SB762: Bill Text

SB762,36,12 448.56 (1) Written referral. Except as provided in this subsection and s. 448.52, a person may practice physical therapy only upon the written referral of a physician, physician assistant, chiropractor, dentist, podiatrist, primary spinal care practitioner, or advanced practice nurse prescriber certified under s. 441.16 (2). Written referral is not required if a physical therapist provides services in schools to children with disabilities, as defined in s. 115.76 (5), pursuant to rules promulgated by the department of public instruction; provides services as part of a home health care agency; provides services to a patient in a nursing home pursuant to the patient's plan of care; provides services related to athletic activities, conditioning, or injury prevention; or provides services to an individual for a previously diagnosed medical condition after informing the individual's physician, physician assistant, chiropractor, dentist, podiatrist, primary spinal care practitioner, or advanced practice nurse prescriber certified under s. 441.16 (2) who made the diagnosis. The examining board may promulgate rules establishing additional services that are excepted from the written referral requirements of this subsection.

SB762,86 Section 86. 448.56 (1m) (b) of the statutes is amended to read:

SB762,36,19 448.56 (1m) (b) The examining board shall promulgate rules establishing the requirements that a physical therapist must satisfy if a physician, physician assistant, chiropractor, dentist, podiatrist, primary spinal care practitioner, or advanced practice nurse prescriber makes a written referral under sub. (1). The purpose of the rules shall be to ensure continuity of care between the physical therapist and the health care practitioner.

SB762,87 Section 87. 448.956 (1m) of the statutes is amended to read:

SB762,37,2 448.956 (1m) Subject to sub. (1) (a), a licensee may provide athletic training to an individual without a referral, except that a licensee may not provide athletic training as described under s. 448.95 (5) (d) or (e) in an outpatient rehabilitation setting unless the licensee has obtained a written referral for the individual from a practitioner licensed or certified under subch. II, III, IV, V, or, VII, or VIII of this chapter; under ch. 446; or under s. 441.16 (2).

SB762,88 Section 88. 448.956 (3) (c) of the statutes is amended to read:

SB762,37,8 448.956 (3) (c) Treat or rehabilitate an employee with an injury or illness that has resulted from an employment activity as directed, supervised, and inspected by a physician, as defined in s. 448.01 (5), or by a person licensed under subch. VIII or under s. 446.02, who has the power to direct, decide, and oversee the implementation of the treatment or rehabilitation.

SB762,89 Section 89. 448.956 (4) of the statutes is amended to read:

SB762,37,15 448.956 (4) If a licensee or the consulting physician of the licensee determines that a patient's medical condition is beyond the scope of practice of the licensee, the licensee shall, in accordance with the protocol established under sub. (1) (a), refer the patient to a health care practitioner who is licensed under ch. 446 or 447 or subch. II, III or, IV, or VIII of ch. 448 and who can provide appropriate treatment to the patient.

SB762,90 Section 90. Subchapter VIII of chapter 448 [precedes 448.971] of the statutes is created to read:

SB762,37,18 chapter 448

SB762,37,19 subchapter viii

SB762,37,21 spinal medicine affiliated credentialing board

SB762,37,22 448.971 Definitions. In this subchapter:

SB762,37,24 (1) "Affiliated credentialing board" means the spinal medicine affiliated credentialing board.

SB762,37,25 (2) "Licensee" means a person who is licensed under s. 448.9725.

SB762,38,1 (3) "Practice of chiropractic" has the meaning given in s. 446.01 (2).

SB762,38,4 (4) "Primary spinal care practitioner" means an individual possessing the degree of doctor of spinal medicine or equivalent degree as determined by the affiliated credentialing board.

SB762,38,9 (5) "Spinal medicine" means the integration and application of the practice of chiropractic and the practice of medicine and surgery that is limited to conditions of the spine and of the musculoskeletal, neuromuscular, and nervous systems and includes prescribing and administering drugs. The practice of spinal medicine does not include all of the following:

SB762,38,10 (a) Surgery.

SB762,38,12 (b) Administering a general anesthetic, except under the direction of a person licensed to practice medicine and surgery under subch. II.

