A 4706: Expands the scope of chiropractic practice.

  
  STATE OF NEW YORK ________________________________________________________________________ 4706 2025-2026 Regular Sessions  IN ASSEMBLY February 4, 2025 ___________ Introduced by M. of A. CLARK, LUPARDO -- read once and referred to the Committee on Higher Education AN ACT to amend the education law, in relation to modernizing the chiropractic scope of practice; and to repeal certain provisions of such law relating thereto The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 6551 of the education law, as added by chapter 987 2 of the laws of 1971, paragraphs a and b of subdivision 2 as amended by 3 chapter 450 of the laws of 1983, and subdivision 3 as amended by chapter 4 683 of the laws of 1991, is amended to read as follows: 5 § 6551. Definition of practice of chiropractic. 1. The practice of 6 the profession of chiropractic is defined as [detecting and correcting 7 by manual or mechanical means structural imbalance, distortion, or 8 subluxations in the human body for the purpose of removing nerve inter- 9 ference and the effects thereof, where such interference is the result 10 of or related to distortion, misalignment or subluxation of or in the 11 vertebral column. 2.] the examination, evaluation, detection, diagnosis 12 of the human body and/or treatment or correction of: subluxations in the 13 vertebral column or other articular segments by manual or mechanical 14 means, neuromusculoskeletal conditions, structural imbalance, 15 distortion, and/or dysfunction of the human body and the effects there- 16 of; including restoring nervous system integrity, structural balance 17 and/or function; as it may relate to any human disease, pain, injury, 18 deformity or physical condition. 19 2. a. The practice of chiropractic includes, but is not limited to, 20 physical and functional examination of patients, health assessment, work 21 capability assessment, handicap eligibility assessment, school and other 22 sports assessment, school attendance assessment, spinal health assess- 23 ment, analysis, or to give consultation, advice, recommendations and 24 counseling regarding anatomy, physiology, neurology, general health EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05767-01-5 
 A. 4706 2 1 matters, wellness and health optimization by any means of communication, 2 the use of x-ray and diagnostic imaging studies using ionizing and non- 3 ionizing imaging methods, adjustment, mobilization, manipulation, trac- 4 tion, and decompression, and other procedures consisting of but not 5 limited to, heat, cold, light, air, water, sound, electricity, massage, 6 manual therapies, therapeutic exercise with or without assistive devices 7 and clinical laboratory testing methods approved by the department as 8 being appropriate to the practice of chiropractic. 9 b. Chiropractic examination, diagnostic and treatment methods may also 10 include electrodiagnostic testing and manipulation under anesthesia when 11 appropriate education standards have been met and as approved by the 12 department as being appropriate to the practice of chiropractic. 13 c. The practice of the profession of chiropractic allows a licensed 14 chiropractor who has successfully completed a registered doctoral, post- 15 doctoral or continuing education certification program of a higher 16 education credential by an accrediting agency, which contains courses of 17 study in wellness care methods, nutrition, and dietary advice satisfac- 18 tory to the department; use of wellness care methods and the ability to 19 engage in nutritional counseling and dietary advice, including the 20 dispensing of food concentrates, food extracts, nutraceuticals, vita- 21 mins, minerals, and other nutritional supplements approved by the 22 department as being appropriate to, and as a part of, the practice of 23 chiropractic, as the above relates to the definition of the practice of 24 chiropractic in subdivision one of this section. 25 3. a. A license to practice as a chiropractor shall permit a chirop- 26 ractic practitioner in their professional discretion the ability to 27 take, order and use x-ray and diagnostic imaging studies but shall not 28 permit the holder thereof to use [radio-therapy, fluoroscopy, or any 29 form of ionizing radiation except X-ray which shall be used for the 30 detection of structural imbalance, distortion, or subluxations in the 31 human body] ionizing radiation sources for the purposes of radiotherapy. 32 b. The requirements and limitations with respect to the use of [X-ray] 33 diagnostic imaging studies by chiropractors shall be enforced by the 34 state commissioner of health and [he] the commissioner is authorized to 35 promulgate rules and regulations after conferring with the [board] 36 department to carry out the purposes of this subdivision. 37 c. Chiropractors shall retain for a period of three years all [X-ray 38 films] diagnostic images taken in the course of their practice, together 39 with the records pertaining thereto, and shall make such [films] images 40 and records available to the state commissioner of health or [his] their 41 representative on demand. 42 [3.] 