www.njchiropractors.com I 7 Q What are the minimum requirements that a chiropractor in New Jersey performing paper reviews must comply with? A In general, with regard to chiropractic paper reviews, it is a violation of the chiropractic record review regulation if the reviewing chiropractor does not perform all of the following: 1) they must make a reