1.1 	A bill for an act
1.2 	relating to health care; implementing advertising restrictions on chiropractors; 
1.3 	amending Minnesota Statutes 2004, section 148.10, subdivision 1.
1.4 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.5 	Section 1. Minnesota Statutes 2004, section 148.10, subdivision 1, is amended to read:
1.6 		Subdivision 1.Grounds. (a) The state Board of Chiropractic Examiners may refuse 
1.7 	to grant, or may revoke, suspend, condition, limit, restrict or qualify a license to practice 
1.8 	chiropractic, or may cause the name of a person licensed to be removed from the records 
1.9 	in the office of the court administrator of the district court for:
1.10 	(1) Advertising that is false or misleading; that violates a rule of the board; or that 
1.11 	claims the cure of any condition or disease.
1.12 	(2) The employment of fraud or deception in applying for a license or in passing 
1.13 	the examination provided for in section  148.06 or conduct which subverts or attempts to 
1.14 	subvert the licensing examination process. 
1.15 	(3) The practice of chiropractic under a false or assumed name or the impersonation 
1.16 	of another practitioner of like or different name.
1.17 	(4) The conviction of a crime involving moral turpitude.
1.18 	(5) The conviction, during the previous five years, of a felony reasonably related to 
1.19 	the practice of chiropractic.
1.20 	(6) Habitual intemperance in the use of alcohol or drugs.
1.21 	(7) Practicing under a license which has not been renewed.
1.22 	(8) Advanced physical or mental disability.
1.23 	(9) The revocation or suspension of a license to practice chiropractic; or other 
1.24 	disciplinary action against the licensee; or the denial of an application for a license by 
2.1 	the proper licensing authority of another state, territory or country; or failure to report to 
2.2 	the board that charges regarding the person's license have been brought in another state 
2.3 	or jurisdiction.
2.4 	(10) The violation of, or failure to comply with, the provisions of sections  148.01
2.5 	to  148.105, the rules of the state Board of Chiropractic Examiners, or a lawful order of 
2.6 	the board. 
2.7 	(11) Unprofessional conduct.
2.8 	(12) Being unable to practice chiropractic with reasonable skill and safety to patients 
2.9 	by reason of illness, professional incompetence, senility, drunkenness, use of drugs, 
2.10 	narcotics, chemicals or any other type of material, or as a result of any mental or physical 
2.11 	condition, including deterioration through the aging process or loss of motor skills. If the 
2.12 	board has probable cause to believe that a person comes within this clause, it shall direct 
2.13 	the person to submit to a mental or physical examination. For the purpose of this clause, 
2.14 	every person licensed under this chapter shall be deemed to have given consent to submit 
2.15 	to a mental or physical examination when directed in writing by the board and further to 
2.16 	have waived all objections to the admissibility of the examining physicians' testimony or 
2.17 	examination reports on the ground that the same constitute a privileged communication. 
2.18 	Failure of a person to submit to such examination when directed shall constitute an 
2.19 	admission of the allegations, unless the failure was due to circumstances beyond the 
2.20 	person's control, in which case a default and final order may be entered without the taking 
2.21 	of testimony or presentation of evidence. A person affected under this clause shall at 
2.22 	reasonable intervals be afforded an opportunity to demonstrate that the person can resume 
2.23 	the competent practice of chiropractic with reasonable skill and safety to patients.
2.24 	In addition to ordering a physical or mental examination, the board may, 
2.25 	notwithstanding section  13.384,  144.651, or any other law limiting access to health 
2.26 	data, obtain health data and health records relating to a licensee or applicant without the 
2.27 	licensee's or applicant's consent if the board has probable cause to believe that a doctor of 
2.28 	chiropractic comes under this clause. The health data may be requested from a provider, 
2.29 	as defined in section  144.335, subdivision 1, paragraph (b), an insurance company, or a 
2.30 	government agency, including the Department of Human Services. A provider, insurance 
2.31 	company, or government agency shall comply with any written request of the board under 
2.32 	this subdivision and is not liable in any action for damages for releasing the data requested 
2.33 	by the board if the data are released pursuant to a written request under this subdivision, 
2.34 	unless the information is false and the provider or entity giving the information knew, 
2.35 	or had reason to believe, the information was false. Information obtained under this 
2.36 	subdivision is classified as private under sections  13.01 to  13.87. 
