Scope Info

 

Chiropractors are different and many practices focus on different things.  Our scope defines what we can do and what we can’t do in our practices.  For many years we have had a narrow scope with broad application and we have done well preserving our vitalistic philosophy. Although the NYSCA and The NY Chiropractic Council had originally agreed to wait until there was a merger/unified organization before scope was to be discussed, the NYSCA leadership put out a new scope bill to The Council and the profession-at-large for review and was going to submit their changes with or without the New York Chiropractic Council's input. 

Many members of the Council had reservations about opening the scope and making changes to it, but we have to be at the table in order to protect our membership's interests.  There was a great deal of time and back and forth with ideas and many hours of discussion over many points including the tiniest details. What you see here is a summary of the points with some explanations as to what they affect and how the changes truly impact the practicing chiropractor.  With such a diverse group that has many different opinions it is an arduous task to come up with a scope that makes everyone 100% happy.  Our bill is not perfect but it does maintain a great deal of room for many to practice as they wish whether they focus on pain, extremities, or the 33 principles.  We welcome constructive criticism and rants all the same but please be respectful of others and their opinions! Remember the bill can and will change when and if it gets in front of lawmakers.


Scope Highlights Explained


1. Allows for stand-alone examination.   Examinations under our current law have always been limited to the detection of subluxations (and their associated correction) of our patients. We as a profession have advocated for peer to peer examinations of our patients under insurance including No-Fault and Workers Compensation. Currently Stand-alone physicals are not permitted. Recently our colleagues who were performing DOT exams were advised that they could no longer do so due to this requirement.  This language would lead to allowing a chiropractor to perform assessments for: health, work capability, DOT, handicap eligibility, scoliosis, school, and other sports, and school attendance.  
2. Allows for diagnosis. Current law does not allow for a chiropractor to render a diagnosis. Every chiropractor that bills an insurance company or fills out a “super-bill” for a patient so the patient can be reimbursed by their insurance company currently uses an ICD-10 diagnostic classification code. Even if the code is subluxation only, it is still a diagnosis. 

