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OPRA - Open Public Records Act

RULE PROPOSAL
VOLUME 43, ISSUE 22
ISSUE DATE:NOVEMBER 21, 2011
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY STATE BOARD OF CHIROPRACTIC EXAMINERS


Proposed Amendment: N.J.A.C. 13:44E-1.1
Proposed New Rules: N.J.A.C. 13:44E-1A.5 and 1A.6

Purpose and Scope; Licensure

Authorized By: New Jersey State Board of Chiropractic Examiners, Jonathan Eisenmenger, Executive Director.

Authority: N.J.S.A. 45:9-41.23.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2011-184.
 
Submit written comments by January 20, 2012 to:
   Jonathan Eisenmenger, Executive Director
   New Jersey Board of Chiropractic Examiners
   124 Halsey Street
   Newark, New Jersey 07101
 
The agency proposal follows:
 
Summary

The New Jersey Board of Chiropractic Examiners (Board) is proposing amendments to N.J.A.C. 13:44E and new rules to implement P.L. 2009, c. 322 (the Act), which expanded the scope of practice of chiropractors and mandated continuing education and malpractice insurance requirements.

The Board is proposing to amend N.J.A.C. 13:44E-1, which contains the rules on purpose and scope of practice. The word "definitions" is deleted from the heading of Subchapter 1; terms are defined in the subchapters where they are used. The proposed amendments to N.J.A.C. 13:44E-1.1 redefine and expand the scope of chiropractic practice consistent with the Act. The scope of the practice of chiropractic has been expanded to include the examination, diagnosis, analysis, assessment, adjustment, manipulations, and treatment of the articulations and soft tissue of the body. The proposed amendments to recodified N.J.A.C. 13:44E-1.1(c) describe the circumstances under which a chiropractor must refer a patient to another health care professional.

Proposed new N.J.A.C. 13:44E-1.1(d) covers the tests and treatments chiropractors are permitted to perform. It also permits licensees to provide nutritional counselling and dispense and sell nutritional supplements if the licensee has completed human nutrition coursework from an accredited college or university approved by the Board based upon criteria set forth in N.J.S.A. 45:9-41.6. The proposed amendments also permit the licensees to use the title "doctor," so long as it is qualified by the words "doctor of chiropractic," "chiropractor," or "chiropractic physician"; or its abbreviation "D.C."

The proposed amendments to N.J.A.C. 13:44E-1A4(d), (e), (f), and (h) would require a licensee whose license has expired to submit evidence that he or she has completed the continuing education requirements for the period that his or her license was expired, up to a total of 30 credits. An applicant would be required to submit to the Board a detailed list of all courses that the applicant has completed to become current. If the Board determines that there is a subject area in which the applicant is deficient, the Board may require the applicant to complete additional continuing education in that subject matter before reinstating the license.

Proposed new N.J.A.C. 13:44E-1A.5 governs continuing education requirements of licensees. Pursuant to this proposed new rule, in order to qualify for renewal of his or her license, licensees would be required to complete 30 course-hours of continuing education during the preceding renewal period. These 30 credits must include a minimum of two credits covering professional ethics or recordkeeping and a minimum of two credits of nutritional education. For the biennial renewal period beginning on September 1, 2013, licensees would be permitted to count towards the continuing education requirement any courses taken between January 18, 2010 and August 31, 2013.

Under proposed new N.J.A.C. 13:44E-1A.5(d) through (f), licensees would be able to take courses taught by accredited chiropractic schools, colleges, institutions and universities, or in a subject matter tested on for licensure, that have been approved by Providers of Approved Continuing Education (PACE) or the Board. The Board would retain the right to reject any PACE-approved program that involves practice building, practice management, and/or marketing, or any program that does not have significant intellectual or practical content dealing with matters directly related to the practice of chiropractic or with professional responsibilities or ethical obligations of licensees. The Board will not grant credit for basic courses required for graduation from a chiropractic college or university or for initial licensure; the Board expects licensees to take post-doctoral courses that will build upon basic knowledge and bring licensees up-to-date on new developments relating to the practice of chiropractic.

