PROPOSED RULEMAKING
STATE BOARD
OF CHIROPRACTIC
[ 49 PA. CODE CH. 5 ]
Review of Chiropractic Treatment
[40 Pa.B. 1641]
[Saturday, March 27, 2010]The State Board of Chiropractic (Board) proposes to amend its regulations to add §§ 5.55 and 5.56 (relating to independent chiropractic examination; and chiropractic peer review) to read as set forth in Annex A.
Effective date
The amendments will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
Section 302(3) of the Chiropractic Practice Act (act) (63 P. S. § 625.302(3)) authorizes the Board to promulgate, adopt and enforce rules and regulations necessary to carry out the act.
Background and Need for the Amendment
Chiropractors often review the treatment of another chiropractor or independently examine a chiropractic patient, such as for workers' compensation or motor vehicle accident purposes. The proposed rulemaking will set forth standards for a licensed chiropractor to follow in those situations.
Description of the Proposed Amendments
Proposed § 5.55—Independent chiropractic examination.
The proposed rulemaking would first address independent chiropractic examinations. Proposed subsection (a) would set the basic qualifications by requiring that a chiropractor performing an independent chiropractic examination be currently licensed in this Commonwealth, actively practice at least 20 hours a week, and have professional liability insurance that covers independent chiropractic examinations. Proposed subsection (b) would provide that a chiropractor may not perform an independent chiropractic examination if the chiropractor has previous professional involvement with the patient or chiropractor under review, has performed or provided precertification or other professional services in the same matter, or the chiropractor's impartiality may reasonably be questioned.
Proposed subsection (c) would require a chiropractor performing an independent examination to obtain and review the patient record of the treating chiropractor. Proposed subsection (d) would require a chiropractor performing an independent examination to take a history and perform a clinical examination of the patient and to complete a patient record. Proposed subsection (e) would require a chiropractor performing an independent chiropractic examination to prepare, review and sign a report of the examination. This report would include a description of records reviewed, a recital of history and examination findings, discussion of tests and the basis for conducting the test, review of the patient's response to prior care and treatment, and other facts supporting the opinion, and the clinical rationale for any opinion. Proposed subsection (f) would require a chiropractor performing an independent examination to provide a copy of the report to the treating chiropractor. Proposed subsection (g) would prohibit a chiropractor performing an independent examination from recommending to the patient any alteration in care or soliciting the patient for care.
Finally, proposed subsection (h) would define the term ''independent chiropractic examination'' to include a chiropractic examination of a workers' compensation claimant at the request of the employer and a chiropractic examination of a person injured in a motor vehicle accident upon court order.
Proposed § 5.56—Chiropractic peer review.
The proposed rulemaking would also address chiropractic peer review. Proposed subsection (a) would set the basic qualifications by requiring that a chiropractor performing a chiropractic peer review be currently licensed in this Commonwealth, actively practice at least 20 hours a week, hold an adjunctive procedures certificate if the review addresses adjunctive procedures, and have professional liability insurance that covers chiropractic peer review. Proposed subsection (b) would provide that a chiropractor may not perform a chiropractic peer review if the chiropractor had previous professional involvement with the patient or chiropractor under review, has performed or provided precertification or other professional services in the same matter, or the chiropractor's impartiality may reasonably be questioned.
Proposed subsection (c) would require a chiropractor performing a peer review to prepare, review and sign a report of the peer review. This report would include a description of records reviewed, a review of the patient's response to prior care and treatment, and other facts supporting the opinion, and the clinical rationale for any opinion. Proposed subsection (d) would require a chiropractor performing a peer review to provide a copy of the report to the treating chiropractor.
Finally, proposed subsection (e) would define the term ''chiropractic peer review'' to include a utilization review or peer review of chiropractic treatment of a workers' compensation claimant and a peer review of chiropractic treatment of a person injured in a motor vehicle accident.
Fiscal Impact and Paperwork Requirements
The proposed regulations will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The regulations will impose no additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector.
Sunset Date
The Board continuously monitors the effectiveness of its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on March 11, 2010, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey comments, recommendations or objections to the proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria which have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor of comments, recommendations or objections raised.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Regulatory Unit Counsel, Department of State, P. O. Box 2649, Harrisburg, PA 17105-2649, or by e-mail at st-chiropractic@state.pa.us, within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Use reference No. 16A-4315 (review of chiropractic treatment), when submitting comments.