3. Retains the detection and correction of subluxations as our primary focus as chiropractors for purposes of restoring nervous system integrity. This has always been the primary focus of chiropractic and is guaranteed to remain the primary objective of chiropractors here in New York. The way this section is worded, a chiropractor wishing to only focus on the detection and correction of subluxations for the sole purpose of restoring nerve system integrity may continue to do so.  
4. Allows for stand-alone extremity or extra-spinal care. A chiropractor wishing to correct extra-spinal subluxations may now do so without the need to correlate it back to a vertebral subluxation in the corresponding area of the extremity. If a person comes to you for an extremity complaint and in the rare case doesn’t also have a vertebral subluxation, you may now correct the extra-spinal dysfunction by itself. Currently correction of a TMJ or Patellofemoral joint dysfunction would technically not be allowable because it is not part of the vertebral column. 
5. Specifies that chiropractors can treat neuromusculoskeletal conditions. Doctors of chiropractic are well trained and positioned to treat conditions of the neuromusculoskeletal system.  Presently, despite this expertise, carriers and government agencies choose to limit our ability to serve our patients.  The phrasing of neuromusculoskeletal conditions allows for extremity adjusting or other examination without relation to a spinal nexus. This creates opportunity to better serve patients and be properly recognized by carriers and agencies.
6. Allows for assessments for: health, work capability, handicap eligibility, school and other sports, and school attendance. This would be explained by item 1 as these needed the stand-alone part of an evaluation and examination.
7. Allows for traction and decompression treatment methods. These have long been approved by the chiropractic board as being appropriate to the practice of chiropractic. This section now spells it out in our scope of practice.
8. Allows for ancillary adjunctive therapy procedures. These have long been approved by the chiropractic board as being appropriate to the practice of chiropractic. This section now spells it out in our scope of practice.
9. Specifies a chiropractor can perform electrodiagnostic testing and manipulation under anesthesia if appropriate education standards and testing have been met. These have long been approved by the chiropractic board as being appropriate to the practice of chiropractic when additional education and testing has been achieved. This section now spells it out in our scope of practice
10. Allows for nutrition to be utilized in your practice. This section allows for the chiropractor to provide another layer of conservative care for their patients, as clinically trained and educated. Like other highlighted scope changes we are already allowed to use nutrition in practice as stated on the state Ed department website.
11. Allows for all ionizing and non-ionizing imaging methods including tests such as video fluoroscopy if appropriately trained in such methods. Additional imaging tests for subluxations and structural imbalance such as diagnostic spinal ultrasound for example may now be used and VF, if trained and tested, would now be allowed. 
12. Allows chiropractors to now use diagnostic clinical laboratory methods approved by the board. This now allows the chiropractor the ability to perform certain tests instead of only being able to order these tests. This is necessary to be able to perform evaluations for work such as a urine dip stick. 
13. Allows for the use of topical analgesic substances and anesthetic balms, salves or emollients. The State Board has issued a position statement that states these are currently within the scope of practice of chiropractic.
14. Allows chiropractors to advise on over the counter substances.  Trained and well-educated chiropractors should be able to advise patients on OTC substances, including use, cessation, contraindications, and possible side effects.  This is done by lay people in many stores and settings, and it sensible to allow chiropractors to do so as well without jeopardizing their license.  The state board opined at the January 17, meeting the following,” Typically, we feel the classification of OTC Medications include anti-inflammatories and pain relievers. There is no prohibition against advising or recommending OTC Medications. We cannot prescribe but we can advise or recommend.”.
15. Allows chiropractors to use the title Chiropractor, Doctor of Chiropractic, or Chiropractic Physician.  To allow chiropractors to use appropriate terminology to reference their profession as currently recognized including the physician level status that is recognized federally and in other states.
16. Changes the New York state chiropractic board to an all chiropractic board plus one public member. Currently our board must include an MD, and DO along with an educator. The new scope law would eliminate these three positions.
17. Education requirements now coincide with CCE Requirements for pre-professional study. Meaning that three years, not two are required before being able to enter a chiropractic program (All US schools require four years but CCE still requires a minimum of three years)
18. Cleans up the section under exempt persons to allow for student clinicians, students performing externships or preceptorships, chiropractors traveling from another state to provide emergency services, travel to treat with sports teams or VIPs, purposes of consultation, chiropractic instruction at schools, seminars or teaching facilities or to provide services for diplomats or as commissioned chiropractic officers. Students performing externships or preceptorships from all chiropractic colleges may now be able to perform these requirements in New York.
19. Cleans up the section under limited permit to allow for graduates of chiropractic schools to practice under the supervision of a licensed chiropractor for one year while waiting to pass national boards.
20. Allows protection under the Good Samaritan law for chiropractors to provide basic emergency services as any other “lay person” would without being held to the standard of a doctor during those situations.
21. A new section that would define a new profession known as a chiropractic clinical assistant. This would be for any chiropractic assistant that is performing clinical duties that require direct patient contact. This would require additional training and certification to be known as a "Certified Chiropractic Clinical Assistant". Creating the position of Clinical Chiropractic Assistant allows for chiropractors to delegate appropriate clinical duties (vitals, modalities).  The bill outlines appropriate training for these individuals and does not allow them to perform adjustments on patients.  The intent is to keep chiropractors competitive in a healthcare environment where all other doctoral level providers can delegate duties to mid-level providers or clinical assistants. The hope is this allows better service to the patient as well.  It should be noted that this would not change the duty or role of current chiropractic assistants, and would only allow clinical roles for those who are trained and certified as “Certified Chiropractic Clinical Assistants”.


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Scope FAQs


1. Is this legislation supported by both Associations?


Yes. The New York State Chiropractic Association submitted a draft of scope modernization to the profession and the New York Chiropractic Council worked with it to produce a draft that was supported by both organizations.  Each group worked hard to achieve a draft document that preserves the traditions of the profession. Each organization recognized the changes in our education and training over the last 50 years that the NYS Board has used to interpret accepted Chiropractic standards of care. 

