This conclusion is supported by an analysis by department staff. Licensed chiropractors are required to complete 40 hours of continuing education (CE) each biennium. Continuing education hours have traditionally only been available at locations near urban (higher population density) areas. The economics of hosting and presenting all day or multi-day presentations requires that CE providers attract a large number of attendees. This may cause significant financial burden in terms of travel expenses and lost income due to time away from the practice.
The use of modern technology (an example would be Internet-based CE courses) will offer chiropractors more educational opportunities while reducing travel and time away from office related costs.
This rule does not mandate that any CE provider offer non-traditional or technology-based CE, therefore, there would be no additional mandated expenses to CE providers.
Anticipated costs incurred by private sector/fiscal estimate: The department finds that this rule has no significant fiscal effect on the private sector.
Effect on small business: These proposed rules will have no significant economic impact on a substantial number of small businesses, as defined in s.
227.114 (1), Stats. The Department's Regulatory Review Coordinator may be contacted by email at
larry.martin@drl.state.wi.us, or by calling (608) 266-8608.
Agency contact person
Pamela Haack, Paralegal, Department of Regulation and Licensing, Office of Legal Counsel, 1400 East Washington Avenue, Room 152, P.O. Box 8935, Madison, Wisconsin 53708-8935. Telephone: (608) 266-0495. Email:
pamela.haack@drl.state.wi.us.
TEXT OF RULE
SECTION 1. Chir 5.01 (1) (c) and (d) are repealed.
SECTION 2. Chir 5.01 (3) is renumbered Chir 5.01 (3) (a) and is amended to read:
Chir 5.01 (3) (a) To obtain credit for completion of continuing education programs, a chiropractor shall certify on his or her application for renewal of license registration that he or she has completed all continuing education credits as required in this section for the previous 2 year license registration period. A chiropractor shall retain for a minimum period of 4 years, and shall make available to the board or its agent upon request, certificates of attendance issued by the program sponsor for all continuing education programs for which he or she claims credit for purposes of renewal of his or her license registration. Chiropractors attending a program for credit shall be present in the room where a program is being presented in order to claim credit. A chiropractor may claim credit hours for continuing education for which he or she was in actual attendance in the room, except for authorized break periods or to attend to personal hygiene needs.
SECTION 3. Chir 5.01 (3) (b) to (e) are created to read:
Chir 5.01 (3) (b) Except as provided in par. (c), chiropractors attending a program for credit shall be present in the room where a program is being presented in order to claim credit. A chiropractor may claim credit hours for continuing education for which he or she was in actual attendance in the room, except for authorized break periods or to attend to personal hygiene needs.
(c) Chiropractors may obtain up to 12 continuing education credit hours through alternative based, non-classroom programs. The programs shall be approved by the board under the provisions of s.
Chir 5.02. The chiropractor shall have completed all parts of the course for which credit is awarded by the provider.
(d) The programs shall include a written assessment instrument, designed to ensure that the chiropractor actively participated in the presentation of material and derived a measurable benefit from participation.
(e) Home study programs and other technology based, non-classroom presentations may be approved for credit in excess of 12 credit hours only in cases of extreme hardship, as determined by the board.
SECTION 4. Chir 5.02 (1) (i) is created to read:
Chir 5.02 (1) (i) A technology based, non-classroom program shall meet these additional requirements:
1. The program shall include a written assessment instrument, designed to ensure that the chiropractor actively participated in the presentation of material and derived a measurable benefit from participation.
2. The program shall contain a reasonable security procedure to assure that the chiropractor enrolled is the actual participant.
SECTION 5. Chir 5.02 (3) is repealed.
SECTION 6. Chir 5.02 (4) (a) 8., a. and b. are created to read:
Chir 5.02 (4) (a) 8. If the course is a technology based, non-classroom program, a description of the methods employed to fulfill the following requirements:
a. The program shall include a written assessment instrument, designed to ensure that the chiropractor actively participated in the presentation of material and derived a measurable benefit from participation.
b. The program shall contain a reasonable security procedure to assure that the chiropractor enrolled is the actual participant.
SECTION 7. Chir 5.02 (7) is created to read:
Chir 5.02 (7) The approval of a course shall be effective only for the biennium in which it is approved.
