Maryland Department of Health

Maryland Department of Health & Mental Hygiene

Board of Chiropractic Examiners

COMAR: Title 10, Subtitle 43, et seq.

Regulations for Chiropractors and Chiropractic Assistants

Maryland Department of Health & Mental Hygiene

Board of Chiropractic Examiners

Code of Regulations: Title 10.43. et. seq.

Enclosed are the regulations implementing Health Occupations Article, Title 3, Annotated Code of Maryland. These regulations are frequently reviewed and revised. The enclosed present the regulations now in force effective October 22, 2007. Questions regarding interpretation should be directed to the Board Executive Director at 410.764-4726.

For further information visit the Board websites at:

www.mdchiro.org (for chiropractic issues)

www.mdmassage.org (for massage issues)

Index

10.43.01 General Regulations

10.43.02 Rules of Procedure

10.43.03 Advertising

10.43.04 Licensure by Credentials

10.43.05 Chiropractic Externship

10.43.06 Fees

10.43.07 Chiropractic Assistants

10.43.08 License Examinations – Special Needs

10.43.09 Repealed

10.43.10 Monetary Penalties

10.43.11 Continuing Education

10.43.12 License Examinations

10.43.13 Public Demonstrations

10.43.14 Code of Ethics

10.43.15 Recordkeeping

Title 10

DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Subtitle 43

BOARD OF CHIROPRACTIC EXAMINERS

Chapter 01 General Regulations

Authority: Health Occupations Article, Title 3, Annotated Code of Maryland.

.01 Rules of Order.

All proceedings of the Board in regular session shall be governed by Robert's Rules of Order.

.02 Board Officers, Members, and Staff.

A. The president of the Board or the president of the Board's designee shall direct the operation of the staff through the executive director.

B. Board members may not have monetary, pecuniary, or other interest in the affairs of any:

(1) Staff member; or

(2) Organization engaged in business with the Board, including:

(a) Businesses;

(b) Enterprises; or

C. A Board member or Board staff may not serve for compensation as an instructor in a continuing education course or program under Board cognizance over which that Board member or staff member serves in an approval capacity.

.03 Preliminary Educational Qualifications Credits.

Preliminary educational qualifications credits acceptable to the Board are:

A. Certificates or diplomas issued by public and private high schools accredited by the National Council of Secondary Educational Institutions or as recognized by the state or city issuing them.

B. Certificates issued by the department of education of the states and possessions of the United States to applicants having 15 or more units to their credit.

C. Applicants presenting foreign credits of preliminary education shall have them certified by the consul or the embassy of the country in which they were acquired.

D. Bachelor's degree accredited by the State.

.04 Examination Requirements.

A. The Board shall accept examination results only from the National Board of Chiropractic Examiners for applicants for a chiropractic license, including applicants seeking to practice chiropractic with physical therapy privileges.

B. The Board shall set the minimum passing score for each section of the National Board of Chiropractic Examiners' examination.

C. The Board shall administer a jurisprudence examination at least twice a year at times and places to be announced by the Board.

D. An applicant for the jurisprudence examination shall have first successfully completed all required parts of the National Board of Chiropractic Examiners' examination to the satisfaction of the Board.

E. The examination shall begin promptly at a time announced by the Board and shall be proctored by a Board member or Board staff member.

F. The applicant shall present a letter of admission and at least one form of personal, valid, current, U.S. government or state issued photo identification. There is no excuse, waiver, or exception for this requirement.

G. The application shall be executed, verified, and submitted to the Board before the date of examination.

H. The applicant shall follow all directions of the examination proctor.

I. The examination paper shall be retained by the Board as follows:

(1) Passing examination papers shall be retained for 30 days;

(2) Failing examination papers shall be retained for 90 days;

(3) All examination papers shall be destroyed after the expiration of the time periods established under §I(1) and (2) of this regulation; and

(4) Retained examination papers may not be reviewed by the applicant following the completion of the applicant's examination.

J. The Board shall administer the jurisprudence examination in the English language with no provisions made by the Board to accommodate the examination in any foreign language.

K. An applicant who fails the jurisprudence examination three times may not retake the examination until the Board has reviewed the applicant's file and approved a retake.

.05 Licenses.

A. Temporary Licenses. The Board may not issue any temporary license to practice chiropractic in Maryland.

B. An individual practicing chiropractic without a license shall be prosecuted and subject to penalties as prescribed in Health Occupations Article, Title 3, Subtitle 5, Annotated Code of Maryland.

C. The Board shall issue a license only upon an applicant's successful completion of the:

(1) National Board of Chiropractic Examiners' examination, Parts I, II, III, and IV;

(2) Jurisprudence examination; and

(3) National Board of Chiropractic Examiners' Physiotherapy examination, if applicable.

D. The Board may waive educational or examination requirements for any licensed chiropractor applying to practice exclusively with a visiting organization for not more than 30 days per calendar year if the:

(1) Chiropractor practices in a Board-approved, recognized jurisdiction with an active license in good standing; and

(2) Practice is limited exclusively to members of the visiting organization.

E. Display of License in Office. A license holder shall display conspicuously at all times at the license holders' place of business the license granted by the Board.

F. A license holder shall maintain a current, correct mailing address with the Board.

G. Licensure by Credential.

(1) An application for licensure by credential shall be based on a written SPEC examination administered by the National Board of Chiropractic Examiners, a jurisprudence examination administered by the Board, and the education and professional qualifications of the applicant.

(2) At the Board's discretion, an applicant for licensure by credential shall appear before the Board in person before the license is granted.

H. Renewals.

(1) A license holder failing to renew a license shall:

(a) Be notified by the Board by certified mail of the delinquency; and

(b) Have the license revoked if the license holder does not renew by September 30th of the renewal year.

(2) Continuing Education.

(a) Upon renewal, when audited by the Board, a license holder shall submit written evidence of the successful completion of the number of continuing education hours and cardiopulmonary resuscitation (CPR) certification required by the Board for renewal.

(b) The license holder shall have completed the required credit hours by the time of renewal.

(d) Only a course program approved by the Board may be used to meet the continuing education requirement of §H(2) of this regulation.

(e) The requirement may be waived by the Board upon proof of unusual and extreme hardship or disability, and upon application to the Board at least 60 days before September 1.

I. Reinstatements. An applicant for reinstatement of a license that has lapsed for a period of more than 2 years shall be admitted only after satisfying the Board as to the applicant's efficiency by examination and the payment of fees due.

J. Types of Licenses.

(1) The Board shall issue two types of license:

(a) A license covering the practice of chiropractic and physical therapy, as defined in Health Occupations Article, §3-101(f) and (g), Annotated Code of Maryland; and

(b) A license permitting the holder to practice chiropractic as defined in Health Occupations Article, §3-101(f) and (g), Annotated Code of Maryland.

(2) An individual holding the chiropractic license and wishing to qualify for the license to practice physical therapy in conjunction with a practice of chiropractic may do so by taking 270 hours (60 minute hours) instruction in physical therapy in a chiropractic school or college teaching an approved course in the subject, and by passing the National Board of Chiropractic Examiners Physiotherapy examination with a minimum score of 75 percent.

.06 Disclosure for Compelling Public Purpose.

A. The Board may find that a compelling public purpose warrants disclosure of information in an application, certification, licensing, or investigative file, regardless of whether there has been a request for the information, if:

(1) The information concerns possible criminal activity and the disclosure is to a federal, state, or local law enforcement or prosecutorial official or authority;

(2) The information concerns a possible violation of law and the disclosure is to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation, and the information disclosed is limited to information relevant to the possible violation by that individual; or

(3) The information concerns conduct by an individual that the Board reasonably believes may pose a risk to the public health, safety, or welfare, and the disclosure is to a law enforcement authority, administrative official, or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges.

B. Other Disclosures. This regulation does not prohibit or limit the Board's ability to disclose general licensing information as provided in State Government Article, §10-617(h), Annotated Code of Maryland, or any information that the Board may otherwise disclose by law.

Administrative History

Effective date: February 1, 1969

Regulation .02-1 adopted as an emergency provision effective November 25, 1985 (12:25 Md. R. 2469); emergency status expired May 24, 1986 (Emergency provisions are temporary and not printed in COMAR)

Regulation .06 amended effective January 21, 1991 (18:1 Md. R. 30)

Regulation .06E amended effective April 27, 1977 (4:9 Md. R. 719)

Regulation .08 repealed effective October 24, 1983 (10:21 Md. R. 1902)

——————

Chapter revised effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .02 amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .04F amended effective October 22, 2007 (34:21 Md. R. 1915)

Regulation .05 amended effective October 22, 2007 (34:21 Md. R. 1915)

Chapter 02 Rules of Procedure for Board Hearings

Authority: Health Occupations Article, §3-205(a)(1), State Government Article, §10-206; Annotated Code of Maryland.

.01 Scope.

This chapter applies to all contested case hearings before the Board of Chiropractic Examiners or before the Office of Administrative Hearings. It does not apply to conferences or other informal investigations or proceedings.

.02 Notice of Hearing.

A. Written notice of a hearing shall be sent by the Board to all interested parties at least 30 days before the hearing. The notice shall state the date, time, and place of the hearing. It shall also state the issues or charges involved in the proceeding, provided, however, that if by reason of the nature of the proceeding, the issues cannot be fully stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as practicable.

B. Service upon a party shall be by delivery of the charging document and a copy of the complaint to the party in person. Instead of personal service, the Board may serve the charging document and a copy of the complaint by registered or certified mail, restricted delivery, return receipt requested.

.03 Representation of Parties.

Every party appearing at formal hearings has the right to appear in proper person, or by or with counsel.

.04 Pre-hearing Procedures.

A. Pre-hearing Conferences. The Board may set a pre-hearing conference as it deems appropriate.

B. Oaths and Subpoenas. The Board may administer oaths and compel the attendance of witnesses and the production of physical evidence before it from witnesses upon whom process is served anywhere within the State as in civil cases in the circuit court of the county or of Baltimore City, by subpoena issued over the signature of the President or Secretary and the seal of the Board. Upon a request by a party and statement under oath that the testimony or evidence is necessary to their defense, the Board shall issue a subpoena in their behalf.

C. All motions filed by a party with the Board or the Office of Administrative Hearings, as appropriate, shall be accompanied by a memorandum of points and authorities and shall be filed at least 15 days before the hearing. A copy shall be served on the opposing party. Any response shall be filed with the Board or the Office of Administrative Hearings, as appropriate, at least 7 days before the hearing and a copy shall be served on the opposing party.

D. Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may require another party to produce, within 15 days, the following:

(1) A list of witnesses to be called;

(2) Copies of documents intended to be produced at the hearing; or

(3) Both §A(1) and (2) of this regulation.

E. Mandatory Discovery.

(1) Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier:

(a) The name and curriculum vitae of any expert witness who will testify at the hearing; and

(b) A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion.

(2) If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the Board or the Office of Administrative Hearings, as appropriate, shall exclude from the hearing the testimony and any report of the expert.

(3) The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report.

(a) At the prehearing conference, if scheduled; or

(b) Immediately before the scheduled hearing.

(4) If an expert adopts a sufficiently specific charging document as the expert's report, that adoption satisfies the requirements set forth in this section.

F. Parties are not entitled to discovery of items other than as listed in §§D and E of this regulation.

G. Both parties have a continuing duty to supplement their disclosures of witnesses and documents.

H. Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list:

(1) After the prehearing conference, if scheduled; or

(2) Later than 15 days before the hearing, if no prehearing conference is scheduled.

I. The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes.

J. Construction.

(1) In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01.

(2) In the event of a conflict between this regulation and COMAR 28.02.01, this regulation applies.

.05 Conduct of the Hearing.

A. Duties of Presiding Officer.

(1) The Board shall conduct hearings before a quorum of the Board.

(2) For purposes of a hearing under this chapter, four Board members present and entitled to vote shall constitute a quorum.

(3) Board action shall be by majority vote of all the members then serving.

(4) The President, or the President's designee, shall be the presiding officer, and shall have complete charge of the hearing, permit the examination of witnesses, admit evidence, rule on the admissibility of evidence, and adjourn or recess the hearing from time to time.

(5) The presiding officer may set reasonable time limits in arguments and presentation of evidence.

(6) The presiding officer shall be responsible for decorum in hearings and can suspend the proceedings as necessary to maintain decorum.

B. Legal Advisor and Counsel for the Board.

(1) The presiding officer may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board, and, upon such a request, this counsel has all the rights with regard to the:

(a) Submission of evidence, examination and cross-examination of witnesses;

(b) Presentation of summation and argument; and

(2) The presiding officer may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law.

C. Order of Procedure. The State shall present its case first. Then the respondent shall present his case. After this the State may present rebuttal.

D. Examination of Witnesses and Introduction of Evidence.

(1) The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §§10-208 and 10-209, Annotated Code of Maryland.

(2) Every party has the right on every genuine issue to:

(a) Call witnesses and present evidence;

(b) Cross-examine every witness called by the agency, or other party;

(d) File objections, exceptions, and motions, except that when a party is represented by counsel, all the submissions of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by this counsel.

(3) The presiding officer, or the presiding officer's designee, may examine:

(a) A witness called by a party; and

(b) An individual in attendance at the hearing.

(4) A member of the Board may examine a witness called by a party.

(5) The Board may submit evidence from an investigative file to other administrative and criminal investigative offices to assist in the investigation and prosecution of a case.

.06 Records and Transcripts.

