AN ACT Relating to establishing a chiropractic practice board; amending RCW 18.25.005, 18.25.019, 18.25.020, 18.25.030, 18.25.040, 18.25.070, and 18.130.020; reenacting and amending RCW 18.120.020 and 18.130.040; adding new sections to chapter 18.25 RCW; repealing RCW 18.25.015, 18.25.050, 18.25.100, 18.26.010, 18.26.020, 18.26.028, 18.26.030, 18.26.040, 18.26.050, 18.26.060, 18.26.070, 18.26.080, 18.26.090, 18.26.110, 18.26.900, 43.131.295, and 43.131.296; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 7, chapter 97, Laws of 1974 ex. sess. and RCW 18.25.005 are each amended to read as follows:

For the purpose of chapter((s)) 18.25 ((~~and 18.26~~)) RCW, the term "chiropractic" shall mean and include that practice of health care which deals with the detection of subluxations, which shall be defined as any alteration of the biomechanical and physiological dynamics of contiguous spinal structures which can cause neuronal disturbances, the chiropractic procedure preparatory to, and complementary to the correction thereof, by adjustment or manipulation of the articulations of the vertebral column and its immediate articulations for the restoration and maintenance of health; it includes the normal regimen and rehabilitation of the patient, physical examination to determine the necessity for chiropractic care, the use of x-ray and other analytical instruments generally used in the practice of chiropractic: PROVIDED, That no chiropractor shall prescribe or dispense any medicine or drug nor practice obstetrics or surgery nor use x-rays for therapeutic purposes: PROVIDED, HOWEVER, That the term "chiropractic" as defined in this ((~~act~~)) chapter shall not prohibit a practitioner licensed under chapter 18.71 RCW from performing accepted medical procedures, except such procedures shall not include the adjustment by hand of any articulation of the spine: AND PROVIDED FURTHER, That nothing herein shall be construed to prohibit the rendering of dietary advice.

NEW SECTION. Sec. 2. A new section is added to chapter 18.25 RCW to read as follows:

The definitions in this section apply throughout this chapter unless the context clearly indicates otherwise:

(1) "Board" means the chiropractic practice board.

(2) "License" means a certificate of license to practice chiropractic in this state as provided for in this chapter.

(3) "Members" means members of the chiropractic practice board.

(4) "Secretary" means the secretary of the chiropractic practice board.

(5) "Department" means the department of licensing.

(6) "Director" means the director of licensing.

NEW SECTION. Sec. 3. A new section is added to chapter 18.25 RCW to read as follows:

(1) The chiropractic practice board is created. The board shall consist of thirteen practicing doctors of chiropractic and two members of the public. The board shall perform the duties as provided in this chapter.

(2) The director of licensing shall appoint the members of the board. The doctors of chiropractic shall hold a bachelors degree, have graduated from a chiropractic college accredited by the United States department of education approved accrediting agency, have passed the national board of chiropractic examiners boards I and II, and have been engaged in the active licensed practice of chiropractic medicine in this state for a minimum of three years. In making the appointments of the doctors of chiropractic, the director shall consider qualities including but not limited to professional leadership, community service, scientific achievement, postgraduate work, and teaching services. The director shall appoint the members of the public from persons whose occupation is other than the administration of health activities or the provision of health services, who have no fiduciary obligation to a health facility or other health agency, and who have no material financial interest in the rendering of health services. No public member of the board may be related by blood or marriage to any other member of the board, to any person providing health services, or to any person administering health activities. (3) Appointments shall be for a term of three years. The director or the director's designee shall designate the terms of the initial members of the board. The terms of the initial members shall be staggered. Members may only serve two consecutive terms, but may be eligible to serve again after being off the board for not less than a three-year period.

(4) Vacancies of members shall be filled within thirty days of the existence thereof by the director as in the case of original appointment, the appointee to hold office for the remainder of the unexpired term.

(5) Any member of the board may be removed by the director for neglect of duty, misconduct, malfeasance, or misfeasance in office, after being given a statement of the charges against the member and sufficient opportunity to be heard thereon.

(6) The director may appoint temporary members who may be called by the chair of the board to assist or serve with the board or its subcommittees in the absence of regular board members or due to increased work load. Temporary board members shall meet the requirements of subsection (2) of this section.

