LRBs0450/1
MDK&PJH:wlj&jld:rs
2003 - 2004 LEGISLATURE
SENATE SUBSTITUTE AMENDMENT 2,
TO 2003 SENATE BILL 275
March 10, 2004 - Offered by Senator Schultz.
SB275-SSA2,1,9 1An Act to renumber 446.07; to amend 441.001 (3) (a), 441.001 (4) (b), 446.01
2(2) (b), 446.02 (2) (b), 446.02 (4), 446.02 (9) (a), 446.03 (intro.), 446.05 (1) and
3446.05 (2); to repeal and recreate 446.07 (title); and to create 446.01 (1k),
4446.01 (1L), 446.02 (6m), 446.02 (7s), 446.03 (8), 446.04 (6), (7), (8), (9), (10) and
5(11), 446.05 (3), 446.05 (4) and 446.07 (2) of the statutes; relating to: the
6definition of the practice of chiropractic; chiropractic evaluations and
7treatments; unprofessional conduct by chiropractors; delegations by
8chiropractors; nutritional guidance provided by chiropractors to patients;
9granting rule-making authority, and providing penalties.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB275-SSA2, s. 1 10Section 1. 441.001 (3) (a) of the statutes is amended to read:
SB275-SSA2,2,711 441.001 (3) (a) "Practical nursing" means the performance for compensation
12of any simple acts in the care of convalescent, subacutely or chronically ill, injured

1or infirm persons, or of any act or procedure in the care of the more acutely ill, injured
2or infirm under the specific direction of a nurse, physician, chiropractor licensed
3under ch. 446,
podiatrist licensed under ch. 448, dentist licensed under ch. 447 or
4optometrist licensed under ch. 449, or under an order of a person who is licensed to
5practice medicine, podiatry, dentistry or optometry in another state if that person
6prepared the order after examining the patient in that other state and directs that
7the order be carried out in this state.
SB275-SSA2, s. 2 8Section 2. 441.001 (4) (b) of the statutes is amended to read:
SB275-SSA2,2,159 441.001 (4) (b) The execution of procedures and techniques in the treatment
10of the sick under the general or special supervision or direction of a physician,
11chiropractor licensed under ch. 446, podiatrist licensed under ch. 448, dentist
12licensed under ch. 447 or optometrist licensed under ch. 449, or under an order of a
13person who is licensed to practice medicine, podiatry, dentistry or optometry in
14another state if the person making the order prepared the order after examining the
15patient in that other state and directs that the order be carried out in this state.
SB275-SSA2, s. 3 16Section 3. 446.01 (1k) of the statutes is created to read:
SB275-SSA2,2,1917 446.01 (1k) "Patient" means an individual who receives treatment or services
18from a chiropractor or who has received treatment or services under the supervision,
19direction, or delegation of a chiropractor.
SB275-SSA2, s. 4 20Section 4. 446.01 (1L) of the statutes is created to read:
SB275-SSA2,2,2121 446.01 (1L) "Pattern of conduct" means more than one occurrence.
SB275-SSA2, s. 5 22Section 5. 446.01 (2) (b) of the statutes is amended to read:
SB275-SSA2,3,223 446.01 (2) (b) To employ or apply chiropractic adjustments, and the principles
24or techniques of chiropractic science, that are taught at a chiropractic college or

1university approved by the Council on Chiropractic Education or its successor,
in the
2diagnosis, treatment or prevention of any of the conditions described in s. 448.01 (10).
SB275-SSA2, s. 6 3Section 6. 446.02 (2) (b) of the statutes is amended to read:
SB275-SSA2,3,114 446.02 (2) (b) The examining board shall promulgate rules establishing
5educational requirements for obtaining a license under par. (a). The rules shall
6require that an application for the license that is received by the department after
7June 30, 1998, be accompanied by satisfactory evidence that the applicant has a
8bachelor's degree from a college or university accredited by an accrediting body listed
9as nationally recognized by the secretary of the federal department of education, and
10has graduated from a college or university of chiropractic approved by the examining
11board
accredited by the Council on Chiropractic Education or its successor.