3.1 	In any proceeding under this clause, neither the record of proceedings nor the orders 
3.2 	entered by the board shall be used against a person in any other proceeding.
3.3 	(13) Aiding or abetting an unlicensed person in the practice of chiropractic, except 
3.4 	that it is not a violation of this clause for a doctor of chiropractic to employ, supervise, 
3.5 	or delegate functions to a qualified person who may or may not be required to obtain a 
3.6 	license or registration to provide health services if that person is practicing within the 
3.7 	scope of the license or registration or delegated authority.
3.8 	(14) Improper management of health records, including failure to maintain adequate 
3.9 	health records as described in clause (18), to comply with a patient's request made under 
3.10 	section  144.335 or to furnish a health record or report required by law. 
3.11 	(15) Failure to make reports required by section  148.102, subdivisions 2 and 5, 
3.12 	or to cooperate with an investigation of the board as required by section  148.104, or 
3.13 	the submission of a knowingly false report against another doctor of chiropractic under 
3.14 	section  148.10, subdivision 3. 
3.15 	(16) Splitting fees, or promising to pay a portion of a fee or a commission, or 
3.16 	accepting a rebate.
3.17 	(17) Revealing a privileged communication from or relating to a patient, except 
3.18 	when otherwise required or permitted by law.
3.19 	(18) Failing to keep written chiropractic records justifying the course of treatment of 
3.20 	the patient, including, but not limited to, patient histories, examination results, test results, 
3.21 	and x-rays. Unless otherwise required by law, written records need not be retained for 
3.22 	more than seven years and x-rays need not be retained for more than four years.
3.23 	(19) Exercising influence on the patient or client in such a manner as to exploit the 
3.24 	patient or client for financial gain of the licensee or of a third party which shall include, 
3.25 	but not be limited to, the promotion or sale of services, goods, or appliances.
3.26 	(20) Gross or repeated malpractice or the failure to practice chiropractic at a level 
3.27 	of care, skill, and treatment which is recognized by a reasonably prudent chiropractor as 
3.28 	being acceptable under similar conditions and circumstances.
3.29 	(21) Delegating professional responsibilities to a person when the licensee delegating 
3.30 	such responsibilities knows or has reason to know that the person is not qualified by 
3.31 	training, experience, or licensure to perform them.
3.32 	(22) Initiating direct contact, in person, over the telephone or by other electronic 
3.33 	means, with any person who has suffered an injury arising out of the maintenance or 
3.34 	use of an automobile, for the purpose of influencing that person to receive treatment or 
3.35 	to purchase any good or item from the licensee or anyone associated with the licensee. 
3.36 	This section prohibits direct contact, whether initiated by the licensee individually or on 
4.1 	behalf of the licensee, by any employee, independent contractor, agent, or third party. 
4.2 	This section does not apply when an injured person voluntarily initiates contact with a 
4.3 	licensee. This section does not prohibit licensees from mailing advertising literature 
4.4 	directly, so long as: the word "ADVERTISEMENT" appears clearly and conspicuously at 
4.5 	the beginning of the written materials; the name of the individual licensee appears clearly 
4.6 	and conspicuously within the written materials; the licensee is clearly identified as a 
4.7 	chiropractor within the written materials; and the licensee does not initiate, individually or 
4.8 	through an employee, independent contractor, agent, or third party, direct contact with the 
4.9 	person after the written materials are sent. This section does not apply to:
4.10 	(i) advertising in public media such as telephone directories, professional directories, 
4.11 	ads in newspapers and other periodicals, radio or television ads, Web sites, billboards, or 
4.12 	similar media that does not involve direct contact with specific prospective patients;
4.13 	(ii) general marketing practices such as giving lectures, participating in special 
4.14 	events, trade shows, or meetings of organizations or making presentations relative to 
4.15 	the benefits of chiropractic treatment; or
4.16 	(iii) contact with friends or relatives, or statements made in a social setting.