2. What does the bill do?

The bill amends the current scope of practice to reflect, among other things, changes in standards of care recognized by the NY State Board for Chiropractic. More specifically, the bill adds the word diagnosis to the definition of chiropractic.  It allows for stand-alone care of extremities and allows for nutritional consultation and advice. This bill also allows for protection of Chiropractors under the Good Samaritan law. This bill retains the detection and correction of subluxation for purposes of restoring nervous system integrity as our primary focus. 

3. What are the bill numbers?

The bill number is A8541, in the NYS Assembly and the bill is sponsored by Assemblyman Joseph Lentol.
The bill number is S7427, in the NYS Senate and the bill is sponsored by Senator Andrew J. Lanza

4. Who are the sponsors of our legislation?
 
Assemblyman Joseph Lentol and Senator Andrew Lanza

5. Does the bill allow for drugs and surgery?

No. Chiropractic will remain a drug and surgery free profession.

6. Will I be able to do DOT physicals?

Yes. If adopted, this legislation would allow you to perform DOT physicals once certified to do so.

7. Will I be able to do school physicals?


No. In order to do school physicals, several other sections of law need to be changed.  Once this law is adopted, we will work on changing these sections of law to recognize the amended scope of practice for the profession.

8. Why doesn’t the bill draft address continuing education (CE)?


A bill draft shows proposed changes to existing law. We are not making changes to the CE requirements, so that section won't show up in any bill draft.  It will remain the same, so you look at existing law to review those provisions.

9. Where is the bill in the legislative process?

The bill is currently in the Higher Education Committee in both houses. The Higher Education Committees are charged with reviewing and analyzing all legislation that deals with the professions in New York.

10. How long will it take for the bill to pass in NYS?

It may take many years for this bill to pass.  We are hoping for less than five years, but it could take as long as ten.  Updating and modernizing scopes of practice take many years.  This is not unique to our profession.  All professions face this same challenge. For example, in 2012, the Podiatrists finally passed their scope modernization bill after ten years of effort. The bill was originally introduced in 2003.  After passage, their profession realized that some technical changes were needed. They have been trying to pass the technical changes since 2013. The changes still have not passed.

11. Who opposes our bill?

We feel that there should be no opposition to this bill, as it reflects what our state board has previously opined as being appropriate for our profession.  We believe the Medical Society of the State of New York, the NYS Physical Therapy Association and the NYS Occupational Therapy Association may take opposition to our bill.  We anticipate that other professions may also have comments or questions regarding the legislation.

12. How are we dealing with the potential opposition?


We are in the process of meeting with all the groups we think may comment on our legislation to discuss their issues and see if there is anything we can do to alleviate their concerns and gain their support or at least their neutrality.

13. Where is the State Board on the bill?

The State Board, as a state agency, cannot take an official position on pending legislation. However, we have been briefing them on the developments with the legislation and have shared with them updates on drafts and negotiations.  The State Board is in support of the idea to modernize the scope of practice for the profession.

14. Where are the Colleges on the bill?


Each of the Chiropractic Schools in NYS were informed at all stages of the process. The Colleges, like the State Board, also support scope modernization.

15. What can I do?

Right now, you can contact your local State Assembly member and State Senator and ask them to become a co-sponsor on the legislation.

16. How do I find my NYS Assembly member?

http://nyassembly.gov/mem/search/

17. How do I find my NYS Senator?

https://www.nysenate.gov/registration/nojs/form/start/find-my-senator 

18. What do I tell my Assembly member/Senator?

Please convey to them that you are a Doctor of Chiropractic and you live/work/etc. in their legislative district.  Express that you strongly support this legislation, and tell them why you personally support it.  Then conclude by asking them to support the legislation as well.  They can support it by contacting the sponsor in their respective houses and asking to co-sponsor the legislation and, ultimately, by voting for the bill when it comes up for a vote.

19. Where can I find a memo in support?

The Joint Legislative Task Force (JLTF) memo of support for the bill is available on each Association’s website. 

20. How will I get updates on the process?

We will be hosting joint webinars on the legislation to explain what it does and where we are in the process. We will also send emails with updates when there is news to report; again updates will be posted on each Association’s website.


