SB762,35,2120 448.52 (2m) (b) A chiropractor licensed under ch. 446 or a doctor of chiropractic
21licensed under subch. VIII
claiming to render physical therapy modality services.
SB762,85 22Section 85. 448.56 (1) of the statutes is amended to read:
SB762,36,1223 448.56 (1) Written referral. Except as provided in this subsection and s.
24448.52, a person may practice physical therapy only upon the written referral of a
25physician, physician assistant, chiropractor, dentist, podiatrist, primary spinal care

1practitioner,
or advanced practice nurse prescriber certified under s. 441.16 (2).
2Written referral is not required if a physical therapist provides services in schools to
3children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated
4by the department of public instruction; provides services as part of a home health
5care agency; provides services to a patient in a nursing home pursuant to the
6patient's plan of care; provides services related to athletic activities, conditioning, or
7injury prevention; or provides services to an individual for a previously diagnosed
8medical condition after informing the individual's physician, physician assistant,
9chiropractor, dentist, podiatrist, primary spinal care practitioner, or advanced
10practice nurse prescriber certified under s. 441.16 (2) who made the diagnosis. The
11examining board may promulgate rules establishing additional services that are
12excepted from the written referral requirements of this subsection.
SB762,86 13Section 86. 448.56 (1m) (b) of the statutes is amended to read:
SB762,36,1914 448.56 (1m) (b) The examining board shall promulgate rules establishing the
15requirements that a physical therapist must satisfy if a physician, physician
16assistant, chiropractor, dentist, podiatrist, primary spinal care practitioner, or
17advanced practice nurse prescriber makes a written referral under sub. (1). The
18purpose of the rules shall be to ensure continuity of care between the physical
19therapist and the health care practitioner.
SB762,87 20Section 87. 448.956 (1m) of the statutes is amended to read:
SB762,37,221 448.956 (1m) Subject to sub. (1) (a), a licensee may provide athletic training
22to an individual without a referral, except that a licensee may not provide athletic
23training as described under s. 448.95 (5) (d) or (e) in an outpatient rehabilitation
24setting unless the licensee has obtained a written referral for the individual from a

1practitioner licensed or certified under subch. II, III, IV, V, or, VII, or VIII of this
2chapter; under ch. 446; or under s. 441.16 (2).
SB762,88 3Section 88. 448.956 (3) (c) of the statutes is amended to read:
SB762,37,84 448.956 (3) (c) Treat or rehabilitate an employee with an injury or illness that
5has resulted from an employment activity as directed, supervised, and inspected by
6a physician, as defined in s. 448.01 (5), or by a person licensed under subch. VIII or
7under s. 446.02, who has the power to direct, decide, and oversee the implementation
8of the treatment or rehabilitation.
SB762,89 9Section 89. 448.956 (4) of the statutes is amended to read:
SB762,37,1510 448.956 (4) If a licensee or the consulting physician of the licensee determines
11that a patient's medical condition is beyond the scope of practice of the licensee, the
12licensee shall, in accordance with the protocol established under sub. (1) (a), refer the
13patient to a health care practitioner who is licensed under ch. 446 or 447 or subch.
14II, III or, IV, or VIII of ch. 448 and who can provide appropriate treatment to the
15patient.
SB762,90 16Section 90. Subchapter VIII of chapter 448 [precedes 448.971] of the statutes
17is created to read:
SB762,37,1818 chapter 448
SB762,37,1919 subchapter viii
SB762,37,2120 spinal medicine affiliated
21 credentialing board
SB762,37,22 22448.971 Definitions. In this subchapter:
SB762,37,24 23(1) "Affiliated credentialing board" means the spinal medicine affiliated
24credentialing board.
SB762,37,25 25(2) "Licensee" means a person who is licensed under s. 448.9725.
SB762,38,1
1(3) "Practice of chiropractic" has the meaning given in s. 446.01 (2).
SB762,38,4 2(4) "Primary spinal care practitioner" means an individual possessing the
3degree of doctor of spinal medicine or equivalent degree as determined by the
4affiliated credentialing board.
SB762,38,9 5(5) "Spinal medicine" means the integration and application of the practice of
6chiropractic and the practice of medicine and surgery that is limited to conditions of
7the spine and of the musculoskeletal, neuromuscular, and nervous systems and
8includes prescribing and administering drugs. The practice of spinal medicine does
9not include all of the following:
SB762,38,1010 (a) Surgery.
