1.1                          A bill for an act 
  1.2             relating to health occupations; modifying licensing 
  1.3             requirements for the board of chiropractic examiners; 
  1.4             modifying grounds for disciplinary action and 
  1.5             penalties; allowing specified individuals to practice 
  1.6             chiropractic in this state without being licensed in 
  1.7             this state; amending Minnesota Statutes 2000, sections 
  1.8             148.06, subdivision 1; 148.10, subdivisions 1 and 3; 
  1.9             148.104; 148.105, subdivision 2; and 148.106, 
  1.10            subdivision 10; repealing Minnesota Statutes 2000, 
  1.11            section 148.106, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 
  1.12            and 9. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  Minnesota Statutes 2000, section 148.06, 
  1.15  subdivision 1, is amended to read: 
  1.16     Subdivision 1.  [LICENSE REQUIRED; QUALIFICATIONS.] No 
  1.17  person shall practice chiropractic in this state without first 
  1.18  being licensed by the state board of chiropractic examiners.  
  1.19  The applicant shall have earned at least one-half of all 
  1.20  academic credits required for awarding of a baccalaureate degree 
  1.21  from the University of Minnesota, or other university, college, 
  1.22  or community college of equal standing, in subject matter 
  1.23  determined by the board, and taken a four-year resident course 
  1.24  of at least eight months each in a school or college of 
  1.25  chiropractic or in a chiropractic program that is fully 
  1.26  accredited by the council on chiropractic education or fully 
  1.27  accredited by an agency approved by the United States Office of 
  1.28  Education or their successors as of January 1, 1988.  The board 
  1.29  may issue licenses to practice chiropractic without compliance 
  2.1   with prechiropractic or academic requirements listed above if in 
  2.2   the opinion of the board the applicant has the qualifications 
  2.3   equivalent to those required of other applicants, the applicant 
  2.4   satisfactorily passes written and practical examinations as 
  2.5   required by the board of chiropractic examiners, and the 
  2.6   applicant is a graduate of a college of chiropractic with a 
  2.7   reciprocal recognition agreement with the council on 
  2.8   chiropractic education as of January 1, 1988.  The board may 
  2.9   recommend a two-year prechiropractic course of instruction to 
  2.10  any university, college, or community college which in its 
  2.11  judgment would satisfy the academic prerequisite for licensure 
  2.12  as established by this section. 
  2.13     An examination for a license shall be in writing and shall 
  2.14  include testing in: 
  2.15     (a) The basic sciences including but not limited to 
  2.16  anatomy, physiology, bacteriology, pathology, hygiene, and 
  2.17  chemistry as related to the human body or mind; 
  2.18     (b) The clinical sciences including but not limited to the 
  2.19  science and art of chiropractic, chiropractic physiotherapy, 
  2.20  diagnosis, roentgenology, and nutrition; and 
  2.21     (c) Professional ethics and any other subjects that the 
  2.22  board may deem advisable. 
  2.23     The board may consider a valid certificate of examination 
  2.24  from the National Board of Chiropractic Examiners as evidence of 
  2.25  compliance with the written examination requirements of this 
  2.26  subdivision.  The applicant shall be required to give practical 
  2.27  demonstration in vertebral palpation, neurology, adjusting and 
  2.28  any other subject that the board may deem advisable.  A license, 
  2.29  countersigned by the members of the board and authenticated by 
  2.30  the seal thereof, shall be granted to each applicant who 
  2.31  correctly answers 75 percent of the questions propounded in each 
  2.32  of the subjects required by this subdivision and meets the 
  2.33  standards of practical demonstration established by the board.  
  2.34  Each application shall be accompanied by a fee set by the 
  2.35  board.  The fee shall not be returned but the applicant may, 
  2.36  within one year, apply for examination without the payment of an 
  3.1   additional fee.  The board may grant a license to an applicant 
  3.2   who holds a valid license to practice chiropractic issued by the 
  3.3   appropriate licensing board of another state, provided the 
  3.4   applicant meets the other requirements of this section and 
  3.5   satisfactorily passes a practical examination approved by the 
  3.6   board.  The burden of proof is on the applicant to demonstrate 
  3.7   these qualifications or satisfaction of these requirements. 
  3.8      Sec. 2.  Minnesota Statutes 2000, section 148.10, 
  3.9   subdivision 1, is amended to read: 
  3.10     Subdivision 1.  [GROUNDS.] (a) The state board of 
  3.11  chiropractic examiners may refuse to grant, or may revoke, 
  3.12  suspend, condition, limit, restrict or qualify a license to 
  3.13  practice chiropractic, or may cause the name of a person 
  3.14  licensed to be removed from the records in the office of the 
  3.15  court administrator of the district court for: 
  3.16     (1) Advertising that is false or misleading; that violates 
  3.17  a rule of the board; or that claims the cure of any condition or 
  3.18  disease. 
  3.19     (2) The employment of fraud or deception in applying for a 
  3.20  license or in passing the examination provided for in section 
  3.21  148.06 or conduct which subverts or attempts to subvert the 
  3.22  licensing examination process.  
  3.23     (3) The practice of chiropractic under a false or assumed 
  3.24  name or the impersonation of another practitioner of like or 
  3.25  different name.  
  3.26     (4) The conviction of a crime involving moral turpitude.  
  3.27     (5) The conviction, during the previous five years, of a 
  3.28  felony reasonably related to the practice of chiropractic.  
  3.29     (6) Habitual intemperance in the use of alcohol or drugs.  
  3.30     (7) Failure to pay the annual renewal license fee 
  3.31  Practicing under a license which has not been renewed.  
  3.32     (8) Advanced physical or mental disability.  
  3.33     (9) The revocation or suspension of a license to practice 
  3.34  chiropractic; or other disciplinary action against the licensee; 
  3.35  or the denial of an application for a license by the proper 
  3.36  licensing authority of another state, territory or country; or 
  4.1   failure to report to the board that charges regarding the 
  4.2   person's license have been brought in another state or 
  4.3   jurisdiction.  
  4.4      (10) The violation of, or failure to comply with, the 
  4.5   provisions of sections 148.01 to 148.105, the rules of the state 
  4.6   board of chiropractic examiners, or a lawful order of the board. 
  4.7      (11) Unprofessional conduct.  
  4.8      (12) Being unable to practice chiropractic with reasonable 
  4.9   skill and safety to patients by reason of illness, professional 
  4.10  incompetence, senility, drunkenness, use of drugs, narcotics, 
  4.11  chemicals or any other type of material, or as a result of any 
  4.12  mental or physical condition, including deterioration through 
  4.13  the aging process or loss of motor skills.  If the board has 
  4.14  probable cause to believe that a person comes within this 
  4.15  clause, it shall direct the person to submit to a mental or 
  4.16  physical examination.  For the purpose of this clause, every 
  4.17  person licensed under this chapter shall be deemed to have given 
  4.18  consent to submit to a mental or physical examination when 
  4.19  directed in writing by the board and further to have waived all 
  4.20  objections to the admissibility of the examining physicians' 
  4.21  testimony or examination reports on the ground that the same 
  4.22  constitute a privileged communication.  Failure of a person to 
  4.23  submit to such examination when directed shall constitute an 
  4.24  admission of the allegations, unless the failure was due to 
  4.25  circumstances beyond the person's control, in which case a 
  4.26  default and final order may be entered without the taking of 
  4.27  testimony or presentation of evidence.  A person affected under 
  4.28  this clause shall at reasonable intervals be afforded an 
  4.29  opportunity to demonstrate that the person can resume the 
  4.30  competent practice of chiropractic with reasonable skill and 
  4.31  safety to patients.  
  4.32     In addition to ordering a physical or mental examination, 
  4.33  the board may, notwithstanding section 13.42, 144.651, or any 
  4.34  other law limiting access to health data, obtain health data and 
  4.35  health records relating to a licensee or applicant without the 
  4.36  licensee's or applicant's consent if the board has probable 
  5.1   cause to believe that a doctor of chiropractic comes under this 
  5.2   clause.  The health data may be requested from a provider, as 
  5.3   defined in section 144.335, subdivision 1, paragraph (b), an 
  5.4   insurance company, or a government agency, including the 
  5.5   department of human services.  A provider, insurance company, or 
  5.6   government agency shall comply with any written request of the 
  5.7   board under this subdivision and is not liable in any action for 
  5.8   damages for releasing the data requested by the board if the 
  5.9   data are released pursuant to a written request under this 
  5.10  subdivision, unless the information is false and the provider or 
  5.11  entity giving the information knew, or had reason to believe, 
  5.12  the information was false.  Information obtained under this 
  5.13  subdivision is classified as private under sections 13.01 to 
  5.14  13.87.  
  5.15     In any proceeding under this clause, neither the record of 
  5.16  proceedings nor the orders entered by the board shall be used 
  5.17  against a person in any other proceeding.  
  5.18     (13) Aiding or abetting an unlicensed person in the 
  5.19  practice of chiropractic, except that it is not a violation of 
  5.20  this clause for a doctor of chiropractic to employ, supervise, 
  5.21  or delegate functions to a qualified person who may or may not 
  5.22  be required to obtain a license or registration to provide 
  5.23  health services if that person is practicing within the scope of 
  5.24  the license or registration or delegated authority.  
