The Board has not taken a position regarding the validity of decompression therapy. However, a superior court decision regarding the false advertising of this therapy, as well as a number of Board actions from other states should signal caution to anyone incorporating spinal decompression into your practice. The Board may consider these decisions into its review of any complaints received. See the links below for copies of the original decisions.
The Federal Aviation Administration (FAA) has issued a new position allowing for the completion of the "BasicMed Comprehensive Medical Examination" by "state-licensed physicians".
On July 15, 2016, Congress passed legislation to extend the FAA's funding. This legislation, FAA Extension, Safety, Security Act of 2016 (FESSA) includes relief from holding an FAA medical certificate for certain pilots. This relieve is called BasicMed, and allows certain pilots to qualify for fitness under the BasicMed examination by a "state-licensed physician" in lieu of a third class flight physical by an Aviation Medical Examiner (AME).
The FAA has further determined that the regulatory agencies may determine if the physicians regulated by their board are qualified under scope to provide the BasicMed Comprehensive Medical Examination.
On November, 2017; the Minnesota Board of Chiropractic Examiners determined that chiropractors in Minnesota are qualified to provide the BasicMed Comprehensive Medical Examination. This position established and supported in multiple past legal opinions, [see Board website under Current Issues: Authority of Chiropractors to Perform Certain Physical Exams".] Any chiropractors performing the BasicMed Comprehensive Medical Examination must contact the FAA to obtain the forms and requirements prior to engaging in this service. More information is available on the Nationwide Network of DOT Medical Examiners.
Pursuant to a 2007 Legislation, doctors of chiropractic may provide care to a patient at a discounted fee including care provided for free. It appears that this means they can accept different fees from different persons even for the same services. This does not allow doctors of chiropractic to ignore or forgive payments related to insurance deductibles or co-pays. M.S. 62J.83 Please consult with your attorney if you have questions regarding this change.
In conjunction with Minnesota Statute 62J.83 adopted in 2007, Minnesota Statutes section 148.10, was amended in 2008 by adding Subd. 1a. Free or discounted examination or treatment. (a) Free or discounted examinations must provide sufficient information to allow for a diagnosis and initiation of treatment, with the exception of examinations clearly identified as for the purpose of screening. Free or discounted chiropractic treatments shall be comparable to similar non-discounted chiropractic treatments. (b) When using the word "free," or any other term with essentially the same meaning in reference to delivering any service, examination, or treatment, the following statement must be presented to the patient or guardian for signature and kept on file: "I understand that one or more services provided have been or will be free of charge. Any subsequent services provided will be provided at the fees that have been or will be explained to me." This language replaces the former MN Rule 2500.0500.
The inception of healthcare credit cards was designed to assist patients in covering a specific care plan that was either very expensive and/or projected to last over multiple months or even years. Example: orthodonture which would typically consist of a specified number of services, expected results, with an end date about two years out. The services, results, and the end date were very specific, patients typically followed through to the end, and were able to pay for the care over time interest free.
Circa 2010-2014, there was a rush of chiropractors offering healthcare credit cards to fund prepaid care plans. However, chiropractic is a very different service. Patients often discontinue care after only a handful of visits and expect a refund of the unused charges. Complaints against the Chiropractors came flooding in alleging exploitation of the patient. The charge of exploitation was often supported if 1) the patient was not notified in advance of exactly what was covered or that the services are heavily front-loaded so there would be little or no refund, 2) the doctors were prescribing standard care packages that often were in excess of the needs of the patient, 3) the doctor failed to maintain sufficient funds to cover refunds owed to the patients, as well as other abuses.
In order to stem the tide of complaints and protect the public, the Board promulgated rules regulating prepaid services. If a chiropractor accepts more than $1000 in prepayment for services, including charges to a healthcare credit card, they must be in compliance with the prepaid plan rule, 2500.6060.
In addition to the above issues, the susceptibility for abuse associated with the use of healthcare credit cards resulted in several doctors losing their chiropractic license for felony-level criminal activities related to their credit card practices. While using credit cards is not inherently illegal, we caution you to stay within the guidelines.