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Education Law ACT


L2017-2018 Regular Sessions 
- IN ASSEMBLY -

Introduced by M. of A.  -- read once and referred to the higher education committee

AN ACT to amend the education law, in relation to modernizing the chiropractic scope of practice

The People of the State of New York, represented in Senate and Assembly, do enact as follows:

Section 1. Section 6551 of the education law is amended as follows:

§ 6551. Definition of practice of chiropractic. 1. The practice of the profession of chiropractic is defined as the examination, evaluation, detection, diagnosis of the human body and/or treatment or correction of: subluxations in the vertebral column or other articular segments by manual or mechanical means, neuromusculoskeletal conditions, structural imbalance, distortion, and/or dysfunction of the human body and the effects thereof; including restoring nervous system integrity, structural balance and/or function; as it may relate to any human disease, pain, injury, deformity or physical condition.

2. a. Chiropractic examination, evaluation, diagnosis and/or treatment methods may include, but not be limited to, physical and functional examination of patients, health assessment, work capability assessment, handicap eligibility assessment, school and other sports assessment, school attendance assessment, spinal health assessment, analysis, or to give consultation, advice, recommendations and counseling regarding anatomy, physiology, neurology, general health matters, wellness and health optimization by any means of communication, the use of imaging studies using ionizing and non-ionizing imaging methods, mobilization, manipulation, traction, and decompression, and ancillary procedures consisting of but not limited to, heat, cold, light, air, water, sound, electricity, massage, manual therapies, therapeutic exercise with or without assistive devices and clinical laboratory testing methods approved by the state education department as being appropriate to the practice of chiropractic.
b. Chiropractic examination, diagnostic and treatment methods may also include electrodiagnostic testing and manipulation under anesthesia when appropriate education standards have been met and as approved by the state education Department as being appropriate to the practice of chiropractic.
c. The practice of the profession of chiropractic allows a licensed chiropractor who has successfully completed a registered doctoral, post-doctoral or continuing education certification program of a higher education credential by an accrediting agency, which contains courses of study in wellness care methods, nutrition, and dietary advice satisfactory to the department; use of wellness care methods and the ability to engage in nutritional counseling and dietary advice, including the dispensing of food concentrates, food extracts, vitamins, minerals, and other nutritional supplements approved by the state education department as being appropriate to, and as a part of, the practice of chiropractic.

23. a. A license to practice as a chiropractor shall not permit the holder thereof to use ionizing radiation sources for the purposes of radiotherapy.
b. The requirements and limitations with respect to the use of diagnostic imaging studies by chiropractors shall be enforced by the state commissioner of health and the commissioner is authorized to promulgate rules and regulations after conferring with the Department to carry out the purposes of this subdivision.
c. Chiropractors shall retain for a period of three years all diagnostic images taken in the course of their practice, together with the records pertaining thereto, and shall make such images and records available to the state commissioner of health or his/her representative on demand.

4. Chiropractors may use diagnostic clinical laboratory methods involving chemical or biological means which particular tests and services shall be approved by the Department as appropriate to the practice of chiropractic.

35. A license to practice chiropractic shall not permit the holder thereof to treat for any infectious diseases such as pneumonia, any communicable diseases listed in the sanitary code of the state of New York, any of the cardio-vascular-renal or cardio-pulmonary diseases, any surgical condition, or any benign or malignant neoplasms; to operate; to reduce fractures; to prescribe, administer, dispense or use in practice legend drugs or medicines or controlled substances or to administer or use anesthetics. Chiropractors may use topical analgesic substances and anesthetic balms, salves or emollients or advise on the use of over the counter substances.

§ 2. Section 6552 of the education law is amended as follows:

§ 6552. Practice of chiropractic and use of title "chiropractor," “doctor of chiropractic” or “chiropractic physician. Only a person licensed or otherwise authorized under this article to practice chiropractic may use the title "chiropractor," “doctor of chiropractic” or “chiropractic physician.”