4. Chiropractors may use diagnostic clinical laboratory methods 43 involving chemical or biological means which particular tests and 44 services shall be approved by the department as appropriate to the prac- 45 tice of chiropractic. 46 5. A license to practice chiropractic shall not permit the holder 47 thereof to treat for any infectious diseases such as pneumonia, any 48 communicable diseases listed in the sanitary code of the state of New 49 York, any of the cardio-vascular-renal or cardio-pulmonary diseases, any 50 surgical condition [of the abdomen such as acute appendicitis, or 51 diabetes], or any benign or malignant neoplasms; to operate; to reduce 52 fractures [or dislocations]; to prescribe, administer, dispense or use 53 in [his] their practice drugs or medicines[; or to use diagnostic or 54 therapeutic methods involving chemical or biological means except diag- 55 nostic services performed by clinical laboratories which services shall 56 be approved by the board as appropriate to the practice of chiropractic; 
 A. 4706 3 1 or to utilize electrical devices except those devices approved by the 2 board as being appropriate to the practice of chiropractic. Nothing 3 herein shall be construed to prohibit a licensed chiropractor who has 4 successfully completed a registered doctoral program in chiropractic, 5 which contains courses of study in nutrition satisfactory to the depart- 6 ment, from using nutritional counseling, including the dispensing of 7 food concentrates, food extracts, vitamins, minerals, and other nutri- 8 tional supplements approved by the board as being appropriate to, and as 9 a part of, his or her practice of chiropractic. Nothing herein shall be 10 construed to prohibit an individual who is not subject to regulation in 11 this state as a licensed chiropractor from engaging in nutritional coun- 12 seling.] or controlled substances or to administer or use anesthetics. 13 Chiropractors may use topical analgesic substances and anesthetic balms, 14 salves or emollients or advise on over the counter substances. 15 § 2. Section 6552 of the education law, as added by chapter 987 of the 16 laws of 1971, is amended to read as follows: 17 § 6552. Practice of chiropractic and use of title "chiropractor", 18 "doctor of chiropractic" or "chiropractic physician". Only a person 19 licensed [or exempt] or otherwise authorized under this article [shall] 20 to practice chiropractic [or] may use the title "chiropractor", "doctor 21 of chiropractic" or "chiropractic physician". 22 § 3. Section 6553 of the education law, as added by chapter 987 of the 23 laws of 1971, is amended to read as follows: 24 § 6553. State board for chiropractic. A state board for chiropractic 25 shall be appointed by the board of regents on recommendation of the 26 commissioner for the purpose of assisting the board of regents and the 27 department on matters of professional licensing and professional conduct 28 in accordance with section sixty-five hundred eight of this title. The 29 board shall be composed of not less than [seven] eight members, includ- 30 ing [at least four] seven licensed chiropractors[, one licensed physi- 31 cian who is a doctor of medicine, one licensed physician who is a doctor 32 of osteopathy, and one educator who holds a doctorate or equivalent 33 degree in either anatomy, physiology, pathology, chemistry or microbiol- 34 ogy] in this state for at least five years and one public member. An 35 executive secretary to the board shall be appointed by the board of 36 regents on recommendation of the commissioner. 37 § 4. Section 6554 of the education law, as added by chapter 987 of the 38 laws of 1971, subdivision 3 as amended by chapter 994 of the laws of 39 1971, subdivision 6 as amended by chapter 669 of the laws of 2022, and 40 subdivision 8 as amended by chapter 62 of the laws of 1989, is amended 41 to read as follows: 42 § 6554. Requirements for a professional license. To qualify for a 43 license as a chiropractor, an applicant shall fulfill the following 44 requirements: 45 (1) Application: file an application with the department; 46 (2) Education: have received an education, including [two] three years 47 or ninety semester hours of credit or equivalent trimester or quarter 48 hours of credit of preprofessional college study and completion of a 49 [four-year resident program in chiropractic,] program of chiropractic 50 education of not less than four academic years, or the equivalent there- 51 of in accordance with the commissioner's regulations; 52 (3) Experience: have experience satisfactory to the board and in 53 accordance with the commissioner's regulations[:]; 54 (4) Examination: pass examinations satisfactory to the board and in 55 accordance with the commissioner's regulations[, in clinical chiroprac- 56 tic analysis, the practice of chiropractic, X-ray as it relates to 
 A. 4706 4 1 chiropractic analysis, and examinations satisfactory to the department 2 in anatomy, physiology, pathology, chemistry, microbiology, diagnosis, 3 and the use and effect of X-ray] for the practice of chiropractic; 4 (5) Age: be at least twenty-one years of age; 5 (6) Citizenship or immigration status: be a United States citizen or a 6 noncitizen lawfully admitted for permanent residence in the United 7 States; 8 (7) Character: be of good moral character as determined by the depart- 9 ment; and 10 (8) Fees: pay a fee of one hundred seventy-five dollars to the depart- 11 ment for [admission to a department conducted examination and for] an 12 initial license upon completion and passage of a department approved 13 examination, a fee of eighty-five dollars for each reexamination, a fee 14 of one hundred fifteen dollars for an initial license for persons not 15 requiring admission to a department conducted examination, and a fee of 16 one hundred fifty-five dollars for each triennial registration period. 17 § 5. Section 6555 of the education law, as amended by chapter 537 of 18 the laws of 1983, is amended to read as follows: 19 § 6555. Exempt persons. [Nothing in this article shall be construed 20 to affect or prevent a student enrolled in a college of chiropractic in 21 this state from engaging in all phases of clinical practice under super- 22 vision of a licensed chiropractor or physician in a curriculum regis- 23 tered by the department.] The following persons under the following 24 limitations may practice chiropractic within the state without a 25 license: 26 1. A student enrolled in any accredited college of chiropractic engag- 27 ing in all phases of clinical practice under supervision of a licensed 28 chiropractor or physician in a curriculum registered by the department; 29 or 30 2. A student who is performing a clinical externship or preceptorship 31 in a chiropractic office or clinic setting and who is enrolled in a 32 chiropractic school which meets the standards satisfactory to the 33 department, provided such practice is under the direct supervision of a 34 licensed chiropractor for a maximum period of twelve months; or 35 3. Any chiropractor authorized to practice chiropractic while travel- 36 ling from another state or country in which such chiropractor is 37 licensed, to provide chiropractic services during any emergency services 38 associated with any rescue, recovery or humanitarian relief effort 39 provided such practice is limited to the organized emergency services; 40 or 41 4. A chiropractor who is not a resident of this state who is legally 42 qualified to practice in their state and who is travelling from another 43 state for the purpose of providing chiropractic services for a specific 44 purpose or event of limited duration; or 45 5. Any chiropractor who is licensed in another state or country and 46 who is meeting or communicating with a chiropractor licensed in this 47 state, for purposes of consultation, provided such practice is limited 48 to such consultation; or 49 6. Any chiropractor who is licensed in another state or country, who 50 is visiting a chiropractic school or teaching facility in this state to 51 receive chiropractic instruction for a period not to exceed six months 52 or to conduct chiropractic instruction, provided such practice is limit- 53 ed to such instruction and is under the general supervision of a 54 licensed chiropractor; or 
 A. 4706 5 1 7. Any chiropractor who is authorized by a foreign government to prac- 2 tice in relation to its diplomatic, consular or maritime staffs, 3 provided such practice is limited to such staffs; or 4 8. Any commissioned chiropractic officer who is serving in the United 5 States armed forces or public health service or any chiropractor who is 6 employed in the United States Veterans Administration, provided such 7 practice is limited to such service or employment. 8 § 6. Section 6556 of the education law is REPEALED and a new section 9 6556 is added to read as follows: 10 § 6556. Limited permits. Permits limited as to eligibility, practice 11 and duration, shall be issued by the department to eligible applicants, 12 as follows: 13 1. Eligibility: The following persons shall be eligible for a limited 14 permit: 15 a. A person who fulfills all requirements for a license as a chiro- 16 practor except those relating to the examination and citizenship or 17 permanent residence in the United States; 18 b. A licensed foreign chiropractor who meets guidelines developed in 19 accordance with the commissioner's regulations; 20 c. A licensed foreign chiropractor or a foreign intern who is in this 21 country on a non-immigration visa for the continuation of chiropractic 22 study who meets guidelines developed in accordance with the commission- 23 er's regulations; 24 d. Any graduate of a chiropractic school which meets standards satis- 25 factory to the department, provided such practice is under the general 26 supervision of a licensed chiropractor for a maximum period of twelve 27 months from date of graduation. 28 2. Limit of practice. A permittee shall be authorized to practice 29 chiropractic only under the supervision of a licensed chiropractor and 30 only in a licensed chiropractic office or clinical setting. 31 3. Duration. A limited permit shall be valid for one year. A limited 32 permit may be renewed annually at the discretion of the department. 33 4. Fees. The fee for each limited permit and for each renewal shall be 34 one hundred five dollars. 