Additionally, under proposed new N.J.A.C. 13:44E-1A.5(g), the Board could accredit other educational programs offered by professional organizations or societies, health care professions and schools, as well as equivalent educational programs including examinations, scientific papers, publications, presentations, residency programs, teaching or research appointments, independent study, and distance learning, so long as the other educational programs or equivalent educational programs have significant intellectual or practical content dealing with matters directly related to the practice of chiropractic or with professional responsibilities or ethical obligations of licensees and do not involve practice building, practice management, and/or marketing.

Proposed new N.J.A.C. 13:44E-1A.5(h) sets forth how credit for continuing education courses and programs is calculated.

Pursuant to proposed new N.J.A.C. 13:44E-1A.5(i), the Board will permit only 12 credits obtained through distance learning or Internet courses to count towards the continuing education requirement. Additionally, the Board will grant no more than 10 continuing education credits for programs that take place during the course of one calendar day. The Board's position is that it is unrealistic to believe that quality learning can occur over a period longer than 10 hours per day.

Proposed new N.J.A.C. 13:44E-1A.5(j) states that the Board will not grant continuing education credit for courses involving practice building, practice management, and/or practice marketing.

Proposed new N.J.A.C. 13:44E-1A.5(k) sets forth the criteria that a sponsor must meet and the process that a sponsor must follow in order to become an approved provider of a continuing education program.

Proposed new N.J.A.C. 13:44E-1A.5(l) outlines the procedure that a licensee seeking approval of a particular continuing education program must follow.

Under proposed new N.J.A.C. 13:44E-1A.5(m), a new licensee who had completed an accredited program within 12 months of the beginning of the biennial registration period would be exempt from the continuing education requirements for that period.

Under proposed new N.J.A.C. 13:44E-1A.5(n), (o), (q), (s), and (t), licensees are responsible for certifying on their biennial renewal applications that they have completed the continuing education requirement. They must retain proof of such completion for five years. If a licensee completes more than the required 30 credits, he or she may apply a maximum of seven credits towards the next biennial period. The Board may conduct random audits to determine licensee compliance with the continuing education requirements. If a licensee fails to comply with these requirements, he or she may be subject to the penalties enumerated [page=3077] in N.J.S.A. 45:9-41.32. A second or subsequent offense for failure to comply with continuing education requirements may be considered professional misconduct and would provide grounds for additional discipline, including license suspension or revocation.

Pursuant to proposed new N.J.A.C. 13:44E-1A.5(p), if a licensee is retired or inactive, he or she is not subject to the continuing education requirements. However, if a holder of a retired, inactive, suspended, or revoked license wishes to resume practice, the applicant must provide proof of completion of the required continuing chiropractic education credits for each biennial licensure period for which the licensee was on inactive, retired, suspended, or revoked status. If the total credits required to become current exceeds 30, then 30 is the maximum number required. An applicant would be required to submit to the Board a detailed list of all courses that the applicant has completed to become current. If the Board determines that there is a subject area in which the applicant is deficient, the Board may require the applicant to complete additional continuing education in that subject matter before reinstating the license.

Under proposed new N.J.A.C. 13:44E-1A.5(r), the Board may permit an extension or waiver of the continuing education requirements upon application by the licensee.

Proposed new N.J.A.C. 13:44E-1A.6 requires licensees to maintain malpractice insurance of at least $ 100,000 per occurrence and $ 300,000 per policy year issued by an entity authorized by a governmental entity to write chiropractic malpractice insurance. Under the proposed rule, failure to maintain malpractice insurance is deemed to be professional misconduct.

As the Department has provided a 60-day comment period on this notice of proposal, this notice is excepted from the rulemaking calendar requirements pursuant to N.J.A.C. 1:30-3.3(a)5.
 
Social Impact

The Board believes the proposed amendments and new rules will have a positive effect on licensees by providing them with a clear and comprehensive set of rules to guide them in their professional practice. The proposed amendments and new rules will benefit the public by clearly defining the scope of chiropractic practice and by delineating the treatment modalities and diagnostic tools licensees may use in their practice. The proposed amendments and new rules requiring licensees to engage in continuing education will have a beneficial impact on consumers by ensuring that licensees remain abreast of developments in their field of practice.
 
Economic Impact

The Board believes that the proposed amendments and new rules will have an economic impact on licensees. Licensees must bear the cost of the 30 credit hours of continuing education required under proposed new rule N.J.A.C. 13:44E-1A.5. Licensees holding inactive, retired, or suspended licenses who apply to resume their practice will be responsible for completing the continuing education requirements for the period that his or her license was inactive, retired, revoked, or suspended, up to a total of 30 continuing education credits.

Additionally, proposed new N.J.A.C. 13:44E-1A.6 mandates that licensees maintain malpractice insurance. The costs associated with malpractice insurance premiums will also have an economic impact upon licensees.

Because the proposed amendments and new rules implement the changes to N.J.S.A. 45:9-14.5, which expanded the practice of chiropractic, the Board believes that licensees will benefit by the enlarged patient pool available to them because they are able to perform more services. Additionally, licensees will benefit by being permitted to sell nutritional supplements to consumers. The Board believes that any adverse economic impact that may be experienced by licensees as a result of the proposed amendments and new rules will be offset by the economic benefit to licensees and will be significantly outweighed by the necessary consumer protection established by the proposed amendments and new rules.

The Board believes that the proposed amendments and new rules may impact consumers insofar as the costs for continuing education and malpractice insurance may be passed on to patients in the form of higher fees.
 
Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments and new rules are not subject to any Federal standards or requirements.
 
Jobs Impact

The Board does not anticipate that the proposed amendments and new rules will increase or decrease jobs in the State.
 
Agriculture Industry Impact

The proposed amendments and new rules will have no impact on the agriculture industry in the State.
 
Regulatory Flexibility Analysis

If, for the purposes of the Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., the approximately 3,388 licensees are considered "small businesses," then the following analysis applies.

The costs imposed on small businesses by the proposed amendments and new rules will be the same costs that are imposed on all licensees, and are discussed in the Economic Impact above. The proposed amendments and new rules impose compliance and recordkeeping requirements as detailed in the Summary above. The Board does not believe that licensees will have to employ any professional services in order to comply with the proposed amendments and new rules.
 
Housing Affordability Impact Analysis

The proposed amendments and new rules will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the proposed amendments and new rules concern the licensure and regulation of chiropractors as to scope of practice, continuing education and the requirement for malpractice insurance.
 
Smart Growth Development Impact Analysis

The proposed amendments and new rules will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2, within designated centers, under the State Development and Redevelopment Plan in New Jersey because the proposed amendments and new rules concern the licensure and regulation of chiropractors as to scope of practice, continuing education and the requirement for malpractice insurance.
 
Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
 
SUBCHAPTER 1.    PURPOSE AND SCOPE[; DEFINITIONS]
 
13:44E-1.1   Scope of practice
 
(a) The practice of chiropractic [is that patient health care discipline whose methodology is the adjustment and/or manipulation of the articulations of the spine and related structures.] means a philosophy, science, and healing art concerned with the restoration and preservation of health and wellness through the promotion of well-being, prevention of disease, and promotion and support of the inherent or innate recuperative abilities of the body. The practice of chiropractic includes the reduction of chiropractic subluxation and the examination, diagnosis, analysis, assessment, systems of adjustments, manipulation, and treatment of the articulations and soft tissue of the body. It is within the lawful scope of the practice of chiropractic to diagnose, adjust and treat the articulations of the spinal column and other joints, articulations, and soft tissue and to order and administer physical modalities and therapeutic, rehabilitative and strengthening exercises.
 
(b) During the initial consultation and before commencing chiropractic care, a licensee shall identify and document a clinical condition warranting chiropractic care. Nothing [herein] contained in this section shall be deemed to prohibit a licensee from caring for chiropractic subluxation as determined by chiropractic analytical procedures. Chiropractic analysis [which] that identifies the existence of a subluxation may be the basis for chiropractic care even in the absence of a subjective complaint or other objective findings.
 
[page=3078] [(b)] (c) A chiropractic diagnosis or analysis shall be based upon a chiropractic examination appropriate to the presenting patient[. Should the examination indicate abnormality not generally recognized as amenable to chiropractic care, a licensee shall refer the patient to an appropriate health care provider.], except that a licensed chiropractor who, at any time during the examination, has reasonable cause to believe symptoms or conditions are present that require diagnosis, analysis, treatment, or methods beyond the scope of chiropractic as defined in (a) above, shall refer an individual to a practitioner licensed to practice dentistry, medicine, or surgery in this State or other appropriate licensed healthcare professionals. Nothing [herein] contained in this subsection shall preclude a [licensee] licensed chiropractor from rendering concurrent [and/or] or supportive chiropractic care to any patient so referred.
 
[(c)] (d) The following diagnostic and analytical procedures are within the scope of practice of a licensee:
 
1. The taking and ordering of X-rays [limited to the osseous system];
 
2.-3. (No change.)
 
4. The ordering, but not performing, of such other diagnostic or analytical tests consistent with chiropractic practice including, but not limited to, computerized axial tomography (CT), magnetic resonance imaging (MRI), bone scan, and invasive electromyography (EMG) [and chest x-ray];
 
5. The requesting or performing of such other diagnostic or analytical tests consistent with chiropractic practice including, but not limited to, non-invasive muscle testing and tests using neurocalometer-type devices; [and]
 
6. The requesting or performing of electrodiagnostic tests or other special examinations, to the extent and in the manner authorized by N.J.A.C. 13:44E-3[.];
 
7. The signing or certifying of temporary or permanent impairments and other certifications, such as pre-participation and pre-employment screenings. A chiropractic physician may use recognized references in making his or her determination; and
 
8. The providing of dietary or nutritional counseling, such as the direction, administration, dispensing, and sale of nutritional supplements including, but not limited to, all food concentrates, food extracts, vitamins, minerals, herbs, enzymes, amino acids, homeopathic remedies, and other dietary supplements including, but not limited to, tissue or cell salts, glandular extracts, nutraceuticals, botanicals, and other nutritional supplements; provided that the chiropractor has successfully completed a course of study concerning human nutrition, consisting of not less than 45 credit hours from a college or university accredited by a regional or national accrediting agency recognized by the United States Department of Education and approved by the Board based upon the criteria set forth in N.J.S.A. 45:9-41.3.
 
[(d) A licensee may offer general nutritional advice to a patient when such advice is incidental to the chiropractic care being provided. A licensee shall not offer nutritional advice as treatment for a specific disease, defect, or deformity. A licensee shall not, incidental to chiropractic care, sell, dispense or derive any financial benefit from the sale of vitamins, food products or nutritional supplements. A licensee shall not represent himself or herself as a nutritional consultant.]
 
(e) When clinically indicated, supported and documented in the patient record, a licensee may provide the following procedures in conjunction with chiropractic care to facilitate, enhance and/or prolong the effects of the chiropractic adjustment:
 
1. The ordering and/or administering of physical modalities; [and]
 
2. The ordering and/or administering of therapeutic, rehabilitative and/or strengthening exercises[.]; and
 
3. Perform splinting and bracing, first aid, and other diagnostic or analytical tests including computer aided neuromuscular testing and nerve conduction studies.
 
(f) A chiropractor licensed by the State Board of Chiropractic Examiners may use the title doctor, or its abbreviation in the practice of chiropractic, however, it must be qualified by the words doctor of chiropractic, chiropractor or chiropractic physician or its abbreviation D.C., which may be used interchangeably.
 
