examinations to personally perform a physical examination on the patient that specifically focuses on the orthopedic neuromuscular condition for which the testing has been recommended. N.J.A.C. 13:44E-3.6(c) also lists the factors for determining when a chiropractor should consider repeat testing. In addition, the Board proposes a technical amendment to the heading of the section, so that it refers to "preparation for and performance of the electrodiagnostic test or special examination." Because the rule refers to both electrodiagnostic tests and special examinations, the heading should be amended to accurately reflect the content of the rule.

N.J.A.C. 13:44E-3.7 relates to the use of a testing assistant for technical assistance in performing electrodiagnostic tests and special examinations.

N.J.A.C. 13:44E-3.8 sets forth the duties of a chiropractor in preparing a test report after an electrodiagnostic test or special examination. The section also addresses certain follow-up procedures after testing, such as seeking a second opinion, and discussing findings and recommendations with patients.

N.J.A.C. 13:44E-3.9 sets forth limitations on referring a patient to another practitioner practicing in the same practice space, office building, or nearby mobile office.

N.J.A.C. 13:44E-3.10 sets forth a chiropractor's duties prior to performing a diagnostic test for which a fee will be charged.

N.J.A.C. 13:44E-3.11 relates to the prospective nature of this subchapter's rules with respect to its prohibitions and limitations.

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

The Board believes that the readoption of the existing rules will continue to protect the health, safety, and welfare of New Jersey citizens by identifying those individuals who are qualified and legally authorized to engage in the practice of chiropractic. The rules positively affect the regulated community by clarifying varied aspects of the practice of chiropractic for the benefit of all licensed practitioners and applicants for licensure. The readoption of N.J.A.C. 13:44E is essential in order for the Board to continue to regulate the practice of chiropractic, to identity those individuals who are qualified to engage in the practice of chiropractic and to ensure that every licensed practitioner is aware of the procedures involved in licensure. The readoption of N.J.A.C. 13:44E continues the accepted standards of the practice of chiropractic established by the Board and, in so doing, provides licensed chiropractors with a clear and comprehensive set of rules to guide them in their professional practice. Accordingly, the Board believes that the rules proposed for readoption with amendments will have a positive impact upon those served by chiropractors by continuing to safeguard their health, safety, and welfare and ensuring the maintenance of professional practice standards, which will allow licensees to provide the highest quality of service and care.

The Board also believes that the proposed amendments to N.J.A.C. 13:44E-3.1, 3.2, and 3.5, as they relate to vestibulo-ocular nystagmus tests and other special examinations and electrodiagnostic tests, will protect the health, safety, and welfare of New Jersey citizens by clarifying for chiropractors that they may request and perform these tests, so long as they have met the educational and certification requirements set forth in the rules. Additionally, the Board believes that evaluating courses for electrodiagnostic testing or special examination certification based on performance outcome rather than on course length is a more critical approach that will help to ensure that licensees performing these tests have been properly educated in the selection, administration, and interpretation of these tests.
 
Economic Impact


The rules proposed for readoption and the proposed amendments will not impose any new or additional costs upon applicants for licensure or on consumers. The readopted rules will continue to have an economic impact on applicants for licensure and licensees.

Subchapter 1A will continue to impose costs on applicants and licensees seeking to obtain or maintain licensure. Initial applicants must pay an application fee, as well as fees for related items such as transcripts, examinations, and criminal history background checks required for licensure. Licensees seeking to renew their licenses, and individuals seeking to reinstate inactive or expired licenses, must also pay fees. Additionally, licensees may incur tuition fees when completing the 30 continuing education credits required for biennial license renewal. Licensees must also pay insurance premiums to maintain chiropractic malpractice insurance.

Subchapter 2 will continue to impose costs on a licensee who chooses to advertise. In addition, there may be costs associated with the Board's rules regarding patient records, including those for record maintenance and those associated with providing copies of patient records. The sexual misconduct provision of N.J.A.C. 13:44E-2.3 will impose costs upon licensees who terminate the patient-chiropractic relationship by sending notice via certified mail. The Board's fee schedule set forth at N.J.A.C. 13:44E-2.5 will continue to have an economic impact on licensees, although no new or additional fees will be imposed by the Board at this time. N.J.A.C. 13:44E-2.12 will continue to have an economic impact on licensees who refer patients to physical therapists because it requires licensees to provide certain patient information in writing to the physical therapist upon patient referral. N.J.A.C. 13:44E-2.14 requires certain documentation by a chiropractor who is performing an independent chiropractic examination. The documentation requirement of this provision will continue to have an economic impact on licensees.