A. The Board shall prepare an official record, which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding.

B. A stenographic record of the proceedings shall be made at the expense of the Board. This record need not be transcribed, however, unless requested by a party, or by the Board. The cost of any typewritten transcripts of any proceeding, or part of it, shall be paid by the party requesting the transcript.

.07 Decision and Order.

A. Every decision and order rendered by the Board shall be in writing and shall be accompanied by findings of fact and conclusions of law.

B. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or attorney of record.

.08 Rehearings.

A. Any party aggrieved by the decision and order rendered may apply for rehearing within 10 days after service on him of the decision and order. Action on an application shall lie in the discretion of the Board.

B. Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the person affected by it for failure to comply with its terms.

C. The Board may consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order.

.09 Appeal.

Any person whose license has been revoked or suspended by the Board, or any person placed on probation or reprimand under the regulations in this chapter, may appeal the Board's decision as provided by law.

Administrative History

Effective date: November 7, 1983 (10:22 Md. R. 1966)

Regulation .01 amended effective May 29, 2000 (27:10 Md. R. 966)

Regulation .04 amended effective May 29, 2000 (27:10 Md. R. 966)

Regulation .05 amended effective August 6, 2001 (28:15 Md. R. 1398)

Chapter 03 Advertising

.01 Scope.

A chiropractor may advertise his services subject to the provisions of this chapter.

.02 Qualifications.

A. In an advertisement, a chiropractor shall include at least the chiropractor's:

(1) Name;

(2) Office address;

(3) Telephone number; and

(4) Educational degree.

B. In an advertisement, a chiropractor may state the name of the chiropractor's specialty only if that specialty is approved by the Board.

.03 Prohibitions.

An advertisement may not contain statements that:

A. Contain a misrepresentation of facts or do not reasonably identify the practice as chiropractic;

B. Are likely to mislead or deceive because in context the statement makes only a partial disclosure of relevant facts;

C. Intend to, or are likely to, create false or unjustified expectations of favorable results;

D. Relate to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully disclosing all variables and other relevant factors;

E. Convey the impression that the chiropractor could influence improperly any public body, official, corporation, or any person on behalf of a patient;

F. Contain representations or implications that in reasonable probability can be expected to cause an ordinary prudent person to misunderstand or to be deceived;

G. Contain representations that the chiropractor is willing to perform any procedure which is illegal under the laws or regulations of Maryland or the United States;

H. Contain representations regarding the use of any equipment, treatment, or procedure not within the accepted, prudent practice of chiropractic; or

I. Promise payment, compensation, prizes, or remuneration of any intrinsic value.

.04 Solicitation.

A. A chiropractor may not engage in solicitation, including but not limited to, in-person, telephone, or direct mail solicitation which:

(1) Amounts to fraud, undue influence, intimidation, or overreaching;

(2) Contains statements which would be improper under Regulation .03 of this chapter.

B. A chiropractor shall also be accountable under this regulation if the chiropractor uses an agent, partnership, professional association, or health maintenance organization to implement actions prohibited by this regulation.

Administrative History

Effective date: October 24, 1983 (10:21 Md. R. 1902)

Chapter revised effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .03 amended effective October 22, 2007 (34:21 Md. R. 1916)

Chapter 04 Licensure by Credentials for Chiropractors

.01 Scope.

These regulations apply to all chiropractors seeking licensure by credentials in Maryland. Since licensure by credentials is a privilege, the Board reserves the right to accept or deny this method of licensure based on Regulation .02 of this chapter.

.02 Eligibility.

A. A chiropractor is eligible for licensure by credentials if the applicant has graduated and received the degree Doctor of Chiropractic (D.C.) from a chiropractic college accredited by the Council on Chiropractic Education (C.C.E.) or its successor.

B. The applicant shall:

(1) Be of good moral character and have submitted to the Board three letters of recommendation, one of which shall be sent by the state licensing board in which the applicant is currently licensed;

(2) Meet all the qualifications set forth in the Health Occupations Article, §3-302, Annotated Code of Maryland;

(3) Be currently licensed in another state by virtue of passing an examination that is similar to the examination for which the applicant is seeking licensure by credentials;

(4) Have been in active clinical practice in the state for which the applicant was licensed by examination for the 5 years preceding application or has had full-time faculty status at a chiropractic college accredited by the Council on Chiropractic Education or its successor for at least 5 years before application;

(5) Take and pass the Maryland jurisprudence and the National Board of Chiropractic Examiners SPEC examinations with minimum scores of 75 percent.

.03 Application Procedures.

A. An applicant shall submit the necessary information as set forth in the Health Occupations Article, §3-303, Annotated Code Maryland.