SUBCHAPTER 1A.    LICENSURE
 
13:44E-1A.4   Biennial license renewal; license expiration; reinstatement after expiration; inactive status; return from inactive status
 
(a)-(c) (No change.)
 
(d) An individual whose license has been expired for five years or less for failure to renew pursuant to (c) above may be reinstated by the Board after fulfilling the following:
 
1.-2. (No change.)
 
3. Submission of an affidavit of employment listing each job held during the period of license expiration that includes the name, address, and telephone number of each employer; [and]
 
4. Completion of a criminal history background check as required by N.J.S.A. 45:1-28 et seq., if a criminal history background check has not been completed previously[.]; and
 
5. Submission of proof of having completed the continuing education requirements for each biennial licensure period for which the applicant's license was expired. If the total credits required to become current exceeds 30, then 30 shall be the maximum number required. Any applicant seeking reinstatement of his or her license shall submit to the Board, a detailed list of all continuing education courses that the licensee has completed in order to become current. If the Board determines that there is a deficiency in a particular area of study, the Board may require the applicant to complete additional continuing education courses in the area of the deficiency before reinstating the license.
 
(e) An individual whose license has been expired for more than five years, and has been lawfully practicing in another jurisdiction, shall complete the requirements set forth in (d)1 through [4] 5 above.
 
(f) An individual whose license has been expired for more than five years, and has not been lawfully practicing in another jurisdiction, shall:
 
1. Complete the requirements set forth in (d)1 through [4] 5 above; and
 
2. (No change.)
 
(g) (No change.)
 
(h) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board after fulfilling the following:
 
1. (No change.)
 
2. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status, including the name, address, and telephone number of each employer; [and]
 
3. Completion of a criminal history background check as required by N.J.S.A. 45:1-28 et seq., if a criminal history background check has not been completed previously[.]; and
 
4. Submission of proof of completion of the continuing education credits required pursuant to N.J.A.C. 13:44E-1A.5.
 
(i)-(k) (No change.)
 
13:44E-1A.5   Chiropractic continuing education
 
(a) "Licensee," as used in this section, means a chiropractor licensed and subject to regulation by the Board of Chiropractic Examiners.
 
(b) Except as provided in (c) below, a licensee applying for biennial license renewal shall have completed, during the preceding biennial period, 30 continuing educational credits in order to qualify for the renewal of his or her license. One credit is defined as 50 minutes of instruction. A minimum of two credits shall be completed in the study of State laws and rules governing chiropractic professional ethics or recordkeeping and documentation as it pertains to the practice of chiropractic in this State, and a minimum of two credits shall be completed in nutrition education.
 
(c) For the biennial renewal period beginning September 1, 2013, a licensee who has completed continuing education credits in courses meeting the requirements set forth in this section between January 18, 2010 and August 31, 2013, shall be permitted to apply such credits to qualify for renewal of his or her license for the biennial period commencing on September 1, 2013.
 
(d) The continuing education courses may include, but not be limited to, subject matter and content of study that is taught by accredited chiropractic schools, colleges, institutions, and [page=3079] universities, or in a subject matter tested for licensure, that has been approved by Providers of Approved Continuing Education (PACE), and/or the Board; except that the Board retains the right to reject any PACE-approved program:
 
1. Whose focus is the subject matter described in (j) below; or
 
2. That does not have significant intellectual or practical content dealing primarily with matters directly related to the practice of chiropractic or with professional responsibilities or ethical obligations of licensees.
 
(e) The Board will not grant continuing education credit for completion of basic courses required for graduation from a chiropractic college or university and/or for initial licensure. Continuing education credit shall be granted only for post-doctoral courses designed to build upon basic knowledge and/or to bring licensees up-to-date on new developments relating to the practice of chiropractic.
 