  5.25     (14) Improper management of health records, including 
  5.26  failure to maintain adequate health records as described in 
  5.27  clause (18), to comply with a patient's request made under 
  5.28  section 144.335 or to furnish a health record or report required 
  5.29  by law.  
  5.30     (15) Failure to make reports required by section 148.102, 
  5.31  subdivisions 2 and 5, or to cooperate with an investigation of 
  5.32  the board as required by section 148.104, or the submission of a 
  5.33  knowingly false report against another doctor of chiropractic 
  5.34  under section 148.10, subdivision 3.  
  5.35     (16) Splitting fees, or promising to pay a portion of a fee 
  5.36  or a commission, or accepting a rebate.  
  6.1      (17) Revealing a privileged communication from or relating 
  6.2   to a patient, except when otherwise required or permitted by law.
  6.3      (18) Failing to keep written chiropractic records 
  6.4   justifying the course of treatment of the patient, including, 
  6.5   but not limited to, patient histories, examination results, test 
  6.6   results, and X-rays.  Unless otherwise required by law, written 
  6.7   records need not be retained for more than seven years and 
  6.8   X-rays need not be retained for more than four years.  
  6.9      (19) Exercising influence on the patient or client in such 
  6.10  a manner as to exploit the patient or client for financial gain 
  6.11  of the licensee or of a third party which shall include, but not 
  6.12  be limited to, the promotion or sale of services, goods, or 
  6.13  appliances.  
  6.14     (20) Gross or repeated malpractice or the failure to 
  6.15  practice chiropractic at a level of care, skill, and treatment 
  6.16  which is recognized by a reasonably prudent chiropractor as 
  6.17  being acceptable under similar conditions and circumstances.  
  6.18     (21) Delegating professional responsibilities to a person 
  6.19  when the licensee delegating such responsibilities knows or has 
  6.20  reason to know that the person is not qualified by training, 
  6.21  experience, or licensure to perform them.  
  6.22     (b) For the purposes of paragraph (a), clause (2), conduct 
  6.23  that subverts or attempts to subvert the licensing examination 
  6.24  process includes, but is not limited to:  (1) conduct that 
  6.25  violates the security of the examination materials, such as 
  6.26  removing examination materials from the examination room or 
  6.27  having unauthorized possession of any portion of a future, 
  6.28  current, or previously administered licensing examination; (2) 
  6.29  conduct that violates the standard of test administration, such 
  6.30  as communicating with another examinee during administration of 
  6.31  the examination, copying another examinee's answers, permitting 
  6.32  another examinee to copy one's answers, or possessing 
  6.33  unauthorized materials; or (3) impersonating an examinee or 
  6.34  permitting an impersonator to take the examination on one's own 
  6.35  behalf.  
  6.36     (c) For the purposes of paragraph (a), clauses (4) and (5), 
  7.1   conviction as used in these subdivisions includes a conviction 
  7.2   of an offense that if committed in this state would be deemed a 
  7.3   felony without regard to its designation elsewhere, or a 
  7.4   criminal proceeding where a finding or verdict of guilt is made 
  7.5   or returned but the adjudication of guilt is either withheld or 
  7.6   not entered. 
  7.7      (d) For the purposes of paragraph (a), clauses (4), (5), 
  7.8   and (6), a copy of the judgment or proceeding under seal of the 
  7.9   administrator of the court or of the administrative agency which 
  7.10  entered the same shall be admissible into evidence without 
  7.11  further authentication and shall constitute prima facie evidence 
  7.12  of its contents. 