NEW SECTION. Sec. 4. A new section is added to chapter 18.25 RCW to read as follows:

(1) The board shall divide itself into at least three subcommittees as follows:

(a) The disciplinary subcommittee consisting of at least four board members who are doctors of chiropractic and one public member which shall be responsible for carrying out the duties under RCW 18.25.019 and chapter 18.130 RCW but the action of the full board is necessary to make a final decision. Upon the written request of the disciplinary subcommittee, the office of administrative hearings shall make a sufficient number of administrative law judges available for decisions to be made in a timely manner;

(b) The examining and education subcommittee consisting of at least four board members who are doctors of chiropractic and one public member which shall be responsible for the licensing, examination, and education duties under this chapter; and

(c) The peer review and utilization subcommittee consisting of at least three board members who are doctors of chiropractic and one public member which shall have the responsibilities under section 5 of this act.

(2) The subcommittees shall submit their recommendations and findings to the board. All final decisions shall be made by the full board, but seven members shall constitute a quorum for conducting business.

(3) The board may create additional subcommittees.

NEW SECTION. Sec. 5. A new section is added to chapter 18.25 RCW to read as follows:

(1) The peer review and utilization subcommittee shall review directly the fees of doctors of chiropractic licensed under this chapter. A major purpose of this section is to provide for the regulation of the cost of health care by doctors of chiropractic and its impact upon the business of insurance through peer review activities.

(2) If the board directs, peer review shall be performed by the peer review and utilization subcommittee. The subcommittee shall advise the board as to the appropriateness of services and fees rendered by the doctors of chiropractic whose activities the subcommittee reviews. The board shall establish criteria for screening requests for peer review. Such screening shall occur upon submission by a patient, the patient's representative, insurer, or a doctor of chiropractic of an inquiry about a bill for treatment rendered to a patient by a doctor of chiropractic.

(3) For each peer review request, the peer review and utilization subcommittee shall have the authority to establish and charge a fee, not to exceed fifty dollars, to be paid by the person submitting the request, to assist in defraying the administrative costs of performing the review.

(4) Peer review shall occur upon submission by a patient, the patient's representative, insurer, or a doctor of chiropractic, in accordance with the procedures approved by the board, of an inquiry about a bill for treatment rendered to a patient by a doctor of chiropractic. The peer review and utilization subcommittee shall examine each inquiry submitted to it by the board and shall report its findings to the board for action. The board shall cause copies of such findings to be distributed to the patient, doctor of chiropractic, and third-party payor. The findings of a peer review and utilization subcommittee on each inquiry submitted to it shall be referred to the board and shall include a determination of whether or not the doctor of chiropractic properly utilized services and rendered or ordered appropriate medical treatment or services and whether or not the cost of such treatment was appropriate. The board may adopt, modify, or reject the subcommittee's recommendations.

(5) An annual summary of the findings of the peer review and utilization subcommittee shall be prepared by the board and submitted to the department of licensing. The report may be made available to interested persons upon request and upon payment of necessary administrative costs to defray the expenses of reproduction. No report or summary submitted to the public by the department may disclose the name of identifier of any patient.

(6) The acceptance of, or the request for, payment for treatment rendered to a patient by a doctor of chiropractic constitutes the consent of the doctor of chiropractic to the submission of all necessary records and other information concerning such treatment to the peer review and utilization subcommittee.

(7)(a) The criteria or standards established for the peer review and utilization subcommittee may be adopted by the board as rules under chapter 34.04 RCW. Such criteria shall be developed to conform with accepted standards of the practice of chiropractic.

(b) The decision by the board to refer a matter to a peer review and utilization subcommittee, the establishment by the board of the procedures by which the rendering of chiropractic services are reviewed, and the proceedings and findings of the peer review and utilization subcommittee are not a contested case under chapter 34.04 RCW.

NEW SECTION. Sec. 6. A new section is added to chapter 18.25 RCW to read as follows:

The director, members of the board, and individuals acting on their behalf are immune from suit in any action, civil or criminal, based on any acts performed in the course of their duties.

NEW SECTION. Sec. 7. A new section is added to chapter 18.25 RCW to read as follows:

In addition to those acts defined in chapter 18.130 RCW, the term "unprofessional conduct" as used in this chapter includes failing to differentiate chiropractic care from any and all other methods of healing at all times.

Sec. 8. Section 21, chapter 259, Laws of 1986 and RCW 18.25.019 are each amended to read as follows:

The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses, and the discipline of licensees under this chapter.

Sec. 9. Section 5, chapter 5, Laws of 1919 as last amended by section 14, chapter 7, Laws of 1985 and RCW 18.25.020 are each amended to read as follows:

(1) Any person not now licensed to practice chiropractic in this state and who desires to practice chiropractic in this state, before it shall be lawful for him to do so, shall make application therefor to the director, upon such form and in such manner as may be adopted and directed by the director. Each applicant who matriculates after January 1, 1975, shall have completed ((~~not less than one-half of the requirements for~~)) a baccalaureate degree at an accredited and approved college or university and shall be a graduate of a chiropractic school or college accredited and approved by the chiropractic practice board ((~~of chiropractic examiners~~)) and shall show satisfactory evidence of completion by each applicant of a resident course of study of not less than four thousand classroom hours of instruction in such school or college. Applications shall be in writing and shall be signed by the applicant in his own handwriting and shall be sworn to before some officer authorized to administer oaths, and shall recite the history of the applicant as to his educational advantages, his experience in matters pertaining to a knowledge of the care of the sick, how long he has studied chiropractic, under what teachers, what collateral branches, if any, he has studied, the length of time he has engaged in clinical practice; accompanying the same by reference therein, with any proof thereof in the shape of diplomas, certificates, and shall accompany said application with satisfactory evidence of good character and reputation.

(2) There shall be paid to the director by each applicant for a license, a fee determined by the director as provided in RCW 43.24.086 which shall accompany application and a fee determined by the director as provided in RCW 43.24.086, which shall be paid upon issuance of license. Like fees shall be paid for any subsequent examination and application.

Sec. 10. Section 6, chapter 5, Laws of 1919 as last amended by section 10, chapter 97, Laws of 1974 ex. sess. and RCW 18.25.030 are each amended to read as follows:

Examinations for license to practice chiropractic shall be made by the board ((~~of chiropractic examiners~~)) according to the method deemed by it to be the most practicable and expeditious to test the applicant's qualifications. Such application shall be designated by a number instead of his or her name, so that the identity shall not be discovered or disclosed to the members of the examining committee until after the examination papers are graded.

All examinations shall be in whole or in part in writing, the subject of which shall be as follows: Anatomy, physiology, hygiene, symptomatology, neurology, spinal pathology, x-ray, principles of chiropractic and adjusting, as taught by chiropractic schools and colleges. A license shall be granted to all applicants who shall correctly answer seventy-five percent of all questions asked, and if any applicant shall fail to answer correctly seventy percent of the questions on any branch of said examination, he or she shall not be entitled to a license.

Sec. 11. Section 14, chapter 5, Laws of 1919 as last amended by section 15, chapter 7, Laws of 1985 and RCW 18.25.040 are each amended to read as follows:

Persons licensed to practice chiropractic under the laws of any other state having equal requirements of this chapter, may, in the discretion of the board ((~~of chiropractic examiners~~)), and after examination by the board in principles of chiropractic, x-ray, and adjusting, as taught by chiropractic schools and colleges, be issued a license to practice in this state without further examination, upon payment of a fee determined by the director as provided in RCW 43.24.086.

Sec. 12. Section 10, chapter 5, Laws of 1919 as last amended by section 17, chapter 7, Laws of 1985 and RCW 18.25.070 are each amended to read as follows:

(1) Every person practicing chiropractic shall, as a prerequisite to annual renewal of license, submit to the director at the time of application therefor, satisfactory proof showing attendance of at least twenty-five hours during the preceding three-year period, at one or more chiropractic symposiums which are recognized and approved by the board ((~~of chiropractic examiners~~)): PROVIDED, That the board may, for good cause shown, waive said attendance. The following guidelines for such symposiums shall apply:

(a) Symposiums which shall be approved by the board for licensees practicing or residing within the state of Washington are those sponsored or conducted by any chiropractic association in the state or an approved chiropractic college or other institutions or organizations which devote themselves to lectures or demonstrations concerning matters which are recognized in the state of Washington chiropractic licensing laws;

(b) Rules shall be adopted by the board for licensees practicing and residing outside the state who shall meet all requirements established by the board by rules and regulations.