Subchapter 3 will continue to impose costs on licensees who choose to perform electrodiagnostic tests and special examinations under N.J.A.C. 13:44E-3.5. This provision requires licensees to complete education and achieve certification appropriate to the testing that they wish to perform. Licensees will have to pay for tuition and submit a certification fee to the Board. However, the amendments to N.J.A.C. 13:44E-3.5(a)3, requiring the Board to evaluate courses relating to electrodiagnostic testing and special examinations before they are completed, will let licensees know whether a particular course is appropriate before the licensee has invested time and money in the course.

The Board believes that any costs imposed by the rules proposed for readoption with amendments are significantly outweighed by the consumer protection established by N.J.A.C. 13:44E.
 
Federal Standards Statement

A Federal standards analysis is not required because the rules proposed for readoption with amendments are subject to State statutory requirements and are not subject to any Federal requirements.
 
Jobs Impact

The Board does not believe that the rules proposed for readoption with amendments will either increase or decrease jobs in the State because the rules proposed for readoption with amendments relate to rules for the practice of chiropractic.
 
Agriculture Industry Impact

The rules proposed for readoption with amendments will have no impact on the agriculture industry in this State because the rules proposed for readoption with amendments relate to rules for the practice of chiropractic.
 
Regulatory Flexibility Analysis

Currently, the Board licenses approximately 3,500 chiropractors. If, for the purposes of the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., licensed chiropractors are considered "small businesses," then the following analysis applies.

The readopted provisions of the rules contain the same compliance, recordkeeping, and reporting requirements previously imposed by the Board on its licensees while the proposed amendments will impose upon licensees new compliance requirements.

Subchapter 1 contains a number of compliance requirements. N.J.A.C. 13:44E-1.1(b) requires that a licensee perform an initial consultation in which he or she identifies and documents a clinical condition warranting chiropractic care. N.J.A.C. 13:44E-1.1(c) requires that a licensee refer [page=166] patients to an appropriate health care provider if the patient presents with a problem that is not within the chiropractor's scope of practice. A licensee will be required to comply with the scope of practice, and the licensee could be disciplined for professional misconduct if he or she failed to comply with these standards.

Subchapter 1A sets forth numerous compliance and reporting requirements for persons applying for licensure in New Jersey, either as an initial licensure or as a licensee from another state. The subchapter contains all of the application requirements for licensure, and requires an applicant to submit to a criminal history record background check as set forth in N.J.A.C. 13:44E-1A.2 and 1A.3. N.J.A.C. 13:44E-1A.4 requires all licensees to choose a license status, file an application, and pay a fee. N.J.A.C. 13:44E-1A.4 requires compliance with the requirements for reinstatement for those whose license has expired or those who have chosen inactive status.

N.J.A.C. 13:44E-1A.5 requires all licensees to complete 30 continuing educational credits in order to qualify for license renewal. N.J.A.C. 13:44E-1A.6 also requires licensees to maintain chiropractic malpractice insurance.

Subchapter 2 contains a number of compliance, recordkeeping, and reporting requirements. N.J.A.C. 13:44E-2.1 sets forth the requirements for licensee advertising. These rules require a licensee to retain a video or audiotape of every advertisement communicated by electronic media that may be reviewed upon request by the Board. Also, licensees are required to retain a copy of all advertisements placed by the licensee for three years. The patient record section, N.J.A.C. 13:44E-2.2, requires licensees to maintain records for any person seeking chiropractic care and for patient and third-party carrier billings for professional services. These records must be maintained for a period of seven years after the date of the last entry, or longer if the patient is a minor child. In addition, this section requires licensees to record certain information on radiographs. Radiographs must be maintained for at least seven years. Also, the section contains the compliance and recordkeeping requirements for providing copies of patient records. Finally, where a licensee is no longer practicing or is out of practice for longer than three months, he or she must file a notice with the Board of procedures established for patient record retrieval. If the practice is not attended by another licensee, the licensee must publish a notice of cessation and the established procedure for retrieval of patient records in a newspaper of general circulation in the area where the licensee's practice is located.

N.J.A.C. 13:44E-2.3 requires licensees to keep a record of the certified letter sent to a patient when ending a patient-chiropractor relationship. N.J.A.C. 13:44E-2.4 deals with the chiropractor of record requirements. The chiropractor of record must be identified on all patient records. If there is no identification on the record it will be assumed that the chiropractor for that patient is the owner of the practice. Each entry in the patient record must be initialed. If there are no initials, then it is assumed that the treatment was rendered by the chiropractor of record. Finally, in a multi-chiropractor practice, any change in the chiropractor of record must be affirmatively noted in the patient record.

