The Board’s continuing education (CE) audits have caused some confusion regarding the CE cycle. The registration for acupuncture registrants runs from September 16 to September 15 of the next year, and must be renewed by September 15 of each calendar year. Acupuncture registrants are required to obtain 2 CE credits in acupuncture related subjects each calendar year. Upon LICENSE renewal (by December 31 of each calendar year) you must state that you have completed your CE credits for that calendar year. If you have an acupuncture registration, this includes 2 acupuncture credits. By way of example, some people have taken acupuncture credits in August, renewed their acupuncture registration in September, and then took more acupuncture credits in November, thinking that this last group applies to the NEXT acupuncture registration cycle. THIS IS INCORRECT. All continuing education credits apply only to the calendar year in which they were obtained. You are not required to state on your acupuncture renewal application that you have taken these credits. This statement occurs ONLY on the DC license renewal application, due by 12/31 of each year. The acupuncture renewal application merely asks if you understand that you must take these credits in each calendar year. For a list of required courses and due dates, please go to our continuing education pages.
Doctors of Chiropractic who are separately registered as an Animal Chiropractor in Minnesota may provide chiropractic services to animals. Animal Chiropractic registration requires completion of an approved course, registration with the Board, referral of the animal by a veterinarian, a separate treatment room for animals, and six (6) animal-related CEU's in addition to the 20 CEU's required annually for the DC license. Please visit Statues 148.032-142.035 & Rules 2500.7000 to 2500.7090 or the Animal Chiropractic page for more information.
During educational and disciplinary conferences the Board sometimes receives information indicating that Continuing Education (CE) providers in healthcare documentation may be teaching to a level that does not meet accepted professional standards. This has led to complaints and public action against our licensees. Licensees are required to meet the recordkeeping standards established by Minnesota Statute 148.107. Instructors that teach to a lesser standard may be denied approval for future CE programs.
The 2010 Legislature established language for applicants and currently licensed doctors of chiropractic who have been convicted of felony level criminal sexual conduct. If the behavior occurred with a patient, this chiropractor’s license must be revoked and may never be reinstated. If such conduct occurred with a non-patient, they may have an opportunity to reinstate their license provided certain conditions are met. The language of the bill may be found here.
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.
While permissible for the general public, some marketing activities are illegal for use by health care professionals. Any form of fee splitting for patient referrals is illegal under the chiropractic, state and Federal laws. This includes commissions, kickbacks, referral fees, etc., and any marketing programs that take a percentage of the sale, e.g. Groupon. Engaging in fee splitting may place the licensee at significant risk of being in violation of the laws related to fee-splitting. Licensees are strongly cautioned to avoid any marketing situation in which any third party receives compensation that is in any manner tied directly to the referrals made.
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.
Whether a chiropractor can utilize Mobile MRI services is not at issue. The legality lies in whether ordering services involves any financial considerations that may influence your use of the service. Things to consider before treading into dangerous territory:
Is there any kind of financial incentive including commissions or “rent” payments for use of your space?
Are there minimum requirements that may encourage to you order more MRI’s than you would ordinarily?
Is/are there clear clinical indicators for medical necessity of the procedure?
Is there demonstrable benefit of using the mobile MRI over using another community location? Example: if you practice in a remote location, there may not be a local facility.
These are the more common issues seen by the Board. You are strongly advised to seek legal counsel in any situation in which you may be considering such an option. SPECIAL NOTE: It has come to the attention of the Board that some doctors are being shown Board letters in which cases have been dismissed. DO NOT BE MISLED INTO BELIEVING IN ANY WAY, that this represents a policy or stance of the Board. Any such letter is very specific to an individual recipient, while other similar cases did result in Board Action. Each case will be considered on its own merits and evidence.
Pursuant to a Minnesota Supreme Court decision, (September 15, 2005), the corporate ownership of chiropractic practices and employment of chiropractors MUST occur through a licensed chiropractor. This is known as the "Corporate Practice of Medicine Doctrine." There are certain exceptions, such as HMO's and hospitals.) In this decision, the Supreme Court cited a previous Iowa Supreme Court decision which discussed the notion of "learned professions." Thus only licensees may own a professional firm or employ licensees. An un-licensed spouse may not be part owner of a professional practice. You may view or download the actual text of the decision.
The Board does not discuss or request any confidential matters over the phone. Due to the Minnesota Data Practices Act, all confidential communications with the Board are handled through written correspondence. Be wary of phone calls demanding confidential information such as Social Security numbers or threatening legal or criminal action against you. Scammers are able to mimic known phone numbers in your caller ID making it appear that the Board is calling you. You are encouraged to hang up and contact the Board directly if you receive a suspicious call.
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.
The Legislature has the authority to enact statutes, general laws governing state-wide issues. The regulatory agencies are often granted rulemaking authority to further define and clarify they laws that they are mandated to enforce. E.g. the Legislature enacts a Statute requiring that licensed professionals obtain annual continuing education as a condition of licensure in order to maintain their skills and knowledge. The regulatory agency (Board) then engages in rulemaking to establish the minimum requirements, CE content, due dates, eligibility of CE providers, and penalties for non-compliance, etc. The rulemaking process is very rigorous, involving official postings, notices, and review/approval by an Administrative Law Judge (ALJ). In some cases a public hearing is required. You may track any rules being promulgated from the Board web page under the “Laws & Rules” tab, and you my request to add your name to the Official Rulemaking Mailing list to receive via email the Notices when they are issued.
You can see if any current rule making is underway, along with its purpose and progress under the "Public Information" --> "Rules Promulgation" menu item above. Contact Ron Arnold if you wish to be added to our Official Rule Making Mailing List and receive notices on the progress and direction of these rules.
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