(2) Every person practicing chiropractic within this state shall pay on or before the first day of September of each year, after a license is issued to him or her as herein provided, to said director a renewal license fee to be determined by the director as provided in RCW 43.24.086. The director shall, thirty days or more before September first of each year, mail to all chiropractors in the state a notice of the fact that the renewal fee will be due on or before the first of September. Nothing in this chapter shall be construed so as to require that the receipts shall be recorded as original licenses are required to be recorded.

The failure of any licensed chiropractor to pay ((~~his~~)) the annual license renewal fee by the first day of October following the date on which the fee was due shall work a forfeiture of his or her license. It shall not be reinstated except upon evidence that continuing educational requirements have been fulfilled and the payment of a penalty to be determined by the director as provided in RCW 43.24.086, together with all annual license renewal fees delinquent at the time of the forfeiture, and those for each year thereafter up to the time of reinstatement. ((~~Should the licentiate allow his~~)) If the licensee allows the license to elapse for more than three years, he or she must be reexamined as provided for in RCW 18.25.040.

Sec. 13. Section 3, chapter 117, Laws of 1985 and section 28, chapter 326, Laws of 1985 and RCW 18.120.020 are each reenacted and amended to read as follows:

The definitions contained in this section shall apply throughout this chapter unless the context clearly requires otherwise.

(1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.

(2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.

(3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.

(4) "Health professions" means and includes the following health and health-related licensed or regulated professions and occupations: Podiatry under chapter 18.22 RCW; chiropractic under chapter((s)) 18.25 ((~~and 18.26~~)) RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; dispensing opticians under chapter 18.34 RCW; hearing aids under chapter 18.35 RCW; drugless healing under chapter 18.36 RCW; embalming and funeral directing under chapter 18.39 RCW; midwifery under chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW; optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55 RCW; osteopathy and osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71, 18.71A, and 18.72 RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.78 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.88 RCW; occupational therapists licensed pursuant to chapter 18.59 RCW; veterinarians and animal technicians under chapter 18.92 RCW; health care assistants under chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW; and acupuncturists certified under chapter 18.06 RCW.

(5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.

(6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.

(7) "License", "licensing", and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.

(8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.

(9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.

(10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.

(11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.

(12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.

(13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.

Sec. 14. Section 2, chapter 279, Laws of 1984 as amended by section 2, chapter 259, Laws of 1986 and RCW 18.130.020 are each amended to read as follows:

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Disciplining authority" means (a) the board of medical examiners, the board of dental examiners, and the board of chiropractic ((~~examiners~~)) practice with respect to applicants for a license for the respective professions, (b) the medical disciplinary board, the dental disciplinary board, and the chiropractic ((~~disciplinary~~)) practice board with respect to holders of licenses for the respective professions, or (c) the agency or board having the authority to take disciplinary action against a holder of, or applicant for, a professional or business license upon a finding of a violation of this chapter or a chapter specified under RCW 18.130.040.

(2) "Department" means the department of licensing.

(3) "Director" means the director of licensing or the director's designee.

(4) "Board" means any of those boards specified in RCW 18.130.040.

(5) "Unlicensed practice" means:

(a) Practicing a profession or operating a business identified in RCW 18.130.040 without holding a valid, unexpired, unrevoked, and unsuspended license to do so; or

(b) Representing to a consumer, through offerings, advertisements, or use of a professional title or designation, that the individual is qualified to practice a profession or operate a business identified in RCW 18.130.040, without holding a valid, unexpired, unrevoked, and unsuspended license to do so.

(6) "Disciplinary action" means sanctions identified in RCW 18.130.160.

(7) "Practice review" means an investigative audit of records related to the complaint, without prior identification of specific patient or consumer names, to determine whether unprofessional conduct may have been committed.

(8) "Health agency" means city and county health departments and the department of social and health services.

(9) "License," "licensing," and "licensure" shall be deemed equivalent to the terms "license," "licensing," "licensure," "certificate," "certification," and "registration" as those terms are defined in RCW 18.120.020.