B. The Board may investigate the applicant to insure compliance with all provisions of this chapter.

.04 Requirements of Licensure.

At the Board's discretion, an applicant shall appear before the Board and demonstrate clinical competency in a manner and time to be determined by the Board.

.05 Fees.

A. The fee for licensure by credentials shall be the same as that for licensure by examination.

B. Additional fees may be assessed by the Board for investigatory purposes.

C. The application fee is non-refundable.

Administrative History

Effective date: December 17, 1984 (11:25 Md. R. 2134)

Regulation .02A amended effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .02B amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .03B amended effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .04 amended effective August 6, 2001 (28:15 Md. R. 1398)

Chapter 05 Chiropractic Externship Program

.01 Scope.

These regulations apply to all chiropractic externs and licensed chiropractors who are extension faculty members of a chiropractic college accredited by the Council on Chiropractic Education or its successor.

.02 Definitions.

A. The following terms have the meanings indicated.

B. Terms Defined.

(1) "Accredited college" means a chiropractic school or college accredited by the Council on Chiropractic Education or its successor.

(2) "Approved program" means a program that has been approved by the Board of Chiropractic Examiners and the Council on Chiropractic Education or its successor.

(3) "Board" means the Maryland Board of Chiropractic Examiners.

(4) "Chiropractic extern program" means a 2-semester clinical program:

(a) In which chiropractic externs participate under the direct supervision of a licensed chiropractor who has been approved by the Board to serve as a preceptor; and

(b) That operates in a facility where chiropractic services have been approved by the Board of Chiropractic Examiners.

(5) "Direct supervision" means a licensed chiropractor shall remain on the premises at all times and shall directly supervise and continuously monitor the extern's performance.

(6) "Extern" means an individual enrolled in an accredited chiropractic college who has completed all requirements for the Doctor of Chiropractic program except for the final clinical phase of the program.

(7) "Extern applicant" means an individual who applies to the Board to be approved for the chiropractic externship program.

(8) "Licensed chiropractor" means a chiropractor who is licensed by the Board to practice chiropractic or to practice chiropractic with the right to practice physical therapy, and whose license is in good standing.

(9) "Preceptor or extension faculty member" means a licensed chiropractor actively practicing in the State in good standing who has been appointed to the extension faculty of an accredited chiropractic college and approved by the Board.

.03 Eligibility.

A. An extern applicant is eligible for approval in the chiropractic extern program if the applicant is currently enrolled in an approved program that is recognized by the Board of Chiropractic Examiners as requiring adequate clinical training and as maintaining an acceptable course of chiropractic instruction.

B. An extern applicant shall:

(1) Meet all the qualifications as set forth in Health Occupations Article, §§3-302 and 3-303, Annotated Code of Maryland.

(2) Be in good standing at the chiropractic college.

(3) File the necessary application forms as required by the Board and pay an application fee as set forth in COMAR 10.43.06.

(4) Have three letters of recommendation sent directly to the Board from clinical science professors at

the extern's chiropractic college attesting to the applicant's good moral character and clinical abilities.

.04 Permitted Delegation.

A. A preceptor who is an extension faculty member may delegate duties within the scope of one's license, which constitute the practice of chiropractic, to an extern in accordance with these regulations.

B. A preceptor may permit an extern to perform chiropractic duties as part of a clinical program, subject to the following conditions:

(1) The preceptor shall maintain direct supervision of the extern.

(2) The clinical training program shall be governed by a written agreement between the extern's chiropractic college and the preceptor that:

(a) Has been approved by the Board;

(b) Describes the specific program;

(d) Indicates the legal responsibilities assumed by the extern's chiropractic college.

(3) The chiropractic college shall submit to the Board the names of those doctors selected as extension faculty members. The Board shall notify the college of those approved for the program.

(4) A licensed chiropractor may not supervise more than one extern during the same period.

(5) A licensed chiropractor may delegate or permit only duties and functions which are established as part of the clinical training program and none other.

C. Malpractice insurance in an amount defined by the Council on Chiropractic Education shall be obtained by the extern's chiropractic college and extension faculty member participating in the clinical program before the beginning of the clinical program.

D. A licensed chiropractor seeking preceptor status shall:

(1) Make written application to the Board;

(2) Pay the fee as set forth in COMAR 10.43.06;

(3) Provide written evidence of malpractice insurance as requested by the Board; and

(4) Agree to an administrative inspection of the chiropractic office spaces, equipment, and records as directed by the Board.

Administrative History

Effective date: June 17, 1985 (12:12 Md. R. 1165)

Regulation .02B amended effective August 6, 2001 (28:15 Md. R. 1398); October 22, 2007 (34:21 Md. R. 1916)

Regulation .03B amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .04B amended effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .04D adopted effective August 6, 2001 (28:15 Md. R. 1398)

Chapter 06 Fees

.01 Scope.

This chapter governs those who are licensed and certified or who are applying for licensure and certification by the Board.

.02 Fees for Chiropractic Licensure and Registration.

The following fees are established by the Board:

A. Application fee $150;

B. Examination fee $300;

C. Licensure fee $150;

D. Reexamination fee $400;

E. Renewal fee to be paid on or before August 31 of the renewal year $650;

F. Late renewal fee to be paid, in addition to the renewal fee, for renewal submitted within 30 days after August 31 $500;

G. Reinstatement fee, in addition to the renewal fee and late fee in §§E and F of this regulation, for each renewal period that the license was expired after September 30 $200;

H. Duplicate license fee $ 50;

I. Duplicate license ordered at renewal $25;

J. Inactive status fee $350;

K. Reactivation fee charged to move licensure status from inactive to active status $200;

L. Preceptorship application fee $300;

M. Extern application fee $25;

N. Licensure by credentials $750;

O. Penalty for returned checks $50;

P. Verification of licensure $25;

Q. Chiropractic assistant examination fee $200;

R. Chiropractic assistant renewal fee $200;

S. Penalty for failure to maintain correct address with the Board $200;

T. Late renewal fee for chiropractic assistants $200;

U. Supervising chiropractor application fee $300;

V. Continuing Education Course processing review fee per hourly course unit $25;

W. Mailing labels or roster $100.

.03 Fees for Massage Therapy Certification.

The following fees are established by the Board:

A. Application fee $100;

B. Certification fee $200;

C. State examination fee $275;

D. Reexamination fee $175;

E. Biennial renewal fee $200;

F. Late renewal fee (within 30 days of certificate expiration, in addition to renewal fee) $100;

G. Reinstatement fee (after 31 days of expiration of certificate or registration, in addition to renewal and late fees) $100;

H. Inactive renewal fee $50;

I. Reactivation fee $100;

J. Duplicate certificate fee $40;

K. Duplicate certificate or registration ordered at renewal $20;

L. Verification fee $25;

M. Penalty for returned checks $30;

N. Mailing labels or rosters $100;

O. Penalty for failure to maintain correct address with the Board $100.

P. Continuing Education Course processing fee per hourly course unit $25.

.04 Refunds.

A. Fees are nonrefundable with the exception of the examination fee.

B. The examination fee may be refunded at the discretion of the Board if the applicant's written request is received by registered mail at least 14 days before the examination.

.05 Assessment for Health Care Professionals.

The applicant shall pay at the time of license renewal a fee for health care professionals, assessed by the Maryland Health Care Commission (MHCC), as specified in COMAR 10.25.02.

Administrative History

Effective date: March 30, 1992 (19:6 Md. R. 674)

Regulation .02 amended as an emergency provision effective June 23, 1993 (20:14 Md. R. 1166); emergency status expired December 31, 1993

Regulation .02 amended effective February 14, 1994 (21:3 Md. R. 194)

—————

Chapter revised as an emergency provision effective August 23, 1999 (26:20 Md. R. 1543); revised permanently effective December 13, 1999 (26:25 Md. R. 1899)

Regulation .02 amended effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .02P—S adopted effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .02T adopted effective June 9, 2003 (30:11 Md. R. 735)

Regulation .03 amended effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .03K amended and .03N adopted effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .05 adopted effective August 6, 2001 (28:15 Md. R. 1398)

Chapter 07 Chiropractic Assistants

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Applicant" means a person who is undergoing training to become a chiropractic assistant.

(2) "Board" means the Board of Chiropractic Examiners.

(3) "Chiropractic assistant" means an individual who is registered by the Board to perform the duties authorized under this chapter.

(4) "Direct supervision" means supervision provided by a supervising chiropractor who is personally present and immediately available in the area where the procedures are performed to give aid, direction, and instruction when certain procedures or activities are performed.

(5) "Supervising chiropractor" means a chiropractor licensed by the Board in chiropractic with the right to practice physical therapy as set forth in Health Occupations Article, §3-301(c), Annotated Code of Maryland, and approved as a supervising chiropractor by the Board.

.02 Requirements for Achieving Supervising Chiropractor Status.

A. Only a supervising chiropractor may work with or train a chiropractic assistant or applicant.

B. Only an active, licensed chiropractor who holds physical therapy privileges and has no outstanding disciplinary orders may qualify for supervising chiropractor status.

C. An applicant for supervising chiropractor status shall:

(1) Submit to the Board the required application and fee; and

(2) Successfully pass the Board supervising chiropractor examination and interview.

.03 Responsibilities of the Supervising Chiropractor.

The supervising chiropractor shall:

A. Submit:

(1) The required Board Notification of Employment form before undertaking any training of any chiropractic assistant applicant; and

(2) All other Board-required reports and forms in a timely manner;

B. Notify the Board and course instructor or instructors of any change in status of any chiropractic applicant or assistant within 10 days of the change, including:

(1) Reasons for the change in status;

(2) Training received by the applicant or assistant;

(3) Hours completed by the applicant or assistant; and

(4) The applicant's or assistant's forwarding address;

C. Maintain accurate, legible, and comprehensive records of all clinical training provided to the chiropractic applicant or assistant, including, but not limited to:

(1) Dates and times and duration of training;

(2) Modalities;

(3) Equipment used; and

(4) Any other information as directed by the Board;

D. Immediately produce the records described in §C of this regulation upon request or audit by the Board;

E. Promptly:

(1) Report a chiropractic applicant or assistant not making satisfactory training progress; and

(2) Report before the Board as directed regarding the details of the training program issue;

F. Maintain competency in knowledge of applicable laws and regulations and successfully complete any jurisprudence requirements that may be directed by the Board;

G. Ensure that all patient records accurately and legibly reflect the extent and degree of the involvement or assistance of the chiropractic applicant or assistant;

H. Submit the in-service training hours and verification of chiropractic applicant or assistant competency on a form provided by the Board within 30 days of completion of training or transfer of the chiropractic applicant or assistant to another supervising chiropractor;

I. Be fully responsible for the safe and competent performance of the chiropractic applicant or assistant at all times; and

J. Provide direct supervision to not more than two chiropractic applicants and three chiropractic assistants.

.04 Supervising Chiropractor Prohibited Acts.

A. The supervising chiropractor may not:

(1) Delegate responsibilities in any manner to anyone not holding supervising chiropractor status;

(2) Leave the treatment area when:

(a) Treating a patient; or

(b) A chiropractic applicant or assistant is treating a patient; or

(3) Permit a chiropractic applicant or assistant to treat a patient without the presence of the supervising chiropractor in the treatment area.

B. The license of a licensee who violates this regulation shall be subject to the penalties set forth in COMAR 10.43.10.

.05 Chiropractic Applicant or Assistant Qualifications and Training.

A. A chiropractic assistant or applicant shall:

(1) Be 18 years old or older and of good moral character at the time of application;

(2) Have proof of satisfactory completion of high school or an equivalent education;

(3) Receive, within 1 year of application, minimum training consisting of:

(a) A minimum of 520 in-service training hours, with:

(i) The initial 40 hours consisting of observation procedures as listed in Regulation .09 of this chapter performed by the supervising chiropractor or registered chiropractic assistant; and

(ii) The remaining 480 hours consisting of direct supervision by a supervising chiropractor in the treatment area;

(b) 24 Board-approved hours in anatomy and terminology;

(d) 3 Board-approved hours in jurisprudence and risk management; and

(e) Certification by the American Red Cross or American Heart Association in cardiopulmonary resuscitation (CPR) at the provider level; and

(4) Successfully complete the Board-approved classroom program and in-service training and Board examination within 1 year of application unless waived on a case-by-case basis due to hardship or extenuating circumstances, as provided in §C of this regulation.

B. The Board shall approve all educational courses, programs, texts, equipment, instructors, and study materials.

C. Waiver of Educational Requirements.

(1) Upon written request to the Board, a licensed, certified, or registered healthcare provider in good standing in a Board-recognized jurisdiction, who otherwise meets the requirements of this chapter, may receive a waiver of the educational requirements of this regulation.

(2) An applicant whose educational requirements are waived shall successfully pass:

(a) Both the chiropractic assistant and jurisprudence examination; and

(b) A discretionary Board interview.

.06 Term and Renewal of Registration.

A. A registration expires every 2 years, unless the registration is renewed for a 2-year term.

B. Before a registration expires, the registrant periodically may renew it for another term if the registrant:

(1) Otherwise is entitled to be registered;

(2) Pays a renewal fee as set forth in COMAR 10.43.06;

(3) Submits to the Board a renewal application on the form that the Board requires; and

(4) Submits to the Board verification of at least 10 hours of continuing education in courses approved by the Board.

.07 Examinations.

A. An applicant who otherwise qualifies for registration is entitled to be examined as provided in this regulation.

B. The applicant shall pass a Board proficiency and jurisprudence examination.

C. The applicant shall pay to the Board an examination fee as set forth in COMAR 10.43.06.

D. The Board shall:

(1) Give examinations to applicants twice a year, at the times and places that the Board determines;

(2) Notify each qualified applicant of the time and place of examinations; and

(3) Determine the subject scope, form, and passing score for examination.

E. Reexaminations.

(1) If the applicant fails the examination twice, the applicant may retake the examination only if the applicant:

(a) Pays the reexamination fee; and

(b) Completes additional minimum 10 hour refresher classroom training courses as approved by the Board in areas of deficiency.

(2) An applicant who fails the examination twice may not perform in-service training duties in direct patient care or treatment under Regulation .03 of this chapter.

.08 Activities That May Be Performed by Chiropractic Applicants and Assistants Without Direct Supervision.

Only a chiropractic applicant or assistant may perform the following activities without the direct supervision of a supervising chiropractor:

A. Taking the height, the weight, and vital signs of a patient and recording them in the patient record;

B. Assisting in the dressing, undressing, and draping of a patient;

C. Removing and applying assistive and supportive devices; and

D. Observing treatments and modalities as authorized by the supervising chiropractor.

.09 Activities That May Be Performed by Chiropractic Applicants and Assistants Under Direct Supervision of a Supervising Chiropractor.

A chiropractic applicant or assistant may perform the following activities only under the direct supervision of a supervising chiropractor who is in the treatment area:

A. Functional activities of daily living and hygiene;

B. Gait practice and ambulation;

C. Demonstration of routine follow-up exercise;

D. Assist in moving a patient within the treatment area;

E. Contrast baths;

F. Hot and cold packs;

G. Hubbard tank;

H. Infrared, ultraviolet irradiation and nonlaser light therapy;

I. Muscle stimulation;

J. Electrotherapy;

K. Paraffin baths;

L. Traction therapy;

M. Ultrasound;

N. Whirlpool;

O. Diathermy; and

P. Therapeutic massage, if certified under Health Occupations Article, §3-5A-01, Annotated Code of Maryland.

.10 Chiropractic Applicant or Assistant Prohibited Acts.

A chiropractic applicant or assistant may not engage in any of the following activities:

A. Communicate an evaluation or diagnosis to a patient or third parties;

B. Perform an act requiring the professional skill or judgment of a licensed chiropractor;

C. Perform therapeutic massage unless certified under Health Occupations Article, §3-5A-01, Annotated Code of Maryland;

D. Take x-rays or position patients for x-rays; or

E. Laser and low-level laser treatment or therapy.

.11 Practicing Without Registration.

A. Except as otherwise provided in this chapter, a person may not practice, attempt to practice, or offer to practice as a chiropractic assistant in this State unless registered by the Board.

B. A person may not serve as a chiropractic applicant or assistant unless approved by the Board.

.12 Penalties for Violations of This Chapter.

A. Violations of these regulations may result in disciplinary action against the supervising chiropractor as set forth in Health Occupations Article, §3-313, Annotated Code of Maryland.

B. A person practicing as a chiropractic assistant without being registered, except as provided in these regulations, is guilty of a misdemeanor, and may be fined $5,000 or imprisoned for 1 year, or both.

C. A chiropractic assistant and an applicant for registration is subject to the Board's disciplinary authority under Health Occupations Article, §3-313, Annotated Code of Maryland.

.13 Display of Registration

A chiropractic assistant shall display the registration and any current renewal registration conspicuously in the space where the license holder is engaged in practice, including in any temporary space, or in any exhibit location.

Administrative History

Effective date: May 9, 1994 (21:9 Md. R. 751)

Regulation .01B amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .02 amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .03B, C amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .03C amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .04C amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .04E amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .05B amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .06 amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .07A, C amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .07C amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .08 amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .11 amended effective August 6, 2001 (28:15 Md. R. 1398)

Regulation .12 adopted effective June 9, 2003 (30:11 Md. R. 735)

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Chapter revised effective October 22, 2007 (34:21 Md. R. 1916)

Chapter 08 Licensure Examination – Special Needs Applicants

.01 Scope.

These regulations establish the procedures to be followed by examination applicants who have special needs because of a handicap or religious convictions.

.02 Eligibility Requirements.

A. An applicant with a disability may request modifications in examination materials or procedures by making a written request to the Board that includes:

(1) The applicant's name;

(2) The date of the examination to be modified;

(3) A letter from the appropriate medical professional that:

(a) Confirms the disability; and