Notice of Hearing
Chiropractic Examining Board
NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Chiropractic Examining Board in ss.
15.08 (5) (b) and
227.11 (2), Stats., and interpreting s.
446.04, Stats., the Chiropractic Examining Board will hold a public hearing at the time and place indicated below to consider an order to amend s.
Chir 6.02 (6), relating to adequate education prior to application of new therapies and treatment modalities.
Hearing Date, Time and Location
Date: February 23, 2006
Time: 8:15 a.m.
Location: 1400 East Washington Avenue
Room 121A
Madison, Wisconsin
Appearances at the Hearing
Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions and argument in writing as well. Facts, opinions and argument may also be submitted in writing without a personal appearance by mail addressed to Pamela Haack, Paralegal, Department of Regulation and Licensing, 1400 East Washington Avenue, Room 152, P.O. Box 8935, Madison, Wisconsin 53708-8935, or by email at
pamela.haack@drl.state.wi.us. Comments must be received on or before March 6, 2006 to be included in the record of rule-making proceedings.
Analysis
Statutes interpreted: Section
446.04, Stats.
Explanation of agency authority: The Chiropractic Examining Board licenses and regulates the conduct of chiropractors. The board is authorized under ss.
15.08 (5) and
(6),
446.02 (1) (b) and
446.02 (2) (b), Stats., to promulgate rules relating to the educational requirements for licensure and the requirements for continuing education of chiropractors and unprofessional conduct.
Related statute or rule: There are no other related statutes or rules other than those listed above.
Plain language analysis: This proposed rule-making order makes changes to reflect the need for chiropractors to receive adequate training, education and experience prior to the introduction, or application, of new therapies and treatment modalities in their chiropractic practice application.
New therapies and treatment modalities, such as cold laser therapy and other potential new high-visibility therapies, are being introduced into the practice of chiropractic treatment on a regular basis. To ensure that these new therapies and treatment modalities being made available by advancements in the field are administered appropriately, and to adequately educate chiropractors on the treatment of their patients, a rule change specifying that the chiropractor should have adequate education and training prior to patient application will be required.
SECTION 1 amends the rules to specify that chiropractors need adequate training, education and experience relating to the use of new therapies and treatment modalities in the chiropractic profession to assure competence prior to application.
Summary of, and comparison with, existing or proposed federal regulation: None.
Comparison with rules in adjacent states:
Illinois: Illinois's administrative code has no mention specifically of training requirements; however, the conduct of chiropractors is governed under Section 1285.240 Standards (Illinois Admin. Code). Interestingly, the rules governing the conduct of chiropractors are those of the medical profession and treat chiropractors as members of the medical profession (referring to them as chiropractic physicians). The rules do require that chiropractors act in ways that will not harm the public, breaches the physician's responsibility to a patient in accordance to medical standards of practice and not use any equipment on patients that have not been authorized for use in an approved research program pursuant to rules of the Illinois Department of Public Health authorizing research programs or as otherwise expressly authorized by law. More may be found at:
http://www.ildpr.com/WHO/ar/medicalr.asp
Iowa: Iowa's administrative code governing conduct has no specific language requiring education prior to the use of a new therapy; however, there are requirements for chiropractors to be competent in their practice. Excerpts from their administrative code are as follows:
45.2 (2) Professional incompetence. Professional incompetence includes, but is not limited to:
a. A substantial lack of knowledge or ability to discharge professional obligations within the scope of practice.
b. A substantial deviation from the standards of learning or skill ordinarily possessed and applied by other chiropractic physicians in the state of Iowa acting in the same or similar circumstances.
c. A failure to exercise the degree of care which is ordinarily exercised by the average chiropractic physician acting in the same or similar circumstances.
d. Failure to conform to the minimal standard of acceptable and prevailing practice of a chiropractic physician in this state.
Michigan: Michigan's administrative code relating to rules governing the practice of chiropractic has no specific rules regulating professional conduct. The rules relating to actions against a Michigan chiropractic license holder are covered under Michigan Statutes: Chapter 333.16221 – 16226. More may be found at:
http://www.legislature.mi.gov/mileg.asp?page=executesearch
Minnesota: Minnesota's statutes governing conduct has no specific language requiring education prior to the use of a new therapy; however, there are requirements for chiropractors to be competent in their practice. Excerpts from their administrative code are as follows:
From Minnesota statutes: 148.10 Licenses Revoked; New Licenses.
(11), unprofessional conduct means any unethical, deceptive or deleterious conduct or practice harmful to the public, any departure from or the failure to conform to the minimal standards of acceptable chiropractic practice, or a willful or careless disregard for the health, welfare or safety of patients, in any of which cases proof of actual injury need not be established. Unprofessional conduct shall include, but not be limited to, the following acts of a chiropractor:
(1) gross ignorance of, or incompetence in, the practice of chiropractic
Summary of factual data and analytical methodologies: No study resulting in the collection of factual data was used in reference to this rule-making effort. The primary methodology for revising the rule is the board's ongoing analysis and determination that a rules change is necessary.
Analysis and supporting documents used to determine effect on small business or in preparation of economic impact report: The Department of Regulation and Licensing has a small business review advisory committee (SBRAC) consisting of representatives of a variety of small business and geographic locations. This proposed rule was reviewed by the SBRAC and found that the rule would not have a significant economic impact on small business.
This conclusion is supported by an analysis by department staff. Licensed chiropractors are required to follow the Standards of Conduct Rules under ch.
Chir 6 of the Wisconsin administrative code. The existing rules prevent licensed chiropractors from performing professional services inconsistent with their training, education or experience. Given the current pace of technological advancement, and the resulting marketing effort targeting practitioners, the existing rules governing professional conduct is amended by the board to clarify education and training requirements of chiropractors prior to application and/or incorporation of new technology-based therapies and treatments into their practice.
The incorporation and use of modern technology has always been and will be a part of patient care; however, the rules governing conduct should keep up with those applications, especially where they relate to existing rules of conduct for the protection of the public.
This proposed rule does not mandate any additional education or training with regards to new technology or treatments, unless chiropractors wish to incorporate those new treatments into their practice.
Anticipated costs incurred by private sector/fiscal estimate: The department finds that this rule has no significant fiscal effect on the private sector.
Fiscal estimate
The proposed rule will have no impact on the department's funds.
Effect on small business: These proposed rules will have no significant economic impact on a substantial number of small businesses, as defined in s.
227.114 (1), Stats. The Department's Regulatory Review Coordinator may be contacted by email at
larry.martin@drl.state.wi.us, or by calling (608) 266-8608.
Agency contact person
Pamela Haack, Paralegal, Department of Regulation and Licensing, Office of Legal Counsel, 1400 East Washington Avenue, Room 152, P.O. Box 8935, Madison, Wisconsin 53708-8935. Telephone: (608) 266-0495. Email:
pamela.haack@drl.state.wi.us.
TEXT OF RULE
SECTION 1. Chir 6.02 (6) is amended to read:
Chir 6.02 (6) Performing professional services inconsistent with training, education or experience.
Prior to application to patients of new therapies or treatment modalities, a chiropractor shall obtain adequate and appropriate training and education. Such training and education may be obtained from coursework at an accredited college of chiropractic, or from a board-approved continuing education program or from a program sponsored by an organization listed in s. Chir 5.02 (1) (a).
Notice of Hearing
Insurance
Notice is hereby given that pursuant to the authority granted under s.
601.41 (3), Stats., and the procedures set forth in under s.
227.18, Stats., OCI will hold a public hearing to consider the adoption of the attached proposed rulemaking order affecting Section
Ins 17.28, Wis. Adm. Code, relating to Fund fees for fiscal year 2007.
Hearing Information
Date: February 13, 2006
Time: 10:00 a.m., or as soon thereafter as the matter may be reached
Place: OCI, Room 223, 125 South Webster St
2nd Floor
Madison, WI
Written comments or comments submitted through the Wisconsin Administrative Rule website at:
http://adminrules.wisconsin.gov on the proposed rule will be considered. The deadline for submitting comments is 4:30 p.m. on the 8
th day after the date for the hearing stated in this Notice of Hearing.
Written comments should be sent to:
