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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

1/25/08

2/14/08 HB

275/aHJC/aHFL/aSPAC

/aSFl#1

SHORT TITLE Chiropractic Certification Registry

SB

ANALYST C. Sanchez

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY08

FY09

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Regulation and Licensing Department (RLD)

New Mexico Higher Education (NMHED)

SUMMARY

Synopsis of SFl#1 Amendment

The Senate Floor amendment to HB 275 makes technical changes to the original bill.

Synopsis of SPAC Amendment

The amendment to HB 275 by the Senate Public Affairs Committee removes “in collaboration

with," which will require approval from the Chiropractic board and the medical board in the

following areas:

•

To obtain an advanced practice chiropractic certification the applicant must complete a

minimum of ninety clinical and didactic contact course hours in pharmacology,

pharmacognosy, medication administration and toxicology certified by an examination

from an institution of higher education approved by the board and the New Mexico

medical board.

•

A formulary shall be developed by the board and the New Mexico medical board and the

board of pharmacy.

Removing in collaboration with eliminates the need for either the Chiropractic board or the

medical board to interpret the definition of “in collaboration" and clearly requires the boards to

each approve the educational requirement and the formulary.

House Bill 275/aHJC/aHFL/aSPAC/aSFl#1 – Page

2

Synopsis of HFL Amendment

The House Floor Amendment to HB 275 strikes 1, 2, and 3 from the House Judiciary Committee

amendment.

Number 2 of the amendment inserts and strikes language on page 30 that changes “the use" to

“prescribing and administering and “agencies" to “agent", which reflects more professional

language and legal description.

Number 3 of the amendment inserts “and medical devises; the selling of", which broadens the

term medical appliances and clarifies the selling of herbs.

Number 4 changes “supplements, remedies" to “supplements and remedies" and further expands

prescriptive authority to include “the administering of a drug by injection by a certified advanced

practice chiropractic physician." This does not expand the type of drug that could be prescribed

and administered; rather it authorizes the use of injections as well as consumable natural agents.

Number 5 changes surgery and prescription to “surgery, the prescription", which corrects the

grammar of the sentence.

Number 6 clarifies that the expansion of authority under the Chiropractic Act does not include

the practice of acupuncture.

This amendment does not change the substantive intent of the bill. These language changes are

clarifications.

Synopsis of HJC Amendment

House Judiciary Committee 275 amendment to HB 275 amends the original bill in four respects.

The first three amendments clarify the language in the original bill. Page 30 line 16 changes “the

use of" to “the prescription, administration and dispensing of." Page 30 line 18 after the second

comma inserts the words “medical devises." Page 30 line 22 inserts “except for the dispensing

of a drug by injection," after surgery and strikes “prescription or" and “or dangerous." Finally,

all underscored material on page 30 lines 23 and 24 is removed.

Amendments one, two and three do not change the substantive intent of the bill. These language

changes are clarifications. However, amendment four (4) removes prescriptive authority for

controlled substances.

Synopsis of Original Bill

House Bill 275 amends the Chiropractic Physician Practice Act to include a new registry for

“Advanced Practice Chiropractic Certification." The new certification authorizes certificate

holders to have prescriptive authority for therapeutic and diagnostic purposes. This prescriptive

authority will be limited to therapeutic and diagnostic purposes related to nutrition and pain

management with natural agents. The advanced practice may involve prescriptive authority for

controlled substances.

Qualification for the prescriptive authority requires the chiropractic physicians to obtain

extensive training to include: completing three years of post-graduate clinical chiropractic

House Bill 275/aHJC/aHFL/aSPAC/aSFl#1 – Page

3

practice or equivalent clinical experience, hold an advanced practice chiropractic certification by

a nationally recognized credentialing agency providing credentialing and demonstrated

competency by examination and successful completion of a minimum of ninety clinical and

didactic contact course hours in pharmacology, pharmacognosy, medication administration and

toxicology certified by an examination from an institution of higher education approved by the

board and in collaboration with the New Mexico medical board.

Under the amended Act a formulary would be developed by the board in collaboration with the

Medical Board and the Pharmacy board.

HB 275 also amends the definition sections of the New Mexico Drug, Device and Cosmetic Act

as well as the Controlled Substance Act to include the expanded prescriptive authority for the

Advanced Practice Chiropractic Certification.

FISCAL IMPLICATIONS

Some cost would be incurred by the Chiropractic board to adopt new rules. However, the cost is

minimal since the board budgets for rule change cost each year and these changes would be

included as part of general rules changes.

SIGNIFICANT ISSUES

HB 275 limits the use of chiropractic names (chiropractor, chiropractic physician, chiropractic)

to only those persons licensed pursuant to the Chiropractic Physician Practice Act. HB275

defines the education, training, testing and contact hours needed for Chiropractic Physicians to

apply for the title of Certified Advanced Practice Chiropractic Physician. Further, HB275 defines

the authority of Certified Advanced Practice Chiropractic Physicians with respect to operative

surgery and the prescription, administration and dispensation of therapeutic products. HB275

states that a formulary will be developed by the Chiropractic Board in conjunction with the New

Mexico Medical Board and the Board of Pharmacy.

This legislation will require chiropractic physicians to obtain extensive training in order to be

placed on a registry allowing a chiropractic physician to issue prescriptions. The prescriptive

authority will be limited to therapeutic and diagnostic purposes related to nutrition and pain

management with natural agents. This advanced practice will not involve prescriptive authority

for controlled substances in any manner.

PERFORMANCE IMPLICATIONS

Chiropractic Physicians who apply for the title of Certified Advanced Practice Chiropractic

Physician will be required to meet the criteria established by the Chiropractic Board pursuant to

the provisions of the Chiropractic Physician Practice Act.

ADMINISTRATIVE IMPLICATIONS

A protocol will need to be established to promulgate rules and regulations with the Medical

Board and the Pharmacy Board to collaboratively define the new prescriptive authority intended

by the bill.

House Bill 275/aHJC/aHFL/aSPAC/aSFl#1 – Page

4

TECHNICAL ISSUES

The language in HB 275 under New Material – “Certified Advanced Practice Chiropractic

Physician Authority Defined" should clearly define the limitations of the formulary. The

following additions would avoid confusion:

“A drug formulary shall be developed by the board in conjunction with the New Mexico medical

board and the board of pharmacy. Prescriptive authority shall be limited to the drug formulary

developed by the board in conjunction with the medical board and pharmacy board."

OTHER SUBSTANTIVE ISSUES

The Chiropractic Board will authorize chiropractic physicians as Certified Advanced Practice

Chiropractic Physicians when they have demonstrated completion of advanced coursework and

training and have met all other requirements as established in the Chiropractic Physician Practice

Act and rules set by the Chiropractic Board.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL

The chiropractic physicians will not be able to obtain advanced certification and offer primary

care services related to prescriptive authority using natural agents.

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