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F I S C A L I M P A C T R E P O R T

SPONSOR Lujan, B

ORIGINAL DATE

LAST UPDATED

1/30/07

2/26/07 HB 424/aHHGAC/aHJC

SHORT TITLE

Advance Practice Chiropractic Licensure

SB

ANALYST C. Sanchez

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY07

FY08

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Commission on Higher Education (CHE)

SUMMARY

Synopsis of HJC Amendment

The House Judiciary Committee amendment changes the bill as follows:

On page 31, line 4, after “surgery" insert “, except for the dispensing of a drug by injection".

With the amendment the original bill does exclude the dispensing of a drug by injection.

Synopsis of HHGAC Amendment

On page 3, line 14, after the period, the amendment inserts, “A formulary shall be developed by

the board and approved by the New Mexico medical board and the board of pharmacy."

The amendment defines the agencies responsible for setting up a formulary.

Synopsis of Original Bill

House Bill 424 amends the Chiropractic Physician Act to direct the Board of Pharmacy to

House Bill 424/aHHGAC/aHJC – Page

2

establish an advanced practice chiropractic certification registry. Advance chiropractic

physicians authorized by this board would have prescriptive authority for therapeutic and

diagnostic purposes as authorized by statute. House Bill 424 outlines the criteria necessary to

apply for the advanced designation to include advanced training necessary to obtain the

prescriptive authority as well as national certification by a recognized credentialing agency, and,

after December 31, 2008, successful completion of a graduate degree in the clinical practice

specialty.

House Bill 424 would require completion of a minimum of 90 clinical and didactic contact

course hours in pharmacology, pharmacognosy, medication administration and toxicology

certified by an examination from an institute of higher education approved by the board in

collaboration with the Board of Medicine.

House Bill 424 would require the chiropractic, in conjunction with the New Mexico medical

board, to develop a pilot collaborative program with the University of New Mexico or a

nationally accredited school of pharmacy and the National University of Health Sciences or other

council on chiropractic education approved school for expanded prescriptive authority by 2008.

House Bill 424 would amend sections of NMSA 1978 to include certified advanced practice

chiropractic physicians as practitioners with prescriptive authority.

House Bill 424 would require each applicant to furnish proof to the board of completion of all

required education and training as established by rule of the board prior to inclusion in the

registry.

FISCAL IMPLICATIONS

No fiscal impacts have been identified by the agencies however the LFC believes the Regulation

and Licensing Department would need additional resources to regulate and administer new

chiropractic licenses.

SIGNIFICANT ISSUES

House Bill 424 would allow certified advance practice chiropractic physicians, after completing

a training program, to “prescribe, administer and dispense an herbal medicine, homeopathic

medicine, vitamins, minerals, enzymes, glandular product, naturally derived substance,

protomorphogens, live cell products, gerovital, amino acids, dietary supplements, foods for

special dietary use, bio identical hormones, sterile water, sterile saline, sarapin or its generic,

caffeine, procaine, oxygen, epinephrine and vapocoolants."

Most of these substances are not medications that currently require a prescription. This is

consistent with the Chiropractic Physician Practice Act, which includes in the definition of

chiropractic practice: “...It shall include, but not be limited to, the use of all natural agencies to

assist in the healing act, such as food, water, heat, cold, electricity, mechanical appliances, herbs,

nutritional supplements, homeopathic remedies and any necessary diagnostic procedure,

excluding invasive procedures, except as provided by the board by rule and regulation. It shall

exclude operative surgery and prescription or use of controlled or dangerous drugs;" (1978

NMSA 61-4-2)

House Bill 424/aHHGAC/aHJC – Page

3

PERFORMANCE IMPLICATIONS

House Bill 424 will require the Board of Chiropractic Examiners to develop a new exam for

Certified Advanced Practice Chiropractic Physician's, as well as a new certificate as a Certified

Advanced Practice Chiropractic Physician. Applicants will be required to meet the criteria

established by the Board in order to qualify as a Certified Advanced Practice Chiropractic

Physician.

TECHNICAL ISSUES

The list of substances in Section 2 of the bill contains some items that are not prescription items

and others that are unknown to the reviewer. The prescription status of each item should be

clarified; if none of the items listed in Section 2 require a prescription currently, then the intent

of the bill is unclear, since these therapies are already included in the Chiropractic Physician

Practice Act.

The intent of the bill is to expand the scope of practice of chiropractors. Not only would the bill

permit chiropractors to prescribe, it would also permit them to do so by any means of

administration, including injections. Currently, "injection" is defined as approaching "surgery"

under an Attorney General Opinion from 1977 defining the chiropractor's authority to perform

acupuncture, which pierces the skin but does not result in the introduction of a substance into the

body. Chiropractors are not authorized to perform surgery under the Chiropractic Physician

Practice Act.

Since administering medications via injection would be in conflict with the AG opinion, section

61-4-2 C would also have to be amended to address this.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL

A consequence of not passing House Bill 424 is that prescriptive authority will not be expanded

to chiropractic physicians.

CS/nt