SB762,38,1211 (b) Administering a general anesthetic, except under the direction of a person
12licensed to practice medicine and surgery under subch. II.
SB762,38,18 13448.9715 License required. (1) Except as provided in ss. 257.03 and
14448.972, no person may practice spinal medicine, designate himself or herself as a
15primary spinal care practitioner, use or assume the title "primary spinal care
16practitioner," or append to the person's name the letters "P.S.C.P.," or any other title,
17letters, or designation that represents or may tend to represent the person as a
18primary spinal care practitioner unless the person is a licensee.
SB762,38,22 19(2) (a) A primary spinal care practitioner shall evaluate each patient before
20commencing treatment of the patient to determine whether the patient has a
21condition that is treatable by the practice of spinal medicine. The evaluation shall
22be based upon an examination that is appropriate to the patient.
SB762,39,523 (b) A primary spinal care practitioner shall discontinue the practice of spinal
24medicine on a patient if, at any time after the evaluation under par. (a) or during or
25following treatment of the patient, the primary spinal care practitioner determines

1or reasonably believes that the patient's condition is not treatable by the practice of
2spinal medicine, or will not respond to further practice of spinal medicine by the
3primary spinal care practitioner, except that a primary spinal care practitioner may
4provide maintenance, supportive, and wellness care to the patient if the patient is
5being treated by another health care professional.
SB762,39,206 (c) A primary spinal care practitioner who discontinues the practice of spinal
7medicine as required in par. (b) shall inform the patient of the reason for
8discontinuing the practice of spinal medicine and shall refer the patient to a
9physician. A primary spinal care practitioner may continue to provide maintenance,
10supportive, and wellness care to a patient referred under this paragraph who
11requests these services from the doctor of spinal medicine. A referral under this
12paragraph shall describe the primary spinal care practitioner's findings. If the
13referral is written, the primary spinal care practitioner shall provide the patient
14with a copy and shall maintain a copy in the patient's records. If the referral is oral,
15the primary spinal care practitioner shall communicate the referral directly to the
16physician, shall notify the patient about the referral, and shall make a written record
17of the oral referral. The written record of the oral referral shall include the name of
18the physician to whom the patient was referred and the date of the referral. The
19primary spinal care practitioner shall maintain a copy of the written record of the
20oral referral in the patient's records.
SB762,39,22 21448.972 Applicability. This subchapter does not require a license for any of
22the following:
SB762,39,24 23(1) A person lawfully practicing within the scope of a license, permit,
24registration, or certification granted by this state or the federal government.
SB762,40,2
1(2) A person assisting a primary spinal care practitioner under the direct,
2on-premises supervision of the primary spinal care practitioner.
SB762,40,5 3(3) A student enrolled in a spinal medicine program approved by the affiliated
4credentialing board under s. 448.973 if the student is engaged in activities required
5under that program.
SB762,40,7 6(4) A person performing the gratuitous domestic administration of family
7remedies.
SB762,40,9 8(5) A person furnishing medical assistance or first aid at the scene of an
9emergency.
SB762,40,12 10448.9725 Licensure of primary spinal care practitioners. (1) The
11affiliated credentialing board shall grant a license as a primary spinal care
12practitioner to a person who does all of the following:
SB762,40,1413 (a) Submits an application for the license to the department on a form provided
14by the department.
SB762,40,1515 (b) Pays the fee specified in s. 440.05 (1).
SB762,40,1816 (c) Subject to ss. 111.321, 111.322, and 111.335, submits evidence satisfactory
17to the affiliated credentialing board that the applicant does not have an arrest or
18conviction record.
SB762,40,2019 (d) Submits evidence satisfactory to the affiliated credentialing board
20establishing all of the following:
SB762,40,2321 1. That the applicant has practiced as a licensed chiropractor in good standing
22with the chiropractic examining board for at least two years and remains a licensed
23chiropractor in good standing with the chiropractic examining board under ch. 446.
SB762,41,324 2. That the applicant is a graduate of a master of science degree program in
25spinal medicine approved by the affiliated credentialing board under s. 448.973 and

1possesses a diploma from that program conferring the degree of primary spinal care
2practitioner or equivalent degree as determined by the affiliated credentialing
3board.
SB762,41,6 4(2) The affiliated credentialing board may waive the requirements under sub.
5(1) (d) for an applicant who establishes, to the satisfaction of the affiliated
6credentialing board, all of the following:
SB762,41,77 (a) That the applicant is a graduate of a spinal medicine school or program.