  7.13     (e) For the purposes of paragraph (a), clause (11), 
  7.14  unprofessional conduct means any unethical, deceptive or 
  7.15  deleterious conduct or practice harmful to the public, any 
  7.16  departure from or the failure to conform to the minimal 
  7.17  standards of acceptable chiropractic practice, or a willful or 
  7.18  careless disregard for the health, welfare or safety of 
  7.19  patients, in any of which cases proof of actual injury need not 
  7.20  be established.  Unprofessional conduct shall include, but not 
  7.21  be limited to, the following acts of a chiropractor: 
  7.22     (1) gross ignorance of, or incompetence in, the practice of 
  7.23  chiropractic; 
  7.24     (2) engaging in conduct with a patient that is sexual or 
  7.25  may reasonably be interpreted by the patient as sexual, or in 
  7.26  any verbal behavior that is seductive or sexually demeaning to a 
  7.27  patient; 
  7.28     (3) performing unnecessary services; 
  7.29     (4) charging a patient an unconscionable fee or charging 
  7.30  for services not rendered; 
  7.31     (5) directly or indirectly engaging in threatening, 
  7.32  dishonest, or misleading fee collection techniques; 
  7.33     (6) perpetrating fraud upon patients, third-party payors, 
  7.34  or others, relating to the practice of chiropractic, including 
  7.35  violations of the Medicare or Medicaid laws or state medical 
  7.36  assistance laws; 
  8.1      (7) advertising that the licensee will accept for services 
  8.2   rendered assigned payments from any third-party payer as payment 
  8.3   in full, if the effect is to give the impression of eliminating 
  8.4   the need of payment by the patient of any required deductible or 
  8.5   copayment applicable in the patient's health benefit plan; or 
  8.6   advertising a fee or charge for a service or treatment different 
  8.7   from the fee or charge the licensee submits to a third-party 
  8.8   payer for that service or treatment.  As used in this clause, 
  8.9   "advertise" means solicitation by the licensee by means of 
  8.10  handbills, posters, circulars, motion pictures, radio, 
  8.11  newspapers, television, or in any other manner.  In addition to 
  8.12  the board's power to punish for violations of this clause, 
  8.13  violation of this clause is also a misdemeanor; 
  8.14     (8) accepting for services rendered assigned payments from 
  8.15  any third-party payer as payment in full, if the effect is to 
  8.16  eliminate the need of payment by the patient of any required 
  8.17  deductible or copayment applicable in the patient's health 
  8.18  benefit plan, except as hereinafter provided; or collecting a 
  8.19  fee or charge for a service or treatment different from the fee 
  8.20  or charge the licensee submits to a third-party payer for that 
  8.21  service or treatment, except as hereinafter provided.  This 
  8.22  clause is intended to prohibit offerings to the public of the 
  8.23  above listed practices and those actual practices as well, 
  8.24  except that in instances where the intent is not to collect an 
  8.25  excessive remuneration from the third-party payer but rather to 
  8.26  provide services at a reduced rate to a patient unable to afford 
  8.27  the deductible or copayment, the services may be performed for a 
  8.28  lesser charge or fee.  The burden of proof for establishing that 
  8.29  this is the case shall be on the licensee; and 
  8.30     (9) any other act that the board by rule may define.  
  8.31     Sec. 3.  Minnesota Statutes 2000, section 148.10, 
  8.32  subdivision 3, is amended to read: 
  8.33     Subd. 3.  [REPRIMAND; PENALTIES; PROBATION.] In addition to 
  8.34  the other powers granted to the board under this chapter, the 
  8.35  board may, in connection with any person whom the board, after a 
  8.36  hearing, adjudges unqualified or whom the board, after a 
  9.1   hearing, finds to have performed one or more of the acts 
  9.2   described in subdivision 1: 
  9.3      (1) publicly reprimand or censure the person; 
  9.4      (2) place the person on probation for the period and upon 
  9.5   the terms and conditions that the board may prescribe; and 
  9.6      (3) require payment of all costs of proceedings resulting 
  9.7   in the disciplinary action; and 
  9.8      (4) impose a civil penalty not exceeding $10,000 for each 
  9.9   separate violation, the amount of the civil penalty to be fixed 
  9.10  so as to deprive the doctor of chiropractic of any economic 
  9.11  advantage gained by reason of the violation charged or to 
  9.12  reimburse the board for the cost of the investigation and 
  9.13  proceeding.  For purposes of this section, the cost of the 
  9.14  investigation and proceeding may include, but is not limited to, 
  9.15  fees paid for services provided by the office of administrative 
  9.16  hearings, legal and investigative services provided by the 
  9.17  office of the attorney general, court reporters, witnesses, 
  9.18  reproduction of records, board members' per diem compensation, 
  9.19  board staff time, and travel costs and expenses incurred by 
  9.20  board staff and board members. 
  9.21     Sec. 4.  Minnesota Statutes 2000, section 148.104, is 
  9.22  amended to read: 
  9.23     148.104 [COOPERATION DURING INVESTIGATIONS.] 
  9.24     A doctor of chiropractic who is the subject of an 
  9.25  investigation by or on behalf of the board shall cooperate fully 
  9.26  with the investigation.  Cooperation includes appearing at 
  9.27  conferences, meetings, or hearings scheduled by the board and 
  9.28  for which the board provided notice in accordance with chapter 
  9.29  14; responding fully and promptly to any question raised by or 
  9.30  on behalf of the board relating to the subject of the 
  9.31  investigation; and providing copies of patient health records, 
  9.32  as reasonably requested by the board, to assist the board in its 
  9.33  investigation.  If the board does not have written consent from 
  9.34  a patient allowing the board access to the patient's health 
  9.35  records, a doctor of chiropractic shall delete any data in the 
  9.36  record which identifies the patient before providing the records 
 10.1   to the board. 
 10.2      Sec. 5.  Minnesota Statutes 2000, section 148.105, 
 10.3   subdivision 2, is amended to read: 
 10.4      Subd. 2.  [EXCEPTIONS.] The following persons shall not be 
 10.5   in violation of subdivision 1: 
 10.6      (1) a student practicing under the direct supervision of a 
 10.7   preceptor while the student is enrolled in and regularly 
 10.8   attending a recognized chiropractic college or chiropractic 
 10.9   program; and 
 10.10     (2) a student who is in continuing training and performing 
 10.11  the duties of an intern or resident or engaged in postgraduate 
 10.12  work considered by the board to be the equivalent of an 
 10.13  internship or residency in any institution approved for training 
 10.14  by the board.; 
 10.15     (3) a doctor of chiropractic licensed in another state or 
 10.16  jurisdiction who is in actual consultation in Minnesota; 
 10.17     (4) a doctor of chiropractic licensed in another state or 
 10.18  jurisdiction who is in this state for the sole purpose of 
 10.19  providing chiropractic services at a competitive athletic 
 10.20  event.  The doctor of chiropractic may practice chiropractic 
 10.21  only on participants in the athletic event; 
 10.22     (5) a doctor of chiropractic licensed in another state or 
 10.23  jurisdiction whose duties are entirely of a research, public 
 10.24  health, or educational character and while directly engaged in 
 10.25  such duties, and who is employed in a scientific, sanitary, or 
 10.26  teaching capacity by:  (i) an accredited institution; (ii) a 
 10.27  public or private school, college, or other bona fide 
 10.28  educational institution; (iii) a nonprofit organization which 
 10.29  has tax-exempt status in accordance with the Internal Revenue 
 10.30  Code, section 501(c)(3), and is organized and operated primarily 
 10.31  for the purpose of conducting scientific research; or (iv) the 
 10.32  state department of health; 
 10.33     (6) a doctor of chiropractic licensed in another state or 
 10.34  jurisdiction who treats the doctor of chiropractic's home state 
 10.35  patients or other participating patients while the doctor of 
 10.36  chiropractic and those patients are participating together in 
 11.1   outdoor recreation in this state as defined by section 86A.03, 
 11.2   subdivision 3; and 
 11.3      (7) a person licensed in another state or jurisdiction who 
 11.4   is a commissioned officer of, a member of, or employed by the 
 11.5   armed forces of the United States, the United States Public 
 11.6   Health Service, the Veterans Administration, any federal 
 11.7   institution, or any federal agency while engaged in the 
 11.8   performance of official duties within this state. 
 11.9      Sec. 6.  Minnesota Statutes 2000, section 148.106, 
 11.10  subdivision 10, is amended to read: 
 11.11     Subd. 10.  [CONFIDENTIALITY OF PEER REVIEW RECORDS.] All 
 11.12  data and information acquired by the board or the peer review 
 11.13  committee before August 1, 2001, in the exercise of its duties 
 11.14  and functions in conducting peer reviews before August 1, 2001, 
 11.15  shall be subject to the same disclosure and confidentiality 
 11.16  protections as provided for data and information of other review 
 11.17  organizations under section 145.64.  This subdivision does not 
 11.18  limit or restrict the board or the peer review committee from 
 11.19  fully performing their prescribed peer review duties and 
 11.20  functions, nor does it apply to disciplinary and enforcement 
 11.21  proceedings under sections 14.57 to 14.62, 148.10, 148.105, 
 11.22  214.10, and 214.11.  The peer review committee shall file with 
 11.23  the board a complaint against a health care provider if it 
 11.24  determines that reasonable cause exists to believe the health 
 11.25  care provider has violated any portion of this chapter or rules 
 11.26  adopted under it, for which a licensed chiropractor may be 
 11.27  disciplined.  The peer review committee shall transmit all 
 11.28  complaint information it possesses to the board.  The data, 
 11.29  information, and records are classified as private data on 
 11.30  individuals for purposes of chapter 13.  The patient records 
 11.31  obtained by the board pursuant to this section must be used 
 11.32  solely for the purposes of the board relating to peer review or 
 11.33  the disciplinary process. 
 11.34     Sec. 7.  [REPEALER.] 
 11.35     Minnesota Statutes 2000, section 148.106, subdivisions 1, 
 11.36  2, 3, 4, 5, 6, 7, 8, and 9, are repealed.