NEW JERSEY REGISTER
VOLUME 35, NUMBER 16
MONDAY, AUGUST 18, 2003
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
BOARD OF CHIROPRACTIC EXAMINERS
Independent Chiropractic Examinations

Proposed New Rule: N.J.A.C. 13:44E-2.14

Authorized By: State Board of Chiropractic Examiners, Kevin Earle, Executive Director.

Authority: N.J.S.A. 45:9-14.5 and 45:9-41.23.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2003-342.

Submit comments by October 17, 2003 to:

Kevin B. Earle

Executive Director

State Board of Chiropractic Examiners

PO Box 45004

Newark, NJ 07101

The agency proposal follows:

Summary

Pursuant to its rulemaking authority at N.J.S.A. 45:9-41.23, the State Board of Chiropractic Examiners (the Board) proposes new rule N.J.A.C. 13:44E-2.14 which sets forth standards for chiropractors who perform independent chiropractic examinations (ICE) of patients in New Jersey. The proposed new rule establishes standards for such independent chiropractic examinations performed by a non-attending chiropractor which are equivalent to an examination performed by a treating chiropractor on his or her own patient.

Subsection (a) defines an independent chiropractic examination as the taking of a history and the performance of a clinical examination of a patient by a non-attending chiropractor in this State which includes the evaluation of the patient's current condition and the preparation of a written report.

Subsection (b) sets forth that in order for a chiropractor to perform an independent chiropractic examination, he or she must hold a valid license from the Board and have at least two years of clinical experience after having become licensed, if the license was issued after the promulgation of this rule. Outcome assessment is a skill which is distinct from the analysis necessary to initially render care. The Board views the required clinical experience as essential to the assessment of the outcome of care required by an ICE.

Subsection (c) details the requirements for how chiropractors must perform an independent chiropractic examination. The licensed chiropractor must complete a patient record pursuant to the patient record requirements of N.J.A.C. 13:44E-2.2. The chiropractor must also document in the patient record and report the nature and extent of the records that have been reviewed in connection with the examination. The licensed chiropractor must also perform and document in the patient record and any resulting report, a history, clinical examination and chiropractic analysis or diagnosis pursuant to the scope of practice requirements set forth in N.J.A.C. 13:44E-1.1(b). Additionally, the non-attending chiropractor must document the clinical rationale for an opinion expressed and must not make any recommendations directly to the patient for alterations in care, unless the examination discloses abnormalities or conditions not known to the patient, which require the non-attending chiropractor to advise the patient to consult another health care professional for treatment. Finally, the non-attending chiropractor may not solicit the patient for care and must be the person who in fact prepares and signs the independent chiropractic examination report.

Because the Board is providing a 60-day comment period, the proposal is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30- 3.3(a)5.

Social Impact

The Board believes that the proposed new rule will have a beneficial impact on chiropractic patients. The proposed new rule clearly defines and imposes standards for the performance of an independent chiropractic examination which will protect the health, safety and welfare of chiropractic patients by ensuring that the non-attending chiropractor performs an examination that is equivalent to an examination performed by an attending chiropractor. These new requirements will ensure that the examination will be performed properly by a licensed chiropractor with at least two years of clinical experience, that the examination results will be properly recorded and the examiner is truly objective and held accountable for the opinion on the patient's current condition.

Economic Impact

The Board believes that the proposed new rule will not have an economic impact on current licensees performing independent chiropractic examinations. The rule provides a professional standard that clarifies the licensee's existing duty regarding patient records. The preparation of a report is already required for an independent chiropractic examination and, therefore, the requirement that a licensee document the clinical rationale in the report will have no economic impact.

The proposed new rule may have an economic impact on future licensees who will not be permitted to perform an independent chiropractic examination without two years of clinical experience. However, the Board notes that these potential licensees will have adequate notice of the proposed new rule which will mitigate any economic impact.