SB762,41,98 (b) That the applicant is licensed as a primary spinal care practitioner or its
9equivalent by another licensing jurisdiction in the United States.
SB762,41,1310 (c) That the jurisdiction in which the applicant is licensed required the
11applicant to be a graduate of a school or program approved by the licensing
12jurisdiction or of a school or program that the licensing jurisdiction evaluated for
13education equivalency.
SB762,41,1714 (d) That the applicant has actively practiced spinal medicine, under the license
15issued by the other licensing jurisdiction in the United States, for at least 3 years
16immediately preceding the date of his or her application for a license under this
17subchapter.
SB762,41,19 18(3) The affiliated credentialing board may promulgate rules providing for
19various classes of temporary licenses to practice spinal medicine.
SB762,41,24 20(4) If the affiliated credentialing board finds, based upon considerations of
21public health and safety, that an applicant has not demonstrated adequate
22education, training, or performance on examinations or in past practice, if any, to
23qualify for full licensure under sub. (1), the board may grant the applicant a limited
24license and shall so notify the applicant.
SB762,42,4
1448.973 Education. The affiliated credentialing board shall approve a master
2of science degree program in spinal medicine that is accredited by the Higher
3Learning Commission or an equivalent accrediting body, as determined by the
4affiliated credentialing board, and that includes all of the following:
SB762,42,6 5(1) At least 60 hours of instruction, including classroom instruction, in the
6following subjects:
SB762,42,77 (a) Causes of spinal pain and differential diagnosis.
SB762,42,88 (b) Case management and coordination of care in spinal pain patients.
SB762,42,99 (c) Spinal injuries, correlated with diagnostic imaging.
SB762,42,1010 (d) Public health issues and epidemiology of spinal pain conditions.
SB762,42,1111 (e) Pharmacology.
SB762,42,1212 (f) Nutrition for musculoskeletal health.
SB762,42,1313 (g) Interpreting research and applying evidence in spinal care practice.
SB762,42,14 14(2) At least 500 clinical rotation hours under the supervision of a physician.
SB762,42,16 15(3) An examination in spinal medicine approved by the affiliated credentialing
16board.
SB762,42,19 17448.9735 Issuance of license; expiration and renewal; duplicate
18license.
(1) The department shall issue a certificate of licensure to each person who
19is licensed under this subchapter.
SB762,42,22 20(2) (a) The renewal date for a license granted under this subchapter, other than
21a temporary license granted under rules promulgated under s. 448.9725 (3), is
22specified under s. 440.08 (2) (a).
SB762,42,2423 (b) Renewal applications shall be submitted to the department on a form
24provided by the department and shall be accompanied by all of the following:
SB762,42,2525 1. The renewal fee determined by the department under s. 440.03 (9) (a).
SB762,43,1
12. Proof of completion of continuing education requirements in s. 448.975.
SB762,43,42 3. Proof of current licensure by the chiropractic examining board under ch. 446,
3unless the affiliated credentialing board waives that requirement under s. 448.9725
4(2).
SB762,43,11 5(3) A licensee whose license is lost, stolen, or destroyed may apply to the
6department for a duplicate license. Duplicate license applications shall be submitted
7to the department on a form provided by the department and shall be accompanied
8by the fee specified under s. 440.05 (7) and an affidavit describing the circumstances
9of the loss, theft, or destruction of the license. Upon receipt of an application under
10this subsection, the department shall issue a duplicate license bearing on its face the
11word "duplicate".
SB762,43,14 12448.974 Malpractice liability insurance. (1) Each licensee shall annually
13submit to the affiliated credentialing board evidence satisfactory to the affiliated
14credentialing board that the licensee satisfies any of the following:
SB762,43,1715 (a) The licensee has in effect malpractice liability insurance coverage in the
16amount of at least $1,000,000 per occurrence and $1,000,000 for all occurrences in
17one year.
SB762,43,1818 (b) The licensee meets all of the following conditions:
SB762,43,1919 1. The licensee's principal place of practice is not in this state.
SB762,43,2120 2. The licensee will not be engaged in the practice of spinal medicine in this
21state for more than 240 hours during the following 12 months.
SB762,43,2422 3. The licensee has in effect malpractice liability insurance coverage that
23covers services provided by the licensee to patients in this state and that is in any
24of the following amounts:
SB762,44,3
1a. At least the minimum amount of malpractice liability insurance coverage
2that is required under the laws of the state in which the affiliated credentialing board
3determines that the licensee's principal place of practice is located.