4.17 	(b) For the purposes of paragraph (a), clause (2), conduct that subverts or attempts 
4.18 	to subvert the licensing examination process includes, but is not limited to: (1) conduct 
4.19 	that violates the security of the examination materials, such as removing examination 
4.20 	materials from the examination room or having unauthorized possession of any portion 
4.21 	of a future, current, or previously administered licensing examination; (2) conduct that 
4.22 	violates the standard of test administration, such as communicating with another examinee 
4.23 	during administration of the examination, copying another examinee's answers, permitting 
4.24 	another examinee to copy one's answers, or possessing unauthorized materials; or (3) 
4.25 	impersonating an examinee or permitting an impersonator to take the examination on 
4.26 	one's own behalf.
4.27 	(c) For the purposes of paragraph (a), clauses (4) and (5), conviction as used in these 
4.28 	subdivisions includes a conviction of an offense that if committed in this state would be 
4.29 	deemed a felony without regard to its designation elsewhere, or a criminal proceeding 
4.30 	where a finding or verdict of guilt is made or returned but the adjudication of guilt is either 
4.31 	withheld or not entered.
4.32 	(d) For the purposes of paragraph (a), clauses (4), (5), and (6), a copy of the judgment 
4.33 	or proceeding under seal of the administrator of the court or of the administrative agency 
4.34 	which entered the same shall be admissible into evidence without further authentication 
4.35 	and shall constitute prima facie evidence of its contents.
5.1 	(e) For the purposes of paragraph (a), clause (11), unprofessional conduct means any 
5.2 	unethical, deceptive or deleterious conduct or practice harmful to the public, any departure 
5.3 	from or the failure to conform to the minimal standards of acceptable chiropractic practice, 
5.4 	or a willful or careless disregard for the health, welfare or safety of patients, in any of 
5.5 	which cases proof of actual injury need not be established. Unprofessional conduct shall 
5.6 	include, but not be limited to, the following acts of a chiropractor:
5.7 	(1) gross ignorance of, or incompetence in, the practice of chiropractic;
5.8 	(2) engaging in conduct with a patient that is sexual or may reasonably be interpreted 
5.9 	by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning 
5.10 	to a patient;
5.11 	(3) performing unnecessary services;
5.12 	(4) charging a patient an unconscionable fee or charging for services not rendered;
5.13 	(5) directly or indirectly engaging in threatening, dishonest, or misleading fee 
5.14 	collection techniques;
5.15 	(6) perpetrating fraud upon patients, third-party payors, or others, relating to the 
5.16 	practice of chiropractic, including violations of the Medicare or Medicaid laws or state 
5.17 	medical assistance laws;
5.18 	(7) advertising that the licensee will accept for services rendered assigned payments 
5.19 	from any third-party payer as payment in full, if the effect is to give the impression of 
5.20 	eliminating the need of payment by the patient of any required deductible or co-payment 
5.21 	applicable in the patient's health benefit plan; or advertising a fee or charge for a service 
5.22 	or treatment different from the fee or charge the licensee submits to a third-party payer 
5.23 	for that service or treatment. As used in this clause, "advertise" means solicitation by the 
5.24 	licensee by means of handbills, posters, circulars, motion pictures, radio, newspapers, 
5.25 	television, or in any other manner. In addition to the board's power to punish for violations 
5.26 	of this clause, violation of this clause is also a misdemeanor;
5.27 	(8) accepting for services rendered assigned payments from any third-party payer 
5.28 	as payment in full, if the effect is to eliminate the need of payment by the patient of any 
5.29 	required deductible or co-payment applicable in the patient's health benefit plan, except as 
5.30 	hereinafter provided; or collecting a fee or charge for a service or treatment different from 
5.31 	the fee or charge the licensee submits to a third-party payer for that service or treatment, 
5.32 	except as hereinafter provided. This clause is intended to prohibit offerings to the public 
5.33 	of the above listed practices and those actual practices as well, except that in instances 
5.34 	where the intent is not to collect an excessive remuneration from the third-party payer but 
5.35 	rather to provide services at a reduced rate to a patient unable to afford the deductible or 
6.1 	co-payment, the services may be performed for a lesser charge or fee. The burden of proof 
6.2 	for establishing that this is the case shall be on the licensee; and
6.3 	(9) any other act that the board by rule may define.