SB762,38,18 448.9715 License required. (1) Except as provided in ss. 257.03 and 448.972, no person may practice spinal medicine, designate himself or herself as a primary spinal care practitioner, use or assume the title "primary spinal care practitioner," or append to the person's name the letters "P.S.C.P.," or any other title, letters, or designation that represents or may tend to represent the person as a primary spinal care practitioner unless the person is a licensee.

SB762,38,22 (2) (a) A primary spinal care practitioner shall evaluate each patient before commencing treatment of the patient to determine whether the patient has a condition that is treatable by the practice of spinal medicine. The evaluation shall be based upon an examination that is appropriate to the patient.

SB762,39,5 (b) A primary spinal care practitioner shall discontinue the practice of spinal medicine on a patient if, at any time after the evaluation under par. (a) or during or following treatment of the patient, the primary spinal care practitioner determines or reasonably believes that the patient's condition is not treatable by the practice of spinal medicine, or will not respond to further practice of spinal medicine by the primary spinal care practitioner, except that a primary spinal care practitioner may provide maintenance, supportive, and wellness care to the patient if the patient is being treated by another health care professional.

SB762,39,20 (c) A primary spinal care practitioner who discontinues the practice of spinal medicine as required in par. (b) shall inform the patient of the reason for discontinuing the practice of spinal medicine and shall refer the patient to a physician. A primary spinal care practitioner may continue to provide maintenance, supportive, and wellness care to a patient referred under this paragraph who requests these services from the doctor of spinal medicine. A referral under this paragraph shall describe the primary spinal care practitioner's findings. If the referral is written, the primary spinal care practitioner shall provide the patient with a copy and shall maintain a copy in the patient's records. If the referral is oral, the primary spinal care practitioner shall communicate the referral directly to the physician, shall notify the patient about the referral, and shall make a written record of the oral referral. The written record of the oral referral shall include the name of the physician to whom the patient was referred and the date of the referral. The primary spinal care practitioner shall maintain a copy of the written record of the oral referral in the patient's records.

SB762,39,22 448.972 Applicability. This subchapter does not require a license for any of the following:

SB762,39,24 (1) A person lawfully practicing within the scope of a license, permit, registration, or certification granted by this state or the federal government.

SB762,40,2 (2) A person assisting a primary spinal care practitioner under the direct, on-premises supervision of the primary spinal care practitioner.

SB762,40,5 (3) A student enrolled in a spinal medicine program approved by the affiliated credentialing board under s. 448.973 if the student is engaged in activities required under that program.

SB762,40,7 (4) A person performing the gratuitous domestic administration of family remedies.

SB762,40,9 (5) A person furnishing medical assistance or first aid at the scene of an emergency.

SB762,40,12 448.9725 Licensure of primary spinal care practitioners. (1) The affiliated credentialing board shall grant a license as a primary spinal care practitioner to a person who does all of the following:

SB762,40,14 (a) Submits an application for the license to the department on a form provided by the department.

SB762,40,15 (b) Pays the fee specified in s. 440.05 (1).

SB762,40,18 (c) Subject to ss. 111.321, 111.322, and 111.335, submits evidence satisfactory to the affiliated credentialing board that the applicant does not have an arrest or conviction record.

SB762,40,20 (d) Submits evidence satisfactory to the affiliated credentialing board establishing all of the following:

SB762,40,23 1. That the applicant has practiced as a licensed chiropractor in good standing with the chiropractic examining board for at least two years and remains a licensed chiropractor in good standing with the chiropractic examining board under ch. 446.

SB762,41,3 2. That the applicant is a graduate of a master of science degree program in spinal medicine approved by the affiliated credentialing board under s. 448.973 and possesses a diploma from that program conferring the degree of primary spinal care practitioner or equivalent degree as determined by the affiliated credentialing board.

SB762,41,6 (2) The affiliated credentialing board may waive the requirements under sub. (1) (d) for an applicant who establishes, to the satisfaction of the affiliated credentialing board, all of the following:

SB762,41,7 (a) That the applicant is a graduate of a spinal medicine school or program.

SB762,41,9 (b) That the applicant is licensed as a primary spinal care practitioner or its equivalent by another licensing jurisdiction in the United States.

SB762,41,13 (c) That the jurisdiction in which the applicant is licensed required the applicant to be a graduate of a school or program approved by the licensing jurisdiction or of a school or program that the licensing jurisdiction evaluated for education equivalency.

SB762,41,17 (d) That the applicant has actively practiced spinal medicine, under the license issued by the other licensing jurisdiction in the United States, for at least 3 years immediately preceding the date of his or her application for a license under this subchapter.

SB762,41,19 (3) The affiliated credentialing board may promulgate rules providing for various classes of temporary licenses to practice spinal medicine.

SB762,41,24 (4) If the affiliated credentialing board finds, based upon considerations of public health and safety, that an applicant has not demonstrated adequate education, training, or performance on examinations or in past practice, if any, to qualify for full licensure under sub. (1), the board may grant the applicant a limited license and shall so notify the applicant.

SB762,42,4 448.973 Education. The affiliated credentialing board shall approve a master of science degree program in spinal medicine that is accredited by the Higher Learning Commission or an equivalent accrediting body, as determined by the affiliated credentialing board, and that includes all of the following:

SB762,42,6 (1) At least 60 hours of instruction, including classroom instruction, in the following subjects:

SB762,42,7 (a) Causes of spinal pain and differential diagnosis.

SB762,42,8 (b) Case management and coordination of care in spinal pain patients.

SB762,42,9 (c) Spinal injuries, correlated with diagnostic imaging.

SB762,42,10 (d) Public health issues and epidemiology of spinal pain conditions.

SB762,42,11 (e) Pharmacology.

SB762,42,12 (f) Nutrition for musculoskeletal health.

SB762,42,13 (g) Interpreting research and applying evidence in spinal care practice.

SB762,42,14 (2) At least 500 clinical rotation hours under the supervision of a physician.

SB762,42,16 (3) An examination in spinal medicine approved by the affiliated credentialing board.

SB762,42,19 448.9735 Issuance of license; expiration and renewal; duplicate license. (1) The department shall issue a certificate of licensure to each person who is licensed under this subchapter.

SB762,42,22 (2) (a) The renewal date for a license granted under this subchapter, other than a temporary license granted under rules promulgated under s. 448.9725 (3), is specified under s. 440.08 (2) (a).

SB762,42,24 (b) Renewal applications shall be submitted to the department on a form provided by the department and shall be accompanied by all of the following:

SB762,42,25 1. The renewal fee determined by the department under s. 440.03 (9) (a).

SB762,43,1 2. Proof of completion of continuing education requirements in s. 448.975.

SB762,43,4 3. Proof of current licensure by the chiropractic examining board under ch. 446, unless the affiliated credentialing board waives that requirement under s. 448.9725 (2).

SB762,43,11 (3) A licensee whose license is lost, stolen, or destroyed may apply to the department for a duplicate license. Duplicate license applications shall be submitted to the department on a form provided by the department and shall be accompanied by the fee specified under s. 440.05 (7) and an affidavit describing the circumstances of the loss, theft, or destruction of the license. Upon receipt of an application under this subsection, the department shall issue a duplicate license bearing on its face the word "duplicate".

SB762,43,14 448.974 Malpractice liability insurance. (1) Each licensee shall annually submit to the affiliated credentialing board evidence satisfactory to the affiliated credentialing board that the licensee satisfies any of the following:

SB762,43,17 (a) The licensee has in effect malpractice liability insurance coverage in the amount of at least $1,000,000 per occurrence and $1,000,000 for all occurrences in one year.

SB762,43,18 (b) The licensee meets all of the following conditions:

SB762,43,19 1. The licensee's principal place of practice is not in this state.

SB762,43,21 2. The licensee will not be engaged in the practice of spinal medicine in this state for more than 240 hours during the following 12 months.

SB762,43,24 3. The licensee has in effect malpractice liability insurance coverage that covers services provided by the licensee to patients in this state and that is in any of the following amounts:

SB762,44,3 a. At least the minimum amount of malpractice liability insurance coverage that is required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located.

SB762,44,9 b. If the licensee is not required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located to have in effect a minimum amount of malpractice liability insurance coverage, at least the minimum amount of malpractice liability insurance coverage that the affiliated credentialing board determines is necessary to protect the public.

SB762,44,12 (2) A licensee's principal place of practice is not in this state for purposes of sub. (1) (b) if the affiliated credentialing board determines that, during the following 12 months, any of the following applies:

SB762,44,14 (a) More than 50 percent of the licensee's practice will be performed outside this state.

SB762,44,16 (b) More than 50 percent of the income from the licensee's practice will be derived from outside this state.

SB762,44,18 (c) More than 50 percent of the licensee's patients will be treated by the licensee outside this state.

SB762,44,21 (3) The affiliated credentialing board may suspend, revoke, or refuse to issue or renew the license of a person who fails to procure or to submit proof of the malpractice liability insurance coverage required under sub. (1).

SB762,45,2 448.9745 Malpractice. Except as provided in s. 257.03, a person who practices spinal medicine without a license under s. 448.9725 may be liable for malpractice, and the person's ignorance of a duty ordinarily performed by a primary spinal care practitioner shall not limit his or her liability for an injury arising from his or her practice of spinal medicine.

SB762,45,6 448.975 Continuing education. (1) (a) 1. The affiliated credentialing board shall promulgate rules establishing requirements and procedures for licensees to complete continuing education programs or courses of study in order to qualify for renewal of a license granted under this subchapter.

SB762,45,8 2. The rules shall allow for program sponsors, as defined in s. 446.028, to conduct continuing education programs.

SB762,45,11 3. The rules shall require each licensee to complete at least 50 hours of approved continuing education within each 2-year period immediately preceding the renewal date specified under s. 440.08 (2) (a).

SB762,45,14 (b) 1. A licensee may apply up to 40 of the 50 continuing education hours required under par. (a) toward the continuing education requirements for chiropractors under ch. 446, as determined by the chiropractic examining board.

SB762,45,16 2. At least 25 of the 50 continuing education hours required under par. (a) shall include evidence-based pharmacology and medical procedures-based training.

SB762,45,20 (2) The affiliated credentialing board may waive all or part of the requirements under sub. (1) if the affiliated credentialing board determines that prolonged illness, disability, or other exceptional circumstances prevented a licensee from completing the requirements.

SB762,46,2 448.9755 Fee splitting and billing requirements. (1) Fee splitting. No licensee may give or receive, directly or indirectly, to or from any other person any fee, commission, rebate, or other form of compensation or anything of value for sending, referring, or otherwise inducing a person to communicate with a licensee in a professional capacity, or for any professional services not actually rendered personally by the licensee or at the licensee's direction.

SB762,46,13 (2) Separate billing required. Except as provided in sub. (4), a licensee who renders any spinal medicine service or assistance, or gives any spinal medicine advice or any similar advice or assistance, to any patient, primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber certified under s. 441.16 (2), partnership, or corporation, or to any other institution or organization, including a hospital, for which a charge is made to a patient, shall, except as authorized by Title 18 or Title 19 of the federal Social Security Act, render an individual statement or account of the charge directly to the patient, distinct and separate from any statement or account by any other primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber, or other person.

SB762,46,18 (3) Billing for tests performed by the state laboratory of hygiene. A licensee who charges a patient, other person, or 3rd-party payer for services performed by the state laboratory of hygiene shall identify the actual amount charged by the state laboratory of hygiene and shall restrict charges for those services to that amount.

SB762,46,23 (4) Billing by entity. If 2 or more licensees form an entity for the practice of spinal medicine, the entity may not render a single bill for health care services provided in the name of the entity unless each individual licensed, registered, or certified under this chapter or ch. 446, 449, 450, 455, 457, or 459, who provides services is individually identified on the bill as having rendered those services.

SB762,47,3 448.976 Disciplinary proceedings and actions. (1) In this section, "unprofessional conduct" means an act or attempted act of commission or omission, as defined by the affiliated credentialing board by rule, or an act by a primary spinal care practitioner otherwise in violation of this subchapter or in violation of ch. 446, 450, or 961.

SB762,47,10 (2) Investigation; hearing; action. (a) 1. The affiliated credentialing board shall investigate allegations of unprofessional conduct and negligence in the practice of spinal medicine. The affiliated credentialing board shall refer an allegation of a violation of ch. 446 to the chiropractic examining board for investigation, unless the alleged conduct also involves a violation of this subchapter or ch. 450 or 961, in which case the affiliated credentialing board and the chiropractic examining board shall consult concerning the investigation.