Ibelievetheborshouldconsidermakingtwo(2)Additionalregulatorychangesto233cmr These

Date:

RE:

6-4-15

Suggested AdditionalRegulationsto233CMR

IbelievetheBoRshouldconsidermakingtwo(2)additionalregulatorychangesto233CMR These suggestionsincludeaddingtheconstructof"temporary registration"andimplementingimprovementsto thecurrentcontinuingeducationprocess.

TemporaryChiropracticLicensure:

Theregulatoryconceptoftemporarylicensureispresentacrossmanystatejurisdictionsaswellasa numberofMassachusettslicensingboards. Temporarylicensureenhancespractitionermobilityand reducesillegalunlicensedactivity.AlmosteveryprofessionalathleticteamintheUnitedStateshasa chiropracticpractitioner onstaffthattravelswiththeteat11andprovideschiropracticservicesinwhatever jurisdictiontheteamislocated.Ineveryinstance,theteampractitioner doesnotpossessachiropractic licenseforeachjurisdiction. CurrentlyintheUnitedStates,thereareclosetotwentystatesthatprovide someformoftemporarylicensure. Temporarylicensureisalsousedforcontinuingeducation demonstration presentations,participatinginresearchandclinicalstudies,limitedpatientcare, chiropracticstudentinternshipsandsmallpopulationpatientcareservices. IurgetheBoRtoenacta temporary registrationprovision.

ChiropracticContinuingEducationImprovements:

ItseemstomethattheprocesstheBoRiscurrentlyfollowingindeterminingallowablecontinuing· education(CE)credithourshasbecomeproblematic. The currentprocesslimitschoicesinCEcourses andprogramsaMassachusettschiropracticlicenseecanapplytohisorherlicenserenewalrequirement. Thecurrentprocessisunnecessarilyrestrictiveandimpedesthequalityofchiropracticeducation generally. Thecurrentprocessclearlyaddsanadditionalcostthatgreatlyexceedsanybenefitthe licensedpractitionerorpublicwouldderivefromtheexistingregulation,astohowitiscurrentlybeing applied. Infact,Ibelievethereisadefinitiveadversebenefit. Exec.Order562appearstomandatethat theBoRfixthisregulationtomakeitlessonerous. ·

Asasecondissue,IrequestthattheBoRcodifytheFederationofLicensingBoards'Providersof ApprovedContinuingEducation-Chiropractic(PACE)programwithin233CMRThePACEprogra.nlis tochiropracticprofessionastheACCMEprogram(AccreditationCouncilforContinuingMedical Education)istothemedicalprofession. Currently,aroundthirtystatechiropracticlicensingboardshave languageincludingPACEasauadditionaloptionalmechanismtohelpintheCEapprovalprocess. As youknow,PACEsupplementsalicensingboard's responsibilitytoapproveCEbutdoes notreplaceit. I ampleasedtoreportthatMassachusettshasbeenaPACEapprovalstatesincethePACEprogram's inceptionsome9-yearsago. MyrequestistocodifyPACEfromexistingBoRpolicyintoformal regulation.

Ihaveincludedspecificlanguage (below)fortheBoRtoconsider.

2.01:Definitions

Forpurposes of233CMR2.00through5.00,thefollowingtermsshallhavethefollowing meanings:

Expired meansthedateofvalidityhaspassed.Alapsedorinactivelicenseisalsoexpired.

FCLB means the Federation of Chiropractic Licensing Boards

Date:

RE:

6-4-15

CurrentProposedRegulationsto233CMR

...·

Thecurrentlyproposedregulationsareurgentlyneededtoclarifylong-recognizedandidentified omissionsorunnecessaryburdenstotheexistingchiropracticregulations,233CMR

Second,thecurrentlyproposedregulationshavealreadyundergonetheprocessofhavinga business/competitivenessimpactstatementcompletedand reviewedbytheConsumerAffairsand BusinessRegulationscabinetsecretary,asrequiredperExec.Order562,Section6(March31,2015).

Thecurrentlyproposedregulationsencompassthreedistincttopics. Ihaveincludedafewsalient pointsinsupportofthecurrentproposal:

PeerReviewSection:

•Thedirectassociationbetweentheperformanceofachiropracticpeerreview(chiropractic treatmentplandevelopment) and thepracticeofchiropracticisclearlyestablishedinMGLbut unfortunately,233CMRisdeficientinitsomissionofthisneededpublicsafetysafeguard

•Therehasbeenaproliferation of3'dpartyandinsuranceprogramsthatnowcoverthepayment ofchiropracticserviceswhichdidnotexistwhen233CMRwasdeveloped.

•Theestablishmentofaminimalperiodthatachiropractormustberegisteredforeligibilityto serveaspeerreviewchiropractic-specialistisclearlyestablishedinindustrystandardsand existingregulation. Tobeone'sprofessionalpeerrequiresadegreeofpracticalexperiencethat exceedsmerelyhavingalicensetopractice. Theprincipleofrequiredminimalexperienceis similarlycontainedinourstate's ChiropracticFacility,ChiropractorofRecordrequirement.

•Thelackofclaritytoproperlyconduct,;..chiropracticpeerreviewbyrequiringthereviewer provideanunbiased,professionaljudgment-ratherthanapersonalunsubstantiatedopinion,is acriticalconsumerinterestandpublic-safetytenant.

•Theproposedpeerreviewregulationswillhelplowercoststoconsumers,businesses,insurers andtheCommonwealthbypromotingqualitychiropracticreviewsthatarelesslikelytobe contested,appealedandoverturned. ·

ScopeofPracticeSection:

•Employingaholisticperspectivetodeliveringpatientcareisalong-standingtenantofthe chiropracticprofession. OtherthanthoseservicesthatarestatutorilyprohibitedbyMGL, chiropractorsuseavarietyofclinicalapproachestoimproveapatient'sneurologicalandbody function-beyondjustmanualmanipulationsofbiomechanicalsubluxations. Unfortunately,

233C'MRisdeficientbynotinformingthepublicofthisbasicunderstanding.

•Thepracticeofnutritionalanddietaryaugmentationtoreduce"functional"subluxations,rather thanbiomechanical,isaprimarypracticeapproachformanychiropractors. Recognitionand identificationofthiscommonpracticestandardshouldbeincludedwithin233CMR

ChiropracticFacilitySection:

•Therequirementofanindividualizedprescriptive"complianceplan"foreachlicensed chiropracticfacilitywasavaliantidea-butunfortunately,hasbeenshowntobean

unnecessaryandaddedexpensetochiropracticbusinesses. A bettersystemwouldbetorequire theseorganizationalprogramsforchiropracticfacilitieswhichhavebeensanctionedbythe BoR. CMR233shouldbeamendedto recommend,but notrequire,complianceplans.