Sec. 15. Section 4, chapter 279, Laws of 1984 as amended by section 29, chapter 326, Laws of 1985 and by section 3, chapter 259, Laws of 1986 and RCW 18.130.040 are each reenacted and amended to read as follows:

(1) This chapter applies only to the director and the boards having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

(2) (a) The director has authority under this chapter in relation to the following professions:

(i) Dispensing opticians licensed under chapter 18.34 RCW;

(ii) Drugless healers licensed under chapter 18.36 RCW;

(iii) Midwives licensed under chapter 18.50 RCW;

(iv) Ocularists licensed under chapter 18.55 RCW;

(v) Massage operators and businesses licensed under chapter 18.108 RCW;

(vi) Dental hygienists licensed under chapter 18.29 RCW; and

(vii) Acupuncturists certified under chapter 18.106 RCW.

(b) The boards having authority under this chapter are as follows:

(i) The podiatry board as established in chapter 18.22 RCW;

(ii) The chiropractic ((~~disciplinary~~)) practice board ((~~as established in chapter 18.26 RCW governing licenses issued~~)) under chapter 18.25 RCW;

(iii) The dental disciplinary board as established in chapter 18.32 RCW;

(iv) The board of funeral directors and embalmers as established in chapter 18.39 RCW;

(v) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;

(vi) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;

(vii) The medical disciplinary board as established in chapter 18.72 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;

(viii) The board of physical therapy as established in chapter 18.74 RCW;

(ix) The board of occupational therapy practice as established in chapter 18.59 RCW;

(x) The board of practical nursing as established in chapter 18.78 RCW;

(xi) The board of nursing as established in chapter 18.88 RCW; and

(xii) The veterinary board of governors as established in chapter 18.92 RCW.

(3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. However, the board of chiropractic ((~~examiners~~)) practice has authority over issuance and denial of licenses provided for in chapter 18.25 RCW, the board of dental examiners has authority over issuance and denial of licenses provided for in RCW 18.32.040, and the board of medical examiners has authority over issuance and denial of licenses and registrations provided for in chapters 18.71 and 18.71A RCW. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.

NEW SECTION. Sec. 16. The following acts or parts of acts are each repealed:

(1) Section 1, chapter 53, Laws of 1959, section 1, chapter 50, Laws of 1965 ex. sess., section 1, chapter 51, Laws of 1980, section 49, chapter 279, Laws of 1984 and RCW 18.25.015;

(2) Section 8, chapter 5, Laws of 1919, section 21, chapter 30, Laws of 1975 1st ex. sess., section 2, chapter 277, Laws of 1981, section 16, chapter 7, Laws of 1985 and RCW 18.25.050;

(3) Section 16, chapter 5, Laws of 1919 and RCW 18.25.100;

(4) Section 1, chapter 171, Laws of 1967 and RCW 18.26.010;

(5) Section 2, chapter 171, Laws of 1967 and RCW 18.26.020;

(6) Section 22, chapter 259, Laws of 1986 and RCW 18.26.028;

(7) Section 3, chapter 171, Laws of 1967, section 12, chapter 97, Laws of 1974 ex. sess., section 1, chapter 39, Laws of 1975 1st ex. sess., section 17, chapter 111, Laws of 1979 ex. sess., section 25, chapter 259, Laws of 1986 and RCW 18.26.030;

(8) Section 1, chapter 46, Laws of 1980 and RCW 18.26.040;

(9) Section 5, chapter 171, Laws of 1967, section 21, chapter 158, Laws of 1979 and RCW 18.26.050;

(10) Section 6, chapter 171, Laws of 1967 and RCW 18.26.060;

(11) Section 2, chapter 46, Laws of 1980, section 28, chapter 287, Laws of 1984 and RCW 18.26.070;

(12) Section 8, chapter 171, Laws of 1967 and RCW 18.26.080;

(13) Section 9, chapter 171, Laws of 1967 and RCW 18.26.090;

(14) Section 11, chapter 171, Laws of 1967, section 2, chapter 39, Laws of 1975 1st ex. sess., section 26, chapter 259, Laws of 1986 and RCW 18.26.110;

(15) Section 31, chapter 171, Laws of 1967 and RCW 18.26.900;

(16) Section 21, chapter 197, Laws of 1983 and RCW 43.131.295; and

(17) Section 47, chapter 197, Laws of 1983 and RCW 43.131.296.

NEW SECTION. Sec. 17. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 18. This act is necessary for the immediate preservation of the public peace, health, and safety, the support of the state government and its existing public institutions, and shall take effect June 30, 1987.