§ 3. Section 6553 of the education law is amended as follows:

§ 6553. State board for chiropractic. A state board for chiropractic shall be appointed by the board of regents on recommendation of the commissioner for the purpose of assisting the board of regents and the department on matters of professional licensing and professional conduct in accordance with section sixty-five hundred eight of this title. The board shall be composed of not less than eight members, including seven licensed chiropractors in this state for at least five years and one public member. An executive secretary to the board shall be appointed by the board of regents on recommendation of the commissioner.

§ 4. Section 6554 of the education law is amended as follows:

§ 6554. Requirements for a professional license. To qualify for a license as a chiropractor, an applicant shall fulfill the following requirements:

(1) Application: file an application with the department;

(2) Education: have received an education, including three years or ninety (90) semester hours of credit or equivalent trimester or quarter hours of credit of preprofessional college study and completion of program of chiropractic education of not less than four academic years, or the equivalent thereof, in accordance with the commissioner's regulations;

(3) Experience: have experience satisfactory to the board and in accordance with the commissioner's regulations:

(4) Examination: pass examinations satisfactory to the board and in accordance with the commissioner's regulations for the practice of chiropractic;

(5) Age: be at least twenty-one years of age;

(6) Citizenship or immigration status: be a United States citizen or an alien lawfully admitted for permanent residence in the United States;

(7) Character: be of good moral character as determined by the department; and

(8) Fees: pay a fee of one hundred seventy-five dollars to the department for an initial license upon completion and passage of a department approved examination, a fee of eighty-five dollars for each reexamination, and a fee of one hundred fifty-five dollars for each triennial registration period.

§ 5. Section 6555 of the education law is amended as follows:

§ 6555. Exempt persons. The following persons under the following limitations may practice chiropractic within the state without a license:

a. A student enrolled in any accredited college of chiropractic engaging in all phases of clinical practice under supervision of a licensed chiropractor or physician in a curriculum registered by the department; or
b. A student who is performing a clinical externship or preceptorship in a chiropractic office or clinic setting and who is enrolled in a chiropractic school which meets the standards satisfactory to the department, provided such practice is under the direct supervision of a licensed chiropractor for a maximum period of 12 months; or
c. Any chiropractor authorized to practice chiropractic while travelling from another state or country in which he/she is licensed, to provide chiropractic services during any emergency services associated with any rescue, recovery or humanitarian relief effort provided such practice is limited to the organized emergency services; or
d. A chiropractor who is not a resident of this state who is legally qualified to practice in his/her state and who is traveling from another state for the purpose of providing chiropractic services for a specific purpose or event of limited duration
e. Any chiropractor who is licensed in another state or country and who is meeting or communicating with a chiropractor licensed in this state, for purposes of consultation, provided such practice is limited to such consultation;
f. Any chiropractor who is licensed in another state or country, who is visiting a chiropractic school or teaching facility in this state to receive chiropractic instruction for a period not to exceed six months or to conduct chiropractic instruction, provided such practice is limited to such instruction and is under the general supervision of a licensed chiropractor;
g. Any chiropractor who is authorized by a foreign government to practice in relation to its diplomatic, consular or maritime staffs, provided such practice is limited to such staffs; or
h. Any commissioned chiropractic officer who is serving in the United States armed forces or public health service or any chiropractor who is employed in the United States Veterans Administration, provided such practice is limited to such service or employment;.

§ 6. Article 132 of the Education Law is amended by repealing Section 6556 and replacing it as follows:

§ 6556. Limited permits. Permits limited as to eligibility, practice and duration, shall be issued by the department to eligible applicants, as follows:

1. Eligibility: The following persons shall be eligible for a limited permit:

(1) A person who fulfills all requirements for a license as a chiropractor except those relating to the examination and citizenship or permanent residence in the United States;

(2) A licensed foreign chiropractor who meets guidelines developed in accordance with the commissioner's regulations;

(3) A licensed foreign chiropractor or a foreign intern who is in this country on a non- immigration visa for the continuation of chiropractic study who meets guidelines developed in accordance with the commissioner's regulations;
 
(4) Any graduate of a chiropractic school which meets standards satisfactory to the department, provided such practice is under the general supervision of a licensed chiropractor for a maximum period of 12 months from date of graduation;

2. Limit of practice. A permittee shall be authorized to practice chiropractic only under the supervision of a licensed chiropractor and only in a licensed chiropractic office or clinical setting.