N.J.A.C. 13:44E-2.5 requires applicants and licensees to remit certain fees to the Board. N.J.A.C. 13:44E-2.6A contains the requirements for patient record review by a non-attending chiropractor for the purpose of evaluating prior chiropractic care, the need for continuing chiropractic care, the necessity for diagnostic testing, and/or referrals or consultation. It requires a non-attending chiropractor who determines that there was improper documentation of prior care, or improper documentation or performance of diagnostic testing, referrals, or consultation to specifically note the deviation from the standard set forth in N.J.A.C. 13:44E-2.2. Where the non-attending chiropractor determines that the prior care, diagnostic testing, referrals, or consultations were not necessary, he or she must clearly state the rationale for that opinion.

N.J.A.C. 13:44E-2.7 requires the licensee to comply with the provisions for delegating to, or restricting performance of, certain tasks by an unlicensed assistant. The licensee must write all instructions for duties to be performed by the unlicensed assistant in the patient chart. N.J.A.C. 13:44E-2.7A requires the licensee to supply complete instructions including a written acknowledgement of receipt to the patient for home use of electro-therapy devices. Further, the licensee must document in the patient chart, that an electro-therapy device was ordered for the patient and include the acknowledgement from the patient that he or she has received complete instructions. N.J.A.C. 13:44E-2.8 requires the licensee to notify the Board of any change of address via certified mail, return receipt requested, no later than 10 days after the address change. N.J.A.C. 13:44E-2.9 requires the licensee to display his or her license and current renewal in a conspicuous place in the office or place of practice. N.J.A.C. 13:44E-2.11 requires that licensees refrain from billing or submitting claims for any services, goods, or appliances that are not justified by the needs of the patient; are excessive; represent multiple charges for the same services, goods or appliances; contain an excessive fee, or if insurance is involved, exceed the usual and customary charges for such services, goods, or appliances for patients without insurance.

N.J.A.C. 13:44E-2.12 requires the licensee to supply certain information in writing to the physical therapist when referring a patient for physical therapy. The licensee then is required to consult with the physical therapist about the examination and evaluation. The referring chiropractor is required to document in the patient's chart both the initial and any ongoing consultation with the physical therapist. N.J.A.C. 13:44E-2.13 requires that applicants comply with examination requirements. N.J.A.C. 13:44E-2.14 requires a non-attending chiropractor who is performing a chiropractic examination at the request of a third party for the purpose of evaluating the patient's current condition and preparing a written report to: prepare a patient record pursuant to N.J.A.C. 13:44E-2.2; document the records reviewed and other enumerated information in the patient record and the written report; and document in the patient record and the written report the clinical rationale for the opinion; and author and sign the report.

Subchapter 3 contains a number of compliance, recordkeeping, and reporting requirements. N.J.A.C. 13:44E-3.2 requires a licensee to obtain written informed consent from the patient prior to performing any of the tests under N.J.A.C. 13:44E-3.2(b), but neither the patient nor a third-party payor can be billed for the test. N.J.A.C. 13:44E-3.3 requires that a licensee refer patients to a medical doctor for certain tests. N.J.A.C. 13:44E-3.4 requires a licensee to comply with certain pre-test prerequisites and standards before performing electrodiagnostic tests and special examinations. N.J.A.C. 13:44E-3.4 contains specific recordkeeping and compliance requirements. Licensees must take and document in the patient's record a relevant history of the patient's presenting complaints; perform, at a minimum, a problem-focused examination; establish and document in the patient's record a provisional diagnosis with clinical correlation; and abide by appropriate standards of informed consent explaining potential risks, potential benefits, and other clinical options. N.J.A.C. 13:44E-3.5 requires a licensee to comply with certain educational prerequisites before performing any electrodiagnostic tests or special examinations, including successful completion of a training course and examination demonstrating competency relating to the pertinent tests. The licensee must maintain documentation demonstrating successful completion of that training course. Licensees seeking to utilize experimental equipment or procedures for research purposes must obtain prior written approval by the Board and patient consent, and may not charge the patient or a third-party payor for the service. Licensees performing electrodiagnostic tests or specialized examinations are required to familiarize themselves with contemporary journals and texts to maintain proficiency in the practice of the profession and the specialty.

