WSR 18-24-122
(Chiropractic Quality Assurance Commission)
[Filed December 5, 2018, 9:42 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-21-066.
Title of Rule and Other Identifying Information: The chiropractic quality assurance commission (commission) standards of care, WAC 246-808-320 Protected health information (formerly privileged communications), 246-808-330 Discontinuation of care (formerly patient abandonment), 246-808-350 Unethical requests, 246-808-360 Patient welfare, 246-808-370 Patient disclosure, 246-808-380 Degree of skill, 246-808-390 Illegal practitioners, and 246-808-520 Identification. The commission is proposing to amend, repeal, and update the rules to clarify and consolidate them.
Hearing Location(s): On January 10, 2019, at 10:00 a.m., at the DoubleTree by Hilton - Seattle Airport, 18740 International Boulevard, Seattle, WA 98188.
Date of Intended Adoption: January 10, 2019.
Submit Written Comments to: Robert Nicoloff, Executive Director, Chiropractic Quality Assurance Commission, P.O. Box 47858, Olympia, WA 98504-7858, email, fax 360-236-2360, by January 2, 2019.
Assistance for Persons with Disabilities: Contact Robert Nicoloff, phone 360-236-4924, fax 360-236-2360, TTY 360-833-6388 or 711, email, by January 2, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The commission is proposing to amend WAC 246-808-320, 246-808-330, 246-808-350, 246-808-360, 246-808-390 and 246-808-520, in order to clarify, streamline, and modernize the rule language, and to be consistent with current laws and practice standards. The commission is also proposing to repeal WAC 246-808-370 and 246-808-380, after incorporating the rule language into other rule sections identified within the scope of rule making.
History: Except for revising individual rule sections, a comprehensive review of the chiropractic chapter has not been conducted since 1996. When completed, the proposed changes will satisfy the requirements in law to review rules every five years, along with other rule making currently being done.
As part of the rules chapter review, the commission identified a need for the following improvements, updates, or clarifications:
Addition of direct references in WAC 246-808-320 to state and federal regulations regarding protected health information, in place of outdated language;
Clear direction added to WAC 246-808-330 that a chiropractor must not neglect, ignore, abandon, or refuse to provide treatment to a current patient without reasonable cause, and the steps the chiropractor must take when choosing to discontinue treatment. The current rule is unclear and doesn't directly address patient abandonment;
Combination of four sections dealing with patient welfare into one section and repeal of the other three sections (WAC 246-808-370, 246-808-380 and 246-808-390, being added to WAC 246-808-360) making it easier and more efficient for stakeholders to find. Additionally, the commission is proposing repealing WAC 246-808-390 Illegal practitioners, as this is an existing requirement in the chiropractic laws within RCW 18.25.002 and 18.25.011, and the Uniform Disciplinary Act in RCW 18.180.130, therefore making this rule redundant; and
Clarification added to WAC 246-808-520 on how chiropractors must identify themselves and in WAC 246-808-350 on unethical requests to conceal patient physical disabilities or conditions.
The commission has determined that these sections are outdated, unclear, duplicative of other rule sections, or did not address the topic in the rule title (patient abandonment). Therefore, the need for clarification and streamlining of these rule sections was identified.
Reasons Supporting Proposal: It is the purpose of the commission established under RCW 18.25.0151 to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline. Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state. The proposal meets the intent of the statute by clarifying, streamlining, and modernizing the rules, by making the rules consistent with current laws and practice standards while further protecting the public, and by condensing similar rule sections into one rule for efficiency and ease of use purposes.
Statutory Authority for Adoption: RCW 18.25.0171 and 18.130.050.
Statute Being Implemented: RCW 18.25.0171.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Leann Yount, Program Yount [Manager], Chiropractic Quality Assurance Commission, P.O. Box 47858, Olympia, WA 9504-7858 [98504-7858], governmental.
Name of Agency Personnel Responsible for Drafting and Implementation: Leann Yount, 310 Israel Road S.E., Tumwater, WA 98501, 360-236-2822; and Enforcement: Tammy Kelley, 310 Israel Road S.E., Tumwater, WA 98501, 360-236-2822.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Leann Yount, Program Manager, Chiropractic Quality Assurance Commission, P.O. Box 47858, Olympia, WA 98504-7858, phone 360-236-2822, fax 360-236-2360, TTY 360-833-6388 or 711, email
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rules do not affect businesses.
December 3, 2018
Robert Nicoloff
Executive Director
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-320((Privileged communications.))Protected health information.
((A chiropractor shall not, without the consent of the patient, reveal any information acquired in attending such patient, which was necessary to enable the chiropractor to treat the patient. This shall not apply to the release of information in an official proceeding where the release of information may be compelled by law.))A chiropractor shall comply with the provisions of the Federal Health Insurance Portability and Accountability Act, 42 U.S.C. Sec. 1302(a) and 42 U.S.C. Sec. 1302d-1320d-9, the Health Information Portability and Accountability Act (HIPAA), 45 C.F.R. Parts 160, 162, and 165.
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-330((Patient abandonment.))Discontinuation of care.
((The chiropractor shall always be free to accept or reject a particular patient, bearing in mind that whenever possible a chiropractor shall respond to any reasonable request for his/her services in the interest of public health and welfare.))If a chiropractor chooses to discontinue care, the chiropractor shall:
(1) Advise the patient in writing and document in the patient record that the chiropractor is terminating the doctor-patient relationship; and
(2) Advise the patient to seek any future treatment from another chiropractor or health care provider.
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-350Unethical requests.
A chiropractor shall not ((assist in any immoral practice such as aiding))aid a patient in the pretense ((of disability in order to avoid jury or military duty,)) or the concealment of a physical condition or disability ((in order to secure favorable insurance)).
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-360Patient welfare.
The health and welfare of the patient shall always be paramount((, and expectation of remuneration or lack thereof shall not in any way affect the quality of service rendered the indigent patient)).
(1) A chiropractor owes their patient(s) the highest degree of skill and care.
(2) Absolute honesty shall characterize all transactions with patients.
(3) A chiropractor shall act in the best interest of the patient and not in the interest of any other party.
(4) A chiropractor shall provide evaluations, opinions, and recommendations that are unbiased.
(5) A chiropractor shall neither intentionally exaggerate nor minimize the gravity of the patient's condition, nor offer any false hope or prognosis.
(6) A chiropractor shall provide the highest quality of services regardless of expectation of reimbursement or lack thereof, including care provided to an indigent patient.
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-390Illegal practitioners.
A chiropractor((s)) shall safeguard their profession by exposing those who ((might attempt to)) practice without proper credentials((, and by reporting violations of the laws regulating chiropractic to the proper authorities)). This is in addition to mandatory reporting rules adopted by the secretary of health.
AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)
WAC 246-808-520Identification.
(1) ((A))When using their name, a licensed chiropractor must clearly identify oneself as a chiropractor on ((his/her))their office signs, web site, business cards, letterhead, electronic and other media with the use of one or more of the following: Doctor of chiropractic; D.C.; D.C., Ph.C.; chiropractor; or chiropractic physician consistent with RCW 18.25.090.
(2) ((All identification of chiropractic practice shall be presented))A chiropractor shall identify and present their chiropractic practice in a dignified manner, and ((shall not be))not in a sensational or misleading way.
(3) A chiropractor practicing in a multidisciplinary setting must identify oneself as a chiropractor.
(4) Nothing in this section prohibits the use of a business name that does not include one of the terms in subsection (1) of this section.
The following sections of the Washington Administrative Code are repealed:
WAC 246-808-370
Patient disclosure.
WAC 246-808-380
Degree of skill.