(f) The Board may accredit other educational programs offered by professional organizations or societies, health care professions, schools, colleges, institutions, universities or healthcare facilities as suitable for continuing education credits, so long as such other educational programs have significant intellectual or practical content, which deal primarily with matters directly related to the practice of chiropractic or with the professional responsibilities or ethical obligations of licensees and whose focus is not the subject matter described in (j) below.
 
(g) The Board may accredit other equivalent educational programs including, but not limited to, examinations, scientific papers, professional publications, scientific presentations, residency programs, teaching and/or research appointments, advanced degree or certification program in related fields, scientific exhibits, independent study or research, or self-study programs, or distance learning as suitable for continuing education credits, so long as such other educational programs have significant intellectual or practical content, which deal primarily with matters directly related to the practice of chiropractic or with the professional responsibilities or ethical obligations of licensees and whose focus is not the subject matter described in (j) below.
 
(h) Continuing education credit shall be calculated as follows:
 
1. Continuing professional education programs of national or State professional organizations: one credit hour for every 50 minutes of in-class participation;
 
2. Accredited university or college courses in the subjects set forth in (d) above:
 
i. Applicants shall receive 15 credit hours of continuing education credit for each semester or trimester credit hour earned; 10 credit hours of continuing education credit for each credit hour earned in a quarter; and
 
ii. Applicants attending noncredit courses shall be granted continuing education credit at the rate of one credit hour for every 50 minutes of in-class participation;
 
3. Distance learning programs and other independent study programs: the amount of credit to be allowed for approved distance and individual study programs, including taped study programs, shall be one credit hour for every 50 minutes of distance and individual self-study program participation;
 
4. Teaching or instruction of a course for the first time or teaching a course previously taught if substantial time was spent updating course material: instruction and preparation time: one continuing education credit for each hour of instruction or preparation.
 
i. The total number of continuing education credits that may be granted for service as a teacher or instructor shall not exceed 12 credits per biennial period.
 
ii. Requests for credit shall be accompanied by an outline of the instruction or course.
 
iii. A teacher or instructor that is employed as a teacher or instructor on a full-time basis shall not be eligible to obtain continuing education credits for such activities;
 
5. Scientific papers and professional publications: credit shall be given for each 50-minute period of preparation time on a self-declaration basis, not to exceed 12 credit-hours per biennial period. A copy of the publication article shall be submitted to the Board with a request for continuing education credit.
 
i. Credit may be claimed for published articles and books by the authors of those works. These publications must contribute to the professional competency of chiropractors.
 
ii. In exceptional circumstances, a licensee may request additional credit by submitting the article or book to the Board with an explanation of the circumstances that he or she believes justifies an award of greater credit. When licensees request more than 12 continuing education credit hours during the biennial period, credit hours awarded shall be determined by the Board on a case-by-case basis. Factors such as complexity of the subject matter, length of publication, and the amount of preparation time shall be considered;
 
6. Research and preparation of examinations or acting as an examiner for a clinical examination: one continuing education credit for each hour of research or time spent on the examination, not to exceed six continuing education credits per biennial period; and
 
7. Scientific presentations or exhibits: one continuing education credit for each hour of preparation or presentation, not to exceed six continuing education credits per biennial period.
 
(i) A licensee shall complete no more than 12 of the total continuing chiropractic education credits in distance learning or Internet courses approved by the Board; the remaining credits must be attained through live didactic learning experience, including real time interactive seminars conducted by electronic methods. The Board shall not award more than 10 hours of continuing education credit for any program that takes place during the course of one calendar day.
 
(j) The Board shall not accept courses involving practice building, practice management and/or practice marketing toward the continuing chiropractic education requirements.
 
(k) A provider seeking Board approval to sponsor programs for continuing education credit shall submit an application to the Board, which shall include course and program descriptions, instructor qualifications, locations, dates and times of courses, and other information as required by the Board.
 