3. Duration. A limited permit shall be valid for one year. With the exception of a limited permit issued pursuant to subdivision (5), a limited permit may be renewed annually at the discretion of the department.

4. Fees. The fee for each limited permit and for each renewal shall be one hundred five dollars.

§ 7. Article 132 of the Education Law is amended by adding a new Section 6557 to read as follows:

Special Provisions. 1. Non-liability of licensed chiropractors for first aid or emergency treatment. Notwithstanding any inconsistent provision of any general, special or local law, any licensed chiropractor who voluntarily and without the expectation of monetary compensation renders first aid or emergency treatment at the scene of an accident or other emergency, outside a hospital, doctor's office or any other place having proper and necessary chiropractic equipment, to a person who is unconscious, ill or injured, shall not be liable for damages for injuries alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such first aid or emergency treatment unless it is established that such injuries were or such death was caused by gross negligence on the part of such chiropractor. Nothing in this section shall be deemed or construed to relieve a licensed chiropractor from liability for damages for injuries or death caused by an act or omission on the part of a chiropractor while rendering professional services in the normal and ordinary course of his or her practice.

2. This article shall not be construed to affect or prevent the following:

a. The furnishing of any assistance in an emergency;
b. The chiropractor from being a primary portal of entry healthcare provider.

3. There shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any person, partnership, corporation, firm, society, or other entity on account of the communication of information in the possession of such person or entity, or on account of any recommendation or evaluation, regarding the qualifications, fitness, or professional conduct or practices of a chiropractor, to any governmental agency, chiropractic society, a hospital as defined in article twenty-eight of the public health law, a hospital as defined in subdivision ten of section 1.03 of the mental hygiene law, or a health maintenance organization organized under article forty-four of the public health law or article forty-three of the insurance law, including a committee of an individual practice association or medical group acting pursuant to a contract with a health maintenance organization. The foregoing shall not apply to information which is untrue and communicated with malicious intent.

§ 8. Article 132 of the Education Law is amended by adding a new Section 6558 to read as follows:

§ 6558. Definition of Chiropractic Clinical Assistant.

1. A chiropractic clinical assistant is defined as a person certified in accordance with this article who works under the supervision of a licensed chiropractor performing such patient duties as are assigned by the supervising chiropractor. A chiropractic clinical assistant may only provide patient services on the orders and instructions of a supervising chiropractor. Supervision of a chiropractic clinical assistant by a licensed chiropractor shall be on-site supervision, but not necessarily direct personal supervision. The number of chiropractic clinical assistants supervised by one licensed chiropractor shall not exceed the ratio of four chiropractic clinical assistants to one licensed chiropractor as shall be determined by the commissioner's regulations ensuring that there be adequate supervision in the best interest of public health and safety. Nothing in this section shall prohibit a hospital or other public health law article twenty-eight facility from employing chiropractic clinical assistants, provided they work under the supervision of chiropractor, physician, nurse practitioner or other medical provider designated by the hospital or public health law article twenty-eight facility and not beyond the scope of practice of a chiropractic clinical assistant.

2. A Certified Chiropractic Clinical Assistant may only provide clinical services on the orders and instructions of a supervising Chiropractor.

3. The scope of services for a Certified Chiropractic Clinical Assistant shall include assisting a Chiropractor with providing certain clinical procedures common and customary to the chiropractic setting which include, but are not limited to, the following: Collecting general health data, such as the taking of an oral history, vital signs or neurological, physiological or anatomical measurements; performing objective data collection tests common and customary to the chiropractic setting including, but not limited to dynamic or static surface EMG, Thermography, Heart Rate Variability; applying thermal, light, air, water, sound, electrical and mechanical modalities; monitoring prescribed rehabilitative activities.

