Amendments	Fiscal Memos
SA0313	Amendment 1-0 to SB0313
SA0314	Amendment 2-0 to SB0313

	Amendments	Fiscal Memos
HA0299	Amendment 1-1 to HB0387
HA0300	Amendment 2-2 to HB0387

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

Increase State Expenditures - $1,200/Board of Chiropractic Examiners Other Fiscal Impact - Pursuant to Tenn. Code Ann. § 4-29-121, the Board of Chiropractic Examiners is required to be self-supporting over any two-year period. As of June 30, 2016, the Board had a cumulative reserve balance of $500,907. Any increase in Board expenditures incurred as a result of this bill can be handled within the Boards existing resources without an increase to fee revenue.

Bill Summary

This bill revises certain provisions governing chiropractic physicians and the board of chiropractic examiners, as discussed below. (1) This bill redefines terms relating to chiropractic practice. Under present law, the term "chiropractic" is defined as the science and art of locating and removing interference with nerve transmission and nerve function. A chiropractic physician diagnoses and treats neuromuscular and musculoskeletal conditions through physical agent modalities and manipulative therapies. The adjustment, manipulation or treatment is directed toward restoring and maintaining the normal neuromuscular and musculoskeletal function and health of the patient. A chiropractic physician also makes appropriate health referrals for conditions that may not be treated by physical agent modalities and manipulative therapies. Patient care is conducted with due regard for nutrition, environment, hygiene, sanitation and rehabilitation designed to assist in the restoration and maintenance of the patient's health. A chiropractic physician is not authorized to practice any branch of medicine, osteopathy, or surgery, including venipuncture or the prescribing of medication, acupuncture being the exception. This bill rewrites the above provision to instead define "practice of chiropractic" to mean the diagnosis and treatment of patients limited to: (A) The differential diagnosis of human ailments through examination and evaluation of patients and through the ordering and performance of appropriate diagnostic procedures necessary to clinically correlate a physical examination to a diagnostic impression; (B) The location and removal of interference with nerve transmission and nerve function; (C) The ordering of X-rays, advanced diagnostic imaging, and other diagnostic procedures, and the performance of X-rays and other diagnostic procedures for which the chiropractic physician has received training; (D) The collection of bodily fluids and specimens for analysis; (E) The treatment of neuromuscular, musculoskeletal and other conditions through the use of chiropractic adjustment and manipulation, physical agent modalities, physical therapeutics, manual, rehabilitative and other therapeutic care, and mechanical, chemical, electrical, and thermal methods; (F) The use of acupuncture by a chiropractic physician who has completed 250 hours of an accredited acupuncture course and has passed the National Board of Chiropractic Examiners Acupuncture Exam; (G) The making of appropriate referrals to other healthcare professionals for conditions that are outside the scope of practice of a chiropractic physician; (H) The ordering of durable medical equipment for patients who need such equipment to assist in the restoration of their health; and (I) The provision of supportive care with due regard for nutrition, hygiene, sanitation, and rehabilitation designed to assist in the restoration and maintenance of a patient's health. This bill specifies that a chiropractic physician is not authorized to prescribe legend drugs or controlled substances. (2) Under present law, to become a chiropractic physician a person must be a graduate of an accredited chiropractic college authorized to confer upon graduates the degree of doctor of chiropractic (D.C.). This bill requires that the college be accredited by the Council on Chiropractic Education or its successor, or that the person be a graduate of an international chiropractic college approved by the board of chiropractic examiners. (3) This bill revises provisions relating to the board of chiropractic examiners as follows: (A) Under present law, to be eligible for appointment to the board of chiropractic a chiropractor must be actively engaged in the practice of the profession of chiropractic. This bill specifies that the person must be so practicing "within this state"; (B) Under present law, each member of the board receives $50.00 per diem when actually engaged in the discharge of that member's official duties. This bill increases the per diem to $100; (C) Under present law, when requested, licensees must provide the board satisfactory proof of the licensee's attendance at a chiropractic education program or programs conducted by either the American Chiropractic Association, the International Chiropractors Association, the Tennessee Chiropractic Association, the Tennessee Chiropractic Society, or any other educational program approved or conducted by the board. This bill removes the Tennessee Chiropractic Society from this list; and (D) Present law requires the board to adopt rules and regulations that establish minimum educational standards and criteria for persons performing physical agent modalities and physical treatment in a chiropractic physician's office. This bill rewrites this provision to instead require the board to adopt rules that establish minimum educational standards and criteria for chiropractic therapy assistants performing physical agent modalities, physical treatment, and clinical services under the supervision of a chiropractic physician in the office of the chiropractic physician. ON MAY 4, 2017, THE HOUSE ADOPTED AMENDMENTS #1 AND #2 AND PASSED HOUSE BILL 387, AS AMENDED. AMENDMENT #1 defines the items described above in the bill summary in (1)(A), (C), and (D) as "diagnosis"; defines the items in (1)(B) and (1)(E)-(I) as "treatment"; and defines "practice of chiropractic" to mean the diagnosis and treatment of patients. This amendment revises the items described in (1)(D) to be "the collection of blood, urine, saliva, and hair for analysis" and specifies that venipuncture will only be done by a phlebotomist or other person properly trained to draw blood. This amendment also revises the items in (1)(E) to be "the treatment of neuromuscular, musculoskeletal, and related conditions through the use of chiropractic adjustment and manipulation; physical agent modalities; physical therapeutics; manual, rehabilitative, and other therapeutic care; and mechanical, chemical, electrical, and thermal methods. This amendment adds as "diagnosis" the performance of other noninvasive procedures, in addition to the performance of X-rays, for which the chiropractic physician has received training by an institution accredited by the Council on Chiropractic Education or its successor and which have been approved by the board of chiropractic examiners after consultation with the board of medical examiners. This amendment also revises the rulemaking requirement described in the bill summary in (3)(D) to instead require the board to adopt rules that establish minimum educational standards and criteria for chiropractic therapy assistants performing physical agent modalities, physical treatment, and clinical services that are within the scope of practice of a chiropractic physician and, under the supervision of a chiropractic physician, either in the office of the chiropractic physician or in the presence of the chiropractic physician at another location. AMENDMENT #2 removes "physical therapeutics" from this bill's definition of treatment.