1. Qualified sponsors shall offer courses that meet the following criteria:
 
i. Be a formal course of learning, which contributes directly to the maintenance of professional competence of a licensee;
 
ii. Be at least one credit hour, 50-minute period, in length; however additional credits in excess of one hour may be awarded in 1/2 hour increments;
 
iii. Be conducted by a qualified instructor or discussion leader; and
 
iv. Offer subjects enumerated in (d) above.
 
2. A continuing education sponsor may receive prior approval, valid for the current biennial licensing period in which the approval was issued, for a course of acceptable subject matter, as set forth in (d) above, and be assigned a designated number of continuing education credits by the Board if the program sponsor provides in writing information required by the Board to document the elements of (k)1 above, and in addition, certifies that the sponsor shall:
 
i. Maintain and retain accurate records of attendance for a five-year period;
 
ii. Retain a written outline of course materials for a five-year period; and
 
iii. Comply with the requirements of (k)4 below.
 
3. The Board will post on its website at http://www.njconsumeraffairs.gov/chiro/chiro_licensee.htm a list of all program sponsors that, pursuant to this section, have applied and have been approved to sponsor courses for continuing education credit. Continuing education sponsors shall comply with the following additional requirements:
 
i. The program sponsor shall disclose in advance to prospective participants the objective, prerequisites, experience level, content, required advanced preparation, teaching method, and number of continuing education credits involved in the program;
 
[page=3080] ii. The program sponsor shall provide evidence to the Board that it has policies and procedures in place to verify and adequately monitor the attendance of course participants;
 
iii. The program sponsor shall be responsible for assuring that the number of participants and the physical facilities are consistent with the teaching methods to be utilized;
 
iv. The program sponsor shall select and assign qualified instructors for the continuing education program. Sponsors shall provide to the Board the curriculum vitae of all course instructors and certify to the Board that the sponsor has verified the credentials of all its instructors. Sponsors must notify the Board of any instructor change within 20 days of making the change;
 
v. The program sponsor shall evaluate the performance of its program instructors at the conclusion of each program to determine the instructors' suitability to continue to serve as instructors in the future;
 
vi. Program evaluation shall be in accordance with the following:
 
(1) The sponsor shall provide some means of program evaluation. Evaluations shall be solicited from both the participants and instructors. Programs shall be evaluated to determine whether:
 
(A) Objectives were met;
 
(B) Prerequisites were necessary or desirable;
 
(C) Facilities were satisfactory;
 
(D) The instructor was effective;
 
(E) Advanced preparation materials were satisfactory; and
 
(F) The program content was timely and effective; and
 
(2) Evaluations shall take the form of one or a combination of pre-tests for advanced preparation, post-tests for effectiveness of the program, questionnaires completed at the end of the program or later, or oral feedback to the instructor or sponsor. Instructors shall be informed of their performance and sponsors shall systematically review the evaluation process to insure its effectiveness; and
 
vii. The program sponsor shall be responsible for issuing certificates of satisfactory completion or other comparable documentation to program participants. Such certificates or documentation shall be printed with the following information:
 
(1) Dates attended;
 
(2) Credit hours earned;
 
(3) Course title and description of content, including the method of course delivery and subject area;
 
(4) Course sponsor name;
 
(5) Instructor name; and
 
(6) Course location.
 
4. A continuing education sponsor who has qualified as a sponsor pursuant to (k)1 above, or has obtained prior Board approval for a course pursuant to (k)2 above, shall not alter, amend, update, or reconfigure the approved courses for continuing education credit without the permission of the Board. If a continuing education sponsor alters, amends, updates, or reconfigures a course, the continuing education sponsor must resubmit the course to the Board for approval.
 
(l) A licensee seeking Board approval of a program for continuing education credit, which has not been approved pursuant to (k) above, may submit an application on a form prescribed by the Board, which shall include course and program descriptions, instructor qualifications, locations, dates and times of courses, number of continuing education credits, and other information as required by the Board. The Board shall notify the licensee, in writing, of its determination, which is based upon (e), (f), and (g) above.
 