KATHLEEN G. McCONNELL, D. C.,
ChairpersonFiscal Note: 16A-4315. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 5. STATE BOARD OF CHIROPRACTIC
Subchapter E. MINIMUM STANDARDS OF PRACTICE § 5.55. Independent chiropractic examination.
(a) A chiropractor performing an independent chiropractic examination in this Commonwealth shall:
(1) Hold a current valid license to practice chiropractic in this Commonwealth.
(2) Be currently engaged in the clinical practice of chiropractic in this Commonwealth at least 20 hours per week.
(3) Have professional liability insurance that covers independent chiropractic examinations.
(b) A chiropractor may not perform an independent chiropractic examination if:
(1) The chiropractor had previous professional involvement with the patient or provider under review.
(2) The chiropractor has performed or provided precertification, case management, vocational rehabilitation or any other services in the same matter.
(3) The chiropractor's impartiality may reasonably be questioned.
(c) A chiropractor performing an independent chiropractic examination shall obtain and review the patient record of the currently treating chiropractor.
(d) A chiropractor performing an independent chiropractic examination shall take the patient's history and perform a clinical examination and complete a patient record as required under § 5.51 (relating to patient records).
(e) A chiropractor performing an independent chiropractic examination shall prepare, review and sign a report, containing at a minimum the following:
(1) The nature and extent of the records reviewed, including other information presented, such as test results.
(2) A recital of the history, clinical examination and findings.
(3) The tests performed, including the basis for conducting each test and the results.
(4) A review of the patient's response to prior care and treatment.
(5) Other facts upon which any opinion is based, together with the source of those facts.
(6) The clinical rationale for any opinion expressed with respect to the patient's current condition.
(f) A chiropractor performing an independent chiropractic examination shall provide a copy of the signed report to the chiropractor currently providing chiropractic care to the patient.
(g) A chiropractor performing an independent chiropractic examination may not:
(1) Make recommendations directly to the patient for alterations in care.
(2) Solicit the patient for care.
(h) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:
Independent chiropractic examination—A chiropractic examination and evaluation performed by a chiropractor other than a chiropractor currently providing the patient with chiropractic care and to be used for the purpose of determining the patient's current chiropractic condition and prognosis. The term ''independent chiropractic examination'' includes examination by a chiropractor under section 314 of the Workers' Compensation Act (77 P. S. § 651) or under 75 Pa.C.S. § 1796 (relating to mental or physical examination of person).
§ 5.56. Chiropractic peer review.
(a) A chiropractor performing a chiropractic peer review in this Commonwealth shall:
(1) Currently hold a valid license to practice chiropractic in this Commonwealth.
(2) Be currently engaged in the active practice of chiropractic, in the chiropractic specialty of the chiropractic treatment under review, if any, in this Commonwealth at least 20 hours per week.
(3) Currently hold a valid adjunctive procedures certificate issued by the Board, if the review addresses adjunctive procedures.
(4) Have professional liability insurance that covers chiropractic peer reviews.
(b) A chiropractor may not perform a chiropractic peer review if:
(1) The chiropractor had previous professional involvement with the patient or provider under review.
(2) The chiropractor has performed or provided precertification, case management, vocational rehabilitation or any other services in the same matter.
(3) The chiropractor's impartiality may reasonably be questioned.
(c) A chiropractor performing a chiropractic peer review shall prepare, review and sign a report, containing at a minimum the following:
(1) The nature and extent of the records reviewed, including other information presented, such as test results.
(2) A review of the patient's response to prior care and treatment.
(3) Other facts upon which any opinion is based, together with the source of those facts.
(4) The clinical rationale for any opinion expressed with respect to the patient's prognosis and need for chiropractic care.
(d) A chiropractor performing a chiropractic peer review shall provide a copy of the signed report to the chiropractor currently providing chiropractic care to the patient.
(e) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:
Chiropractic peer review—A review and evaluation of chiropractic patient records performed by a chiropractor other than a chiropractor currently providing the patient with chiropractic care and to be used for the purpose of determining the appropriateness of continued chiropractic care. The term ''chiropractic peer review'' includes utilization review under section 306(f.1)(6) of the Workers' Compensation Act (77 P. S. § 531(6)) and includes peer review under section 420 of the Workers' Compensation Act (77 P. S. §§ 831 and 832) or under 75 Pa.C.S. § 1797(b) (relating to customary charges for treatment).
[Pa.B. Doc. No. 10-554. Filed for public inspection March 26, 2010, 9:00 a.m.]
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