35 § 7. The education law is amended by adding a new section 6557 to read 36 as follows: 37 § 6557. Special provisions. 1. Non-liability of licensed chiropractors 38 for first aid or emergency treatment. Notwithstanding any inconsistent 39 provision of any general, special or local law, any licensed chiroprac- 40 tor who voluntarily and without the expectation of monetary compensation 41 renders first aid or emergency treatment at the scene of an accident or 42 other emergency, outside a hospital, doctor's office or any other place 43 having proper and necessary chiropractic equipment, to a person who is 44 unconscious, ill or injured, shall not be liable for damages for inju- 45 ries alleged to have been sustained by such person or for damages for 46 the death of such person alleged to have occurred by reason of an act or 47 omission in the rendering of such first aid or emergency treatment 48 unless it is established that such injuries were or such death was 49 caused by gross negligence on the part of such chiropractor. Nothing in 50 this section shall be deemed or construed to relieve a licensed chiro- 51 practor from liability for damages for injuries or death caused by an 52 act or omission on the part of a chiropractor while rendering profes- 53 sional services in the normal and ordinary course of their practice. 54 2. This article shall not be construed to affect or prevent the 55 following: 56 a. The furnishing of any assistance in an emergency; 
 A. 4706 6 1 b. The chiropractor from being a primary portal of entry healthcare 2 provider. 3 3. There shall be no monetary liability on the part of, and no cause 4 of action for damages shall arise against, any person, partnership, 5 corporation, firm, society, or other entity on account of the communi- 6 cation of information in the possession of such person or entity, or on 7 account of any recommendation or evaluation, regarding the qualifica- 8 tions, fitness, or professional conduct or practices of a chiropractor, 9 to any governmental agency, chiropractic society, a hospital as defined 10 in article twenty-eight of the public health law, a hospital as defined 11 in subdivision ten of section 1.03 of the mental hygiene law, or a 12 health maintenance organization organized under article forty-four of 13 the public health law or article forty-three of the insurance law, 14 including a committee of an individual practice association or medical 15 group acting pursuant to a contract with a health maintenance organiza- 16 tion. The foregoing shall not apply to information which is untrue and 17 communicated with malicious intent. 18 § 8. The education law is amended by adding a new section 6558 to read 19 as follows: 20 § 6558. Definition of chiropractic clinical assistant. 1. A chirop- 21 ractic clinical assistant is defined as a person certified in accordance 22 with this article who works under the supervision of a licensed chiro- 23 practor performing such patient duties as are assigned by the supervis- 24 ing chiropractor. A chiropractic clinical assistant may only provide 25 patient services on the orders and instructions of a supervising chiro- 26 practor. Supervision of a chiropractic clinical assistant by a licensed 27 chiropractor shall be on-site supervision, but not necessarily direct 28 personal supervision. The number of chiropractic clinical assistants 29 supervised by one licensed chiropractor shall not exceed the ratio of 30 four chiropractic clinical assistants to one licensed chiropractor as 31 shall be determined by the commissioner's regulations ensuring that 32 there be adequate supervision in the best interest of public health and 33 safety. Nothing in this section shall prohibit a hospital or other 34 public health law article twenty-eight facility from employing chirop- 35 ractic clinical assistants, provided they work under the supervision of 36 a chiropractor, physician, nurse practitioner or other medical provider 37 designated by the hospital or public health law article twenty-eight 38 facility and not beyond the scope of practice of a chiropractic clinical 39 assistant. 40 2. A certified chiropractic clinical assistant may only provide clin- 41 ical services on the orders and instructions of a supervising chiroprac- 42 tor. 43 3. The scope of services for a certified chiropractic clinical assist- 44 ant shall include assisting a chiropractor with providing certain clin- 45 ical procedures common and customary to the chiropractic setting which 46 include, but are not limited to, the following: collecting general 47 health data, such as the taking of an oral history, vital signs or 48 neurological, physiological or anatomical measurements; performing 49 objective data collection tests common and customary to the chiropractic 50 setting including, but not limited to dynamic or static surface EMG, 51 thermography, heart rate variability; applying thermal, light, air, 52 water, sound, electrical and mechanical modalities; and monitoring 53 prescribed rehabilitative activities. 54 4. A certified chiropractic clinical assistant must be adequately 55 trained in the proper operation of any device or equipment and know- 56 ledgeable of anatomy and the appropriate safety procedures and contrain- 