SB762,44,94 b. If the licensee is not required under the laws of the state in which the
5affiliated credentialing board determines that the licensee's principal place of
6practice is located to have in effect a minimum amount of malpractice liability
7insurance coverage, at least the minimum amount of malpractice liability insurance
8coverage that the affiliated credentialing board determines is necessary to protect
9the public.
SB762,44,12 10(2) A licensee's principal place of practice is not in this state for purposes of sub.
11(1) (b) if the affiliated credentialing board determines that, during the following 12
12months, any of the following applies:
SB762,44,1413 (a) More than 50 percent of the licensee's practice will be performed outside this
14state.
SB762,44,1615 (b) More than 50 percent of the income from the licensee's practice will be
16derived from outside this state.
SB762,44,1817 (c) More than 50 percent of the licensee's patients will be treated by the licensee
18outside this state.
SB762,44,21 19(3) The affiliated credentialing board may suspend, revoke, or refuse to issue
20or renew the license of a person who fails to procure or to submit proof of the
21malpractice liability insurance coverage required under sub. (1).
SB762,45,2 22448.9745 Malpractice. Except as provided in s. 257.03, a person who
23practices spinal medicine without a license under s. 448.9725 may be liable for
24malpractice, and the person's ignorance of a duty ordinarily performed by a primary

1spinal care practitioner shall not limit his or her liability for an injury arising from
2his or her practice of spinal medicine.
SB762,45,6 3448.975 Continuing education. (1) (a) 1. The affiliated credentialing board
4shall promulgate rules establishing requirements and procedures for licensees to
5complete continuing education programs or courses of study in order to qualify for
6renewal of a license granted under this subchapter.
SB762,45,87 2. The rules shall allow for program sponsors, as defined in s. 446.028, to
8conduct continuing education programs.
SB762,45,119 3. The rules shall require each licensee to complete at least 50 hours of
10approved continuing education within each 2-year period immediately preceding
11the renewal date specified under s. 440.08 (2) (a).
SB762,45,1412 (b) 1. A licensee may apply up to 40 of the 50 continuing education hours
13required under par. (a) toward the continuing education requirements for
14chiropractors under ch. 446, as determined by the chiropractic examining board.
SB762,45,1615 2. At least 25 of the 50 continuing education hours required under par. (a) shall
16include evidence-based pharmacology and medical procedures-based training.
SB762,45,20 17(2) The affiliated credentialing board may waive all or part of the requirements
18under sub. (1) if the affiliated credentialing board determines that prolonged illness,
19disability, or other exceptional circumstances prevented a licensee from completing
20the requirements.
SB762,46,2 21448.9755 Fee splitting and billing requirements. (1) Fee splitting. No
22licensee may give or receive, directly or indirectly, to or from any other person any
23fee, commission, rebate, or other form of compensation or anything of value for
24sending, referring, or otherwise inducing a person to communicate with a licensee

1in a professional capacity, or for any professional services not actually rendered
2personally by the licensee or at the licensee's direction.
SB762,46,13 3(2) Separate billing required. Except as provided in sub. (4), a licensee who
4renders any spinal medicine service or assistance, or gives any spinal medicine
5advice or any similar advice or assistance, to any patient, primary spinal care
6practitioner, chiropractor, physician, physician assistant, advanced practice nurse
7prescriber certified under s. 441.16 (2), partnership, or corporation, or to any other
8institution or organization, including a hospital, for which a charge is made to a
9patient, shall, except as authorized by Title 18 or Title 19 of the federal Social
10Security Act, render an individual statement or account of the charge directly to the
11patient, distinct and separate from any statement or account by any other primary
12spinal care practitioner, chiropractor, physician, physician assistant, advanced
13practice nurse prescriber, or other person.
SB762,46,18 14(3) Billing for tests performed by the state laboratory of hygiene. A
15licensee who charges a patient, other person, or 3rd-party payer for services
16performed by the state laboratory of hygiene shall identify the actual amount
17charged by the state laboratory of hygiene and shall restrict charges for those
18services to that amount.
SB762,46,23 19(4) Billing by entity. If 2 or more licensees form an entity for the practice of
20spinal medicine, the entity may not render a single bill for health care services
21provided in the name of the entity unless each individual licensed, registered, or
22certified under this chapter or ch. 446, 449, 450, 455, 457, or 459, who provides
23services is individually identified on the bill as having rendered those services.
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