Example plan. This covers the information provided to patients only. The doctor must review Rule 2500.6060 for additional requirements and restrictions, including an escrow bank account, fund transfers, account reconciliation, and documentation. Sample care Plan (cannot exceed 50 visits)
The Minnesota Department of Health (MDH), Radiation Safety and Control, X-ray Unit enforces Minnesota Rules, Chapter 4732 on ionizing radiation. This rule addresses advances in equipment technology, scope of practice for operators of x-ray equipment, service provider responsibilities, inspection requirements, and other related matters. These rules affect anyone who has ionizing radiation equipment in their offices. You can find a link to the Department of Health chiropractic x-ray section at the top of the web page under the “FAQ's & Resources” tab, “MDH Radiation & Xrays”
It has come to the attention of the Board, that licensees may, at times, deliver less than standard care as a result of financial considerations or undue influence from third party payors. Neither the clinical judgment of the doctor, nor the quality of care should be improperly influenced by persons or organizations other than the doctor delivering the care. The doctor should offer the patient the appropriate level of care and allow the patient to decide what level of care they wish to receive based upon their circumstances, including financial considerations. If a patient declines to receive care that the doctor deems necessary, the doctor may wish to consider whether he/she is able to continue treating the patient at an acceptable standard of care. Doctors who fail to provide, or at least offer, care at a level consistent with the community standard may find themselves in violation of the practice act and subject to disciplinary sanctions, or separately subject to malpractice actions.
The Minnesota Supreme Court has held “that the corporate employment of chiropractors is prohibited except as expressly permitted by statute. See, e.g. , Minn. Stat. ch. 62D (2004) (permitting nonprofit HMOs); Minn. Stat. ch. 319B (providing for the formation of professional corporations).” You may view or download the actual text of the decision.
Authority of Chiropractors to Perform Different Physical Exams: In the mid 1990's, there was considerable controversy over the authority of doctors of chiropractic to perform certain types of examinations (e.g. truck driver physicals, bus driver physicals, and high school sports physicals.) Over the next few years, a multi-sourced Legislative research resulted in 3 opinions, all clarifying the broad authority of chiropractors to conduct these physical exams, with only a few, very narrow limitations (e.g. exams may not be done via invasive procedures, and X-rays were limited to the bones of the skeleton.) The three opinions were, 1) the fully researched opinion by Robert Holley, Assistant Attorney General (2/21/1995); 2) a clarifying/confirming opinion by Lucinda Jesson, Deputy Attorney General, (4/28/1997); 3) and a similar opinion regarding bus drivers physical exams from Alan Klein, Administrative Law Judge (Confirmed by Chief Administrative Law Judge Kenneth Nickolai) in January, 1998. Finally, Governor Jesse Ventura directed "the Departments of Transportation and Public Safety to follow the advice of the Attorney General and accept chiropractor's signatures." These opinions are available for review and download. As of May 21, 2014, registration by the National Registry of Certified Medical Examiners is required of chiropractors in order to be eligible to perform Commercial Motor Vehicle carrier examinations (those operating trucks or buses for commercial purposes). Following a July, 2016 action by the FAA, and November, 2017, MBCE affirmation, chiropractors are also authorized to perform BasicMed Comprehensive Medical Examinations for certain pilots.
Board has adopted rules for the establishment and maintenance of "Pre-Pay" plans for chiropractic care. This rule applies whenever the doctor accepts $1000 or more in advance payment for care. There are many requirements and restrictions to protect the patient. Some of these conditions include a separate dedicated escrow account, conditions for accessing these funds, a limit of 50 visits per plan, a written plan that includes fees and reimbursement policies. This should not be considered an exhaustive list of the requirements. Click on M.R. 2500.6060 for the actual language of the prepay plan rule. If you have questions regarding the rules, you are encouraged to discuss them with your own private counsel.
These may include ultrasound, cryotherapy, nutritional counseling, acupuncture (for those properly registered), exercise, traction, or other similar therapies, as described in more detail at M.R. 2500.0100. Minnesota Statutes state: "therapeutic services must be performed within a practice where the primary focus is the provision of chiropractic services, to prepare the patient for chiropractic services, or to complement the provision of chiropractic services.” M.S. 148.01, subd 6
The Board does not interpret this statute to mean that such therapies must be delivered on the same day as an adjustment, or even by the same chiropractor who delivered the adjustment. In fact, there are occasions when delivering such a therapy on the same day as the adjustment may be dangerous to the patient, and it is up to the doctor to utilize careful clinical judgment when utilizing rehabilitative therapies proximate to the delivery of chiropractic care. Doctors are reminded, however, that they may be required to defend such decisions before the Board when the delivery of such therapies is so remote in time or relation to chiropractic adjustment that a clinical connection becomes difficult to determine.
As of August 1, 2008, it is illegal and grounds for revocation to make any direct contact “in person, by phone, or by other electronic means, with any person who has suffered an injury arising out of the maintenance or use of an automobile, for the purpose of influencing that person to receive treatment or to purchase any good or item from the licensee or anyone associated with the licenses...” This includes contact by the licensee or any third party operating on behalf of the licensee.
In addition, solicitation by U.S. mail must also meet specific criteria and include specific information and disclosures. Doctors of chiropractic are required to be aware of the conditions of this statute, and comply accordingly. M.S. 65B.54, subd 6