N.J.A.C. 13:44E-3.6 requires a licensee who is performing an electrodiagnostic test or special examination to provide a patient with a written description of the test and any risks. Furthermore, the licensee must fulfill certain requirements with respect to equipment used in electrodiagnostic tests and special examinations. N.J.A.C. 13:44E-3.6 also states that a chiropractor who performs any electrodiagnostic test or special examination may consider repeat testing only under specific circumstances. Under N.J.A.C 13:44E-3.7, a licensee who is using a testing assistant and paying that person a fee other than a regular salary, must maintain for seven years a full record of the fee, including the basis therefor. Under N.J.A.C. 13:44E-3.8, a licensee is required to prepare and retain a comprehensive test report when performing an electrodiagnostic test or special examination. The report must include any technical difficulties. Any raw data or graphs must be retained in the patient record. Both the licensee requesting the test and the licensee performing the test [page=167] must comply with certain follow-up procedures. Under N.J.A.C. 13:44E-3.9, a licensee must comply with certain limitations on referrals. N.J.A.C. 13:44E-3.10 requires a licensee to inform a patient of the fee for a diagnostic test before performing the test, and may bill the patient only under the name of the chiropractor performing the test.

No professional services will be needed to comply with the rules proposed for readoption with amendments. Moreover, the Board believes that any cost of compliance imposed by the rules proposed for readoption and the proposed amendments will not be significant, and are discussed in the Economic Impact statement above. The Board also believes that the rules proposed for readoption with amendments should be uniformly applied to all licensees in order to ensure the health, safety, and welfare of the general public in the practice of chiropractic; and, therefore, no differing compliance requirements for any licensee are provided.
 
Housing Affordability Impact Analysis

The rules proposed for readoption with amendments will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the rules proposed for readoption with amendments relate to rules for the practice of chiropractic.
 
Smart Growth Development Impact Analysis

The rules proposed for readoption with amendments will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules 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 rules proposed for readoption with amendments relate to rules for the practice of chiropractic.
 
Full text of the rules proposed for readoption can be found in the New Jersey Administrative Code at N.J.A.C. 13:44E.
 
Full text of the proposed amendments follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
 
SUBCHAPTER 1A.    LICENSURE
 
13:44E-1A.4   Biennial license renewal; license expiration; reinstatement after expiration; inactive status; return from inactive status
 
(a)-(i) (No change.)
 
(j) A licensee who has been inactive for five years or more, and has not been lawfully practicing in another jurisdiction, shall:
 
1. Complete the requirements set forth in [(g)1] (h)1 through 3 above; and
 
2. (No change.)
 
(k) (No change.)
 
13:44E-1A.5   Chiropractic continuing education
 
(a) (No change.)
 
(b) [Except as provided in (c) below, a] A licensee applying for biennial license renewal shall have completed, during the preceding biennial period, 30 continuing educational credits in order to qualify for the renewal of his or her license. 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 chiropractic professional ethics or recordkeeping and documentation as it pertains to the practice of chiropractic in this State, and a minimum of two credits shall be completed in nutrition education.
 
[(c) For the biennial renewal period beginning September 1, 2013, a licensee who has completed continuing education credits in courses meeting the requirements set forth in this section between January 18, 2010 and August 31, 2013, shall be permitted to apply such credits to qualify for renewal of his or her license for the biennial period commencing on September 1, 2013.]
 
Recodify existing (d)-(j) as (c)-(i) (No change in text.)
 
[(k)] (j) 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.-iii. (No change.)
 
iv. Offer subjects enumerated in [(d)] (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 [(d)] (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 [(k)1] (j)1 above, and in addition, certifies that the sponsor shall:
 
i.-ii. (No change.)
 
iii. Comply with the requirements of [(k)4] (j)4 below.
 
iv.-vii. (No change.)
 
3. (No change.)
 
4. A continuing education sponsor who has qualified as a sponsor pursuant to [(k)1] (j)1 above, or has obtained prior Board approval for a course pursuant to [(k)2] (j)2 above, 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.
 
[(l)] (k) A licensee seeking Board approval of a program for continuing education credit, which has not been approved pursuant to [(k)] (j) above, may submit an application of 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 [(e), (f), and (g)] (d), (e), and (f) above.
 
(l) All coursework required for certification to perform specialized examinations or electrodiagnostic tests referred to in N.J.A.C. 13:44E-3.5(a)2 must be preapproved by the Board at least 90 days prior to the date the course begins.
 
1. A program provider seeking preapproval of a course shall follow the approval process set forth at (k) above.
 
2. A licensee seeking preapproval of a course shall follow the approval process set forth at (k) above.
 
(m)-(t) (No change.)
 
SUBCHAPTER 2.    GENERAL RULES OF PRACTICE
 
13:44E-2.7   Delegable tasks or functions of unlicensed assistants
 
(a)-(b) (No change.)
 