4. A Certified Chiropractic Clinical Assistant must be adequately trained in the proper operation of any device or equipment and knowledgeable of anatomy and the appropriate safety procedures and contraindications with respect to the clinical services he or she is directed to provide.

5. Nothing in this section shall be construed to allow a Certified Chiropractic Clinical Assistant to provide a chiropractic adjustment; manipulation; joint mobilization; perform radiological tests (X-Rays); nutritional instruction; counseling or other therapeutic service or procedure which requires individual licensure in New York State.

6. Registration as a Certified Chiropractic Clinical Assistant is not required for individuals who perform administrative activities of a non-clinical nature.

§ 9. Article 132 of the Education Law is amended by adding a new Section 6559 to read as follows:

§ 6559. Duties of Chiropractic Clinical Assistant. Duties of chiropractic clinical assistant and the use of title "chiropractic clinical assistant."  Only a person certified or otherwise authorized under this article shall participate in the practice of chiropractic as a chiropractic clinical assistant and only a person certified under this section shall use the title "chiropractic clinical assistant."

§ 10. Article 132 of the Education Law is amended by adding a new Section 6560 to read as follows:

§ 6560. Requirements for certification as a chiropractic clinical assistant.

a. Application: file an application with the department;
b. Education: have received an education and training in a chiropractic clinical assistant program in accordance with the commissioner's regulations and department of education; Including but not limited to a minimum of twenty-four (24) hours of didactic study;
c. Experience: have experience satisfactory to the Department for chiropractic in accordance with the commissioner's regulations;
d. Examination: pass an examination satisfactory to the Department and in accordance with the commissioner's regulations;
e. Age: be at least eighteen years of age;
f. Character: be of good moral character as determined by the department;
g. Registration: all certified chiropractic clinical assistants shall register triennially with the education department in accordance with the regulations of the commissioner;
h. Fees: pay a fee for an initial certificate of fifty dollars, and a fee of fifty dollars for each subsequent triennial registration period.
i. A Certified Chiropractic Clinical Assistant shall conduct themselves within the boundaries of proper ethical behavior and shall adhere to acceptable standards of conduct regardless of whether a supervising Chiropractor or person in a position of authority may order, impart or condone behavior or conduct which is improper.
j. “Improper Conduct”, under the meaning of this section, shall include conduct delineated under the Chiropractic Practice Act, Regulations, and such other New York State laws that may apply.
k. The Department of Education may refuse to issue, refuse to renew, or may suspend, revoke, censure, reprimand, restrict, or limit the registration of, or fine any person pursuant to the laws of New York State or the procedures set forth herein, upon one or more of the grounds for discipline set forth in this document.

§ 11. Article 132 of the Education Law is amended by adding a new Section 6561 to read as follows:

§ 6561. Exemptions.

a. This article shall not be construed to affect or prevent a chiropractic clinical assistant student from engaging in clinical assisting under the supervision of a licensed chiropractor as part of a program conducted in an approved program for chiropractic clinical assistants or in a clinical facility or health care agency affiliated with the program for chiropractic clinical assistants.
b. Supervision of a chiropractic clinical assistant student by a licensed chiropractor shall be on- site supervision and direct supervision.

§ 12. Article 132 of the Education Law is amended by adding a new Section 6562 to read as follows:

§ 6562. Limited permits.

a. The department shall issue a limited permit to an applicant who meets all requirements for admission to the certification examination.
b. All practice under a limited permit shall be under the supervision of a licensed chiropractor or other licensed medical provider in a public hospital, an incorporated hospital or clinic, a licensed proprietary hospital, a licensed nursing home, a public health agency, a recognized public or
non-public school setting, the office of a licensed chiropractor, or in the civil service of the state or political subdivision thereof.
c. Limited permits shall be for six months and the department may for justifiable cause renew a limited permit provided that no applicant shall practice under any limited permit for more than a total of one year.
d. Supervision of a permittee by a licensed chiropractor shall be on-site supervision and not necessarily direct personal supervision.
e. The fee for each limited permit and for each renewal shall be fifty dollars.

§ 13. This act shall take effect on the first of January next succeeding the date on which it shall have become a law.

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