 A. 4706 7 1 dications with respect to the clinical services they are directed to 2 provide. 3 5. Nothing in this section shall be construed to allow a certified 4 chiropractic clinical assistant to provide a chiropractic adjustment; 5 manipulation; joint mobilization; perform radiological tests (X-rays); 6 nutritional instruction; and counseling or other therapeutic service or 7 procedure which requires individual licensure in New York state. 8 6. Registration as a certified chiropractic clinical assistant is not 9 required for individuals who perform administrative activities of a 10 non-clinical nature. 11 § 9. The education law is amended by adding a new section 6559 to read 12 as follows: 13 § 6559. Duties of chiropractic clinical assistant and the use of title 14 "chiropractic clinical assistant". Only a person certified or otherwise 15 authorized under this article shall participate in the practice of 16 chiropractic as a chiropractic clinical assistant and only a person 17 certified under this section shall use the title "chiropractic clinical 18 assistant". 19 § 10. The education law is amended by adding a new section 6560 to 20 read as follows: 21 § 6560. Requirements for certification as a chiropractic clinical 22 assistant. 23 1. Application: file an application with the department; 24 2. Education: have received an education and training in a chiroprac- 25 tic clinical assistant program in accordance with the commissioner's 26 regulations and department of education; including but not limited to a 27 minimum of twenty-four hours of didactic study; 28 3. Experience: have experience satisfactory to the department for 29 chiropractic in accordance with the commissioner's regulations; 30 4. Examination: pass an examination satisfactory to the department and 31 in accordance with the commissioner's regulations; 32 5. Age: be at least eighteen years of age; 33 6. Character: be of good moral character as determined by the depart- 34 ment; 35 7. Registration: all certified chiropractic clinical assistants shall 36 register triennially with the education department in accordance with 37 the regulations of the commissioner; 38 8. Fees: pay a fee for an initial certificate of fifty dollars, and a 39 fee of fifty dollars for each subsequent triennial registration period. 40 9. A certified chiropractic clinical assistant shall conduct them- 41 selves within the boundaries of proper ethical behavior and shall adhere 42 to acceptable standards of conduct regardless of whether a supervising 43 chiropractor or person in a position of authority may order, impart or 44 condone behavior or conduct which is improper. 45 10. "Improper conduct", under the meaning of this section, shall 46 include conduct delineated under the chiropractic practice act, regu- 47 lations, and such other New York state laws that may apply. 48 11. The department may refuse to issue, refuse to renew, or may 49 suspend, revoke, censure, reprimand, restrict, or limit the registration 50 of, or fine any person pursuant to the laws of New York state or the 51 procedures set forth herein, upon one or more of the grounds for disci- 52 pline set forth in this article. 53 § 11. The education law is amended by adding a new section 6561 to 54 read as follows: 55 § 6561. Exemptions. 1. This article shall not be construed to affect 56 or prevent a chiropractic clinical assistant student from engaging in 
 A. 4706 8 1 clinical assisting under the supervision of a licensed chiropractor as 2 part of a program conducted in an approved program for chiropractic 3 clinical assistants or in a clinical facility or health care agency 4 affiliated with the program for chiropractic clinical assistants. 5 2. Supervision of a chiropractic clinical assistant student by a 6 licensed chiropractor shall be on-site supervision and direct super- 7 vision. 8 § 12. The education law is amended by adding a new section 6562 to 9 read as follows: 10 § 6562. Limited permits. 1. The department shall issue a limited 11 permit to an applicant who meets all requirements for admission to the 12 certification examination. 13 2. All practice under a limited permit shall be under the supervision 14 of a licensed chiropractor or other licensed medical provider in a 15 public hospital, an incorporated hospital or clinic, a licensed proprie- 16 tary hospital, a licensed nursing home, a public health agency, a recog- 17 nized public or non-public school setting, the office of a licensed 18 chiropractor, or in the civil service of the state or political subdivi- 19 sion thereof. 20 3. Limited permits shall be for six months and the department may for 21 justifiable cause renew a limited permit provided that no applicant 22 shall practice under any limited permit for more than a total of one 23 year. 24 4. Supervision of a permittee by a licensed chiropractor shall be 25 on-site supervision and not necessarily direct personal supervision. 26 5. The fee for each limited permit and for each renewal shall be fifty 27 dollars. 28 § 13. This act shall take effect on the first of January next succeed- 29 ing the date on which it shall have become a law.