(c) A licensee shall not permit an unlicensed assistant to:
 
1. Examine, diagnose, or analyze a patient;
 
2. Notwithstanding (a)2 above, perform massage, unless [certified] licensed as a massage[,] and bodywork [and somatic] therapist [certified] in this State by the Board of Massage[,] and Bodywork [and Somatic] Therapy [Committee created under the New Jersey Board of Nursing] pursuant to N.J.S.A. 45:11-53 to [67 to perform massage therapy] 79.
 
3.-7. (No change.)
 
(d)-(f) (No change.)
 
13:44E-2.13   Chiropractic examination
 
(a) [Effective January 1, 2001, to] To obtain a license to practice chiropractic, a candidate shall successfully pass:
 
1.-2. (No change.)
 
(b)-(c) (No change.)
 
13:44E-2.15   Permissible practice structures
 
(a)-(b) (No change.)
 
(c) A chiropractic physician may offer chiropractic services as an employee of a general business corporation in this State only in one or more of the settings in (c)1 through 6 below. Any such setting shall have a designated chiropractic or medical director, licensed to practice chiropractic or medicine in this State, who is regularly on the premises and who, alone or with other persons authorized by the State Department of Health [and Senior Services], if applicable, is responsible for [page=168] verification of licensure and credentialing of chiropractic providers and the provision of chiropractic services. The settings are as follows:
 
1. The corporation or other business entity is licensed by the New Jersey Department of Health [and Senior Services] as a health maintenance organization, hospital, long- or short-term health care facility, ambulatory care facility, or other type of health care facility or health care provider, such as a diagnostic imaging facility. This may include a licensed facility [which] that is a component part of a for-profit corporation employing or otherwise remunerating licensed health care professionals;
 
2.-6. (No change.)
 
(d)-(i) (No change.)
 
SUBCHAPTER 3.    DETERMINATIONS WITH RESPECT TO THE VALIDITY OF CERTAIN DIAGNOSTIC TESTS, SPECIAL REQUIREMENTS FOR ELECTRODIAGNOSTIC TESTS, AND OTHER SPECIAL EXAMINATIONS
 
13:44E-3.1   Definitions
 
As used in this subchapter, the following words and terms shall have the following meanings, unless the context clearly indicates otherwise.
 
. . .
 
"Special examination" means a diagnostic test, other than electrodiagnostic test, that is not routinely utilized by chiropractic physicians in the course of ordinary practice, such as specialized imaging studies or vestibulo-ocular-nystagmus tests. "Special examination" does not include x-rays, computer-supported range of motion testing, applied kinesiology, gait analysis, postural analysis tests, or muscle testing devices, such as Dynatron or Cyber station.
 
13:44E-3.2   Recognized diagnostic tests; permissible billing
 
(a)-(b) (No change.)
 
(c) A chiropractic physician may bill for any of the following diagnostic tests, which have recognized reliability and validity and can yield data of sufficient clinical value in the development, evaluation, or implementation of a plan of treatment, when clinically supported, subject to the limitations noted:
 
1.-5. (No change.)
 
6. Applied kinesiology and gait analysis; [and]
 
7. Computer-supported range of motion tests, postural analysis tests, or muscle testing devices, such as Dynatron or Cyber station[.]; and
 
8. Vestibulo-ocular-nystagmus tests.
 
(d) (No change.)
 
13:44E-3.5   Educational prerequisites applicable to electrodiagnostic tests and special examinations; certificate requirement
 
(a) A chiropractic physician seeking to perform electrodiagnostic tests and special examinations shall:
 
1. (No change.)
 
2. Successfully complete (and retain certification of completion of) a Board-approved course consisting of course work [consisting of 120 hours of classroom] and practical, hands-on instruction, and an examination [demonstrating competency in the performance of the pertinent tests, approved by the Board:] that demonstrates that the chiropractic physician is capable of recognizing scientifically supportable and practical indications for the test; has knowledge in the proper administration of the test; possesses skill at proper interpretation of the test; and has obtained training in how to integrate the test results into management of the patient's condition. The course shall be:
 
i.-iii. (No change.)
 
3. Within 60 days of [the applicant's receipt of an application form, submit to the Board the completed application form seeking approval of the undergraduate or postgraduate] completion of a course referred to in (a)2 above, [along with the] submit to the Board a completed application form for certification to perform the test or examination sought, together with the one-time certification fee set forth in N.J.A.C. 13:44E-2.5, which the Board shall act upon within 90 days of its receipt [of the application].
 
(b)-(d) (No change.)
 
13:44E-3.6   Informed consent; equipment; preparation for and performance of the electrodiagnostic test or special examination
 
(a)-(c) (No change.)





 

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