(m) A new licensee who completed an accredited graduate chiropractic education program within 12 months of the commencement of the biennial registration period is not required to complete the continuing education requirements for the biennial period.
 
(n) A licensee shall certify on the application for biennial licensure renewal that he or she has completed the required number of continuing education credits. The Board may conduct random audits to determine licensee compliance with the continuing education requirements of this section.
 
(o) A licensee who completes more than 30 continuing chiropractic education credits required pursuant to this section may apply no more than seven of the excess credits to the continuing chiropractic education requirements for the following biennial period only. Excess credits approved for a biennial period may be applied to the continuing education requirements for the next period whether or not approved for that period.
 
(p) Licensees holding an inactive or retired license shall be exempt from continuing education requirements, except that any licensee holding an inactive or retired license, or whose license is suspended or revoked, who applies to resume practice shall provide proof of having completed the continuing chiropractic education requirements for each biennial licensure period for which the licensee was on inactive or retired status. If the total credits required to become current exceeds 30, then 30 shall be the maximum number required. Any applicant seeking to resume practice shall submit to the Board a detailed list of all continuing education courses that the licensee has completed in order to become current. If the Board determines that there is a deficiency in a particular area of study, the Board may require the applicant to complete additional continuing education courses in the area of the deficiency before reinstating the license to active status.
 
(q) To report continuing chiropractic education credits, a licensee shall:
 
1. Certify, on the application for biennial renewal, completion of the required number of continuing education credits; and
 
2. Maintain all evidence of completion of continuing education requirements for a period of not less than five years after satisfaction of the credits and submit such documentation to the Board upon request.
 
(r) The board may extend the time period for completion of continuing chiropractic education requirements or may waive continuing chiropractic education requirements on an individual basis for reasons of hardship, such as severe illness, disability or military service, consistent with the following:
 
1. A licensee seeking an extension or waiver of the continuing education requirements shall apply to the Board in writing setting forth the specific details for the reasons why an extension or a waiver is requested. The licensee shall submit all of the documentation that supports the request for the extension and/or waiver;
 
2. A licensee shall apply for an extension and/or a waiver prior to the expiration of the biennial renewal period. All requests shall be sent to the Board office, by certified mail, return receipt requested; and
 
3. An extension or waiver granted pursuant to this section shall become effective for the biennial licensure period in which the extension or waiver is granted. If the condition that necessitated the extension or waiver continues into the next biennial period, the licensee shall apply to the Board for the renewal of such extension or waiver for the new biennial period.
 
(s) A licensee shall provide verification and proof of compliance with continuing chiropractic education requirements. Non-compliance of with the continuing education requirements shall provide cause for civil penalties pursuant to N.J.S.A. 45:9-41.32.
 
(t) A second or subsequent offense by a licensee for failure to comply with the continuing education requirements may be considered professional misconduct and would provide grounds for additional discipline including license suspension or revocation.
 
13:44E-1A.6   Malpractice insurance
 
(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise:
 
"Authorized" means recognized by a government agency to offer chiropractic malpractice insurance products.
 
"Covered" means ongoing maintenance of insurance in the amount of at least $ 100,000 per occurrence and $ 300,000 per policy year with extended reporting endorsement coverage for claims made (or "tail coverage") issued by a carrier or other entity authorized to write chiropractic malpractice insurance.
 
[page=3081] "Maintaining a professional practice with responsibility for patient care" means the furnishing of professional services to patients in New Jersey including, but not limited to, the testing for, or diagnosis of, or the offering or furnishing of treatment, preventative chiropractic care or consultation relating to chiropractic care at a place, such as an office (even if located in the home) or clinic or through a business entity, regardless of the ownership of the practice.
 
(b) All doctors of chiropractic licensed to practice in this State who maintain a professional practice or have responsibility for patient care shall be covered by chiropractic malpractice insurance.
 
(c) Violations of (b) above shall be deemed professional misconduct within the meaning of N.J.S.A. 45:1-21(e).

 

   
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