PROPOSAL
Maryland Register
Issue Date: February 1, 2019
Volume 46 • Issue 3 • Page 136-138
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 43 BOARD OF CHIROPRACTIC EXAMINERS
10.43.05 Chiropractic Externship Program
Authority: Health Occupations Article, §§3-205 and 3-301, Annotated Code of Maryland
Notice of Proposed Action
[19-045-P]
The Secretary of Health proposes to amend Regulations .01—.04 under COMAR 10.43.05 Chiropractic Externship Program. This action was considered by the Board of Chiropractic Examiners at a public meeting held on October 11, 2018, notice of which was given by publication on the Board’s website at https://health.maryland.gov/chiropractic/Pages/index.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to update and reflect changes in the chiropractic profession, add preceptorship language, and clarify eligibility requirements established in Ch. 658, Acts of 2018.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Jake Whitaker, Acting Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through March 4, 2019. A public hearing has not been scheduled.
.01 Scope.
These regulations apply to all [chiropractic]:
A. Chiropractic externs, chiropractic extern applicants, and licensed chiropractors who are extension faculty members of a chiropractic college accredited by the Council on Chiropractic Education or its successor[.]; and
B. Licensed chiropractors approved by the Board to provide an externship.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) “Accredited [college] Board-approved educational institution” means a chiropractic school [or], college, or university 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) (text unchanged)
(4) “Chiropractic extern program” means [a]:
(a) A 2-semester clinical program:
[(a)] (i) In which a chiropractic [externs participate] student, that has completed all requirements to graduate, participates under the direct supervision of a licensed chiropractor who has been approved by the Board to serve as a preceptor; and
[(b)] (ii) That operates in a facility where chiropractic services have been approved by the Board [of Chiropractic Examiners.]; or
(b) A 6-month clinical program in which an individual has:
(i) Begun the process of applying for licensure, but has not met certain requirements set forth under COMAR 10.43.04;
(ii) Graduated from an accredited Board-approved educational institution;
(iii) Taken and passed the examination of the National Board of Chiropractic Examiners (NBCE);
(iv) Been approved for an extern license by the Board; and
(v) Agreed to practice under the direct supervision of a preceptor who is a Board-approved licensed chiropractor while the extern license is in effect.
(5) “Direct supervision” means a licensed chiropractor [remains]:
(a) Remains on the premises at all times [and directly];
(b) Directly supervises and continuously monitors the extern’s performance within the practice; and
(c) Is immediately available to offer assistance.
(6) “Extern” means [an]:
(a) An individual who has [enrolled]:
(i) Enrolled in an accredited [chiropractic college] Board-approved educational institution [who] and has completed all requirements for the Doctor of Chiropractic program except for the final clinical phase of the program[.]; or
(ii) Graduated from an accredited Board-approved educational institution and is in the process of applying to the Board for a license to practice chiropractic, but has yet to meet certain requirements set forth under COMAR 10.43.04 to qualify for a license; or
(b) A chiropractor licensed in another state who is in the process of applying to the Board for a license to practice chiropractic, but has yet to meet certain requirements set forth under COMAR 10.43.04 to qualify for a license.
(7)—(8) (text unchanged)
(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] Board-approved educational institution.
(10) “Preceptor sponsor” means a licensed chiropractor approved by the Board to supervise the following who are in the process of applying for licensure:
(a) A recent graduate that has completed a preceptorship program; or
(b) A chiropractor licensed in another state, whose license is in good standing.
.03 Eligibility.
A. An extern applicant is eligible for approval in the chiropractic extern program if the applicant is [currently]:
(1) Currently enrolled in an approved program that is recognized by the Board [of Chiropractic Examiners] as [requiring]:
(a) Requiring adequate clinical training; and [as maintaining]
(b) Maintaining an acceptable course of chiropractic instruction[.];
(2) A recent graduate that has completed a preceptorship program; or
(3) A chiropractor licensed in another state, whose license is in good standing.
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]:
(a) At the [chiropractic college] accredited Board-approved educational institution[.]; or
(b) In the state currently licensed;
(3) [File the necessary] Submit the completed application forms as required by the Board [and pay];
(4) Pay [an] the application fee as set forth in COMAR 10.43.06[.];
(5) Submit to a criminal background check;
[(4)] (6) Have three letters of recommendation sent directly to the Board [from]:
(a) From clinical science professors at the extern’s [chiropractic college] accredited Board-approved educational institution attesting to the applicant’s good moral character and clinical abilities[.]; or
(b) Two of which shall be from chiropractors attesting to the applicant’s good moral character and one letter from the licensing board of the state in which the applicant is currently licensed attesting that the license is in good standing; and
(7) Be withdrawn from the program if the applicant has not obtained a license to practice chiropractic within 6 months from the date the externship is approved.
.04 Permitted Delegation.
A. A preceptor who is a Board-approved licensed chiropractor or 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] COMAR 10.43.
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] accredited Board-approved educational institution and the preceptor that:
(a)—(b) (text unchanged)
(c) Enumerates the functions the extern may perform; and
(d) Indicates the legal responsibilities assumed by the extern’s [chiropractic college.] accredited Board-approved educational institution;
(3) The [chiropractic college] accredited Board-approved educational institution shall submit to the Board the names of those doctors selected as extension faculty members. The Board shall notify the [college] educational institution 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.];
(6) The extern may not supervise chiropractic assistants or trainees[.]; and
(7) An extern applicant that is a licensed chiropractor in another state shall have a preceptor sponsor.
C. A preceptor may permit a licensed extern to perform chiropractic duties as part of the chiropractic practice providing the preceptor:
(1) Maintains direct supervision of the extern; and
(2) Ensures the compliance of the extern to the conditions set forth under Regulation .03B(7) of this chapter.
D. A preceptor with a license to practice chiropractic with physical therapy privileges may supervise an applicant applying for a license to practice chiropractic:
(1) With physical therapy privileges; and
(2) Without physical therapy privileges.
E. A preceptor with a license to practice chiropractic without physical therapy privileges may only supervise an extern applying for a license to practice chiropractic without physical therapy privileges.
[C.] F. Malpractice insurance in an amount defined by the Council on Chiropractic Education shall be obtained:
(1) Before the clinical program begins, by the extern’s [chiropractic college]:
(a) Accredited Board-approved educational institution; and [extension]
(b) Extension faculty member participating in the clinical program [before the beginning of the clinical program]; or
(2) By the preceptor sponsor of an extern applicant.
[D.] G. A licensed chiropractor seeking preceptor status shall:
(1) [Make] Submit a completed written application to the Board;
(2)—(4) (text unchanged)
ROBERT R. NEALL
Secretary of Health