Federal Standards Statement

A Federal standards analysis is not required because there are no Federal standards or requirements applicable to the proposed new rule.

Jobs Impact

The Board does not anticipate that the proposed new rule will increase or decrease jobs in the State.

Agriculture Industry Impact

The proposed new rule will have no impact on the agriculture industry in the State.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq. (the Act), requires the Board to give a description of the types and an estimate of the number of small businesses to which the proposed new rule will apply. If, for the purposes of the Act, the approximately 3,200 chiropractors licensed by the Board are deemed "small businesses," then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping, and other compliance requirements of the proposed new rule including the kinds of professional services likely to be needed to comply with the requirements. The Act further requires the Board to estimate the initial and annual compliance costs, outline the manner in which it has designed the rules to minimize any adverse economic impact upon small businesses, and to set forth whether the rules establish differing compliance requirements for small businesses.

The proposed new rule contains no reporting requirements. A chiropractor performing an independent chiropractic examination must abide by several recordkeeping requirements found in subsection (c) regarding what must be documented in the patient record which are discussed in the Summary above.

The rule also contains several compliance requirements. Subsection (b) requires that the chiropractor hold a valid license in New Jersey and have two years of post-licensure clinical experience. Subsection (c) also states that the chiropractor not make any recommendations directly to the patient for alterations in care except with respect to the advice required by N.J.A.C. 13:44E-2.2(f)3, may not solicit the patient for care and must be the author and signor of the independent chiropractic examination report.

The Board believes that no other professional services are necessary to comply with the rule. In order to ensure that all independent chiropractic examinations are provided uniformly throughout the State, all licensees will be expected to comply with the proposed new rule and no differing compliance requirements have been imposed based on the size of the business.

Smart Growth Impact

The Board does not anticipate that the proposed new rule will have any impact on the achievement of smart growth or on implementation of the State Development and Redevelopment Plan, otherwise known as the State Plan.

Full text of the proposal follows:

<< NJ ADC 13:44E-2.14 >>

13:44E-2.14 <<-(Reserved)->> <<+Independent chiropractic examinations+>>

<<+(a) For the purposes of this section, "independent chiropractic examination" means the taking of a history and the performance of a clinical examination of a patient conducted in this State by a chiropractor, other than the attending chiropractor, at the request of a third party, for the purpose of evaluating the patient's current condition and the preparation of a written report.+>>

<<+(b) A chiropractor performing an independent chiropractic examination in the State of New Jersey shall:+>>

<<+1. Hold a valid license to practice chiropractic in the State of New Jersey pursuant to N.J.S.A. 45:9-41.8 or 45:9-41.10; and+>>

<<+2. Have at least two years of clinical experience post-licensure if licensed after the effective date of this section.+>>

<<+(c) A licensed chiropractor performing an independent chiropractic examination shall:+>>

<<+1. Complete a patient record pursuant to N.J.A.C. 13:44E-2.2;+>>

<<+2. Document in the patient record and report the nature and extent of records reviewed including other information presented such as results of diagnostic imaging and/or diagnostic testing;+>>

<<+3. Perform and document in the patient record and in any resulting report a history, clinical examination and a chiropractic analysis or diagnosis, pursuant to N.J.A.C. 13:44E-1.1(b), which includes the specific tests, examinations or observations performed, and the results and evaluation of these specific tests, examinations or observations together with a review of the patient's response to prior care.+>>

<<+4. Document the clinical rationale for an opinion expressed with respect to the patient's present condition in the patient record and report;+>>

<<+5. Not make any recommendations directly to the patient for alterations in care by the attending chiropractor except with respect to the advice required by N.J.A.C. 13:44E-2.2(f)3. If such advice of an abnormality or condition is given to the patient and referral to another health care professional is recommended, such findings shall be documented in the patient record and report;+>>

<<+6. Not solicit the patient for care; and+>>

<<+7. Author and sign the independent chiropractic examination report.+>>



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