SB275-SSA2, s. 7 12Section 7. 446.02 (4) of the statutes is amended to read:
SB275-SSA2,3,2113 446.02 (4) The renewal date and renewal fee for all licenses granted by the
14examining board are specified under s. 440.08 (2) (a). In an application for renewal,
15the applicant shall identify each employee, other than a nurse licensed under ch. 441,
16physical therapist licensed under subch. III of ch. 448, or athletic trainer licensed
17under subch. VI of ch. 448, to whom clinical work is delegated. If the examining board
18has promulgated rules requiring such an employee to complete a training program
19or course of instruction to perform the delegated work, the applicant shall also
20provide the name, date, and sponsoring organization for the training program or
21course of instruction that the employee completed.
SB275-SSA2, s. 8 22Section 8. 446.02 (6m) of the statutes is created to read:
SB275-SSA2,4,323 446.02 (6m) (a) Except as provided in par. (b), a chiropractor who is granted
24a license under this chapter on or before January 1, 2003, may provide counsel,
25guidance, direction, advice, or recommendations to a patient regarding the health

1benefits of vitamins, herbs, or nutritional supplements only if the chiropractor has
2completed 48 hours in a postgraduate course of study in nutrition that is approved
3by the examining board.
SB275-SSA2,4,54 (b) Paragraph (a) does not apply to a chiropractor licensed under this chapter
5who is certified as a dietitian under subch. V of ch. 448.
SB275-SSA2, s. 9 6Section 9. 446.02 (7s) of the statutes is created to read:
SB275-SSA2,4,157 446.02 (7s) A chiropractor shall evaluate each patient to determine whether
8the patient has a condition that is treatable by chiropractic means. An evaluation
9shall be based on an examination that is appropriate to the patient. In conducting
10an evaluation, a chiropractor shall utilize chiropractic science, as defined by rule by
11the examining board, and the principles of education and training of the chiropractic
12profession. A chiropractor shall discontinue treatment by chiropractic means if, at
13any time, the chiropractor determines, or reasonably should have determined, that
14the patient's condition will not respond to further treatment by chiropractic means,
15except that a chiropractor may continue to provide supportive care to a patient.
SB275-SSA2, s. 10 16Section 10. 446.02 (9) (a) of the statutes is amended to read:
SB275-SSA2,5,217 446.02 (9) (a) A student or graduate of a college or university of chiropractic
18that is accredited by the Council on Chiropractic Education or its successor who
19practices chiropractic, in a program for the clinical training of students and
20graduates that is reviewed and approved by the examining board, under the
21supervision of a chiropractor who is approved by the examining board to supervise
22the clinical training of the student or graduate and who is licensed under this chapter
23and is responsible for the student's or graduate's practice in an infirmary, clinic,
24hospital or private chiropractic office that is connected or associated for training

1purposes with a college or university of chiropractic approved by the examining
2board
that is accredited by the Council on Chiropractic Education or its successor.
SB275-SSA2, s. 11 3Section 11. 446.03 (intro.) of the statutes is amended to read:
SB275-SSA2,5,7 4446.03 Reprimand; license revocation, limitation or suspension.
5(intro.) The Subject to ss. 446.04 (11) (d) and 446.05 (3), the examining board, by
6order, may reprimand a licensee or registrant and may deny, limit, suspend or revoke
7any license or certificate of registration if the licensee or registrant:
SB275-SSA2, s. 12 8Section 12. 446.03 (8) of the statutes is created to read:
SB275-SSA2,5,109 446.03 (8) Has violated this chapter or any rule promulgated under this
10chapter.
SB275-SSA2, s. 13 11Section 13. 446.04 (6), (7), (8), (9), (10) and (11) of the statutes are created to
12read:
SB275-SSA2,5,1413 446.04 (6) Billing for chiropractic services that were inappropriate,
14unnecessary, or of substandard quality.
SB275-SSA2,5,15 15(7) Billing for a service that was not performed. This includes:
SB275-SSA2,5,1716 (a) Billing for a service that was performed by a staff person without the
17training required by the laws of this state.
SB275-SSA2,5,2218 (b) A pattern of conduct in which a chiropractor bills a Current Procedural
19Terminology Code in a manner inconsistent with the published standards of the
20Current Procedural Terminology Code, the Current Procedural Terminology
21Assistant, the Wisconsin Chiropractic Association, the American Chiropractic
22Association, or the International Chiropractic Association.
SB275-SSA2,5,2523 (c) A pattern of conduct in which a chiropractor bills for a service using a higher
24level Current Procedural Terminology Code than the service that was actually
25provided to the patient with the intent of obtaining unearned reimbursement.
SB275-SSA2,6,4
1(8) Failure to collect a deductible or co-payment required by a patient's insurer.
2This subsection does not apply if the chiropractor has made reasonable efforts to
3collect the deductible or co-payment or if the patient has financial hardship and the
4chiropractor documents the financial hardship.
SB275-SSA2,6,5 5(9) Falsifying a claim.
SB275-SSA2,6,7 6(10) A pattern of conduct that involves billing for a unit of service that was not
7actually performed with the intent of obtaining unearned reimbursement.
SB275-SSA2,6,8 8(11) Sexual misconduct. In this subsection, all of the following apply:
SB275-SSA2,6,169 (a) A chiropractor engages in sexual misconduct if he or she engages in sexual
10contact, exposure, or gratification, sexually offensive communication, dating a
11patient while the patient is under the chiropractor's professional care or treatment
12or within 6 months after the patient has been discharged from care or treatment, or
13other sexual behavior with or in the presence of a patient under the chiropractor's
14professional care or treatment and a reasonably prudent chiropractor under similar
15conditions and circumstances would find the conduct unprofessional. Consent is not
16an issue under this subsection.
SB275-SSA2,6,1817 (b) "Contact violation" means any violation of par. (a) that involves physical
18contact with a patient under the chiropractor's professional care or treatment.
SB275-SSA2,6,2119 (c) "Noncontact violation" means any violation of par. (a) that does not involve
20physical contact with a patient under the chiropractor's professional care or
21treatment.
SB275-SSA2,6,2522 (d) 1. The examining board shall require a chiropractor who commits a first
23noncontact violation under this subsection to attend training approved by the
24department regarding sexual misconduct and shall suspend his or her chiropractic
25license for not less than 90 days.
SB275-SSA2,7,3
12. The examining board shall suspend the chiropractic license of a chiropractor
2who commits a 2nd noncontact violation or a first contact violation under this
3subsection for one year.
SB275-SSA2,7,54 3. The examining board shall revoke the chiropractic license of a chiropractor
5who commits a 3rd noncontact or a 2nd contact violation under this subsection.
SB275-SSA2, s. 14 6Section 14. 446.05 (1) of the statutes is amended to read:
SB275-SSA2,7,12 7446.05 Procedure for hearings. (1) Subject to the rules promulgated under
8s. 440.03 (1), the examining board may make investigations and conduct hearings
9in regard to the conduct of any licensed chiropractor who, it has reason to believe,
10violated s. 446.02 or 446.03 (1), (6), (7), (7m), or (8) or committed any offense listed
11in s. 446.03
. The person complained against may proceed to review any action of the
12examining board under ch. 227.
SB275-SSA2, s. 15 13Section 15. 446.05 (2) of the statutes is amended to read:
SB275-SSA2,7,1814 446.05 (2) Upon Except as provided in subs. (3) and (4), upon application and
15satisfactory proof that the cause of such revocation or suspension no longer exists,
16the examining board may reinstate any license or registration suspended or revoked
17by it. This subsection does not apply to a license or registration that is suspended
18under s. 440.13 (2) (c) or that is revoked under s. 440.12.
SB275-SSA2, s. 16 19Section 16. 446.05 (3) of the statutes is created to read:
SB275-SSA2,7,2120 446.05 (3) The examining board shall suspend the license of a chiropractor who
21commits a third violation of s. 446.04 (1) to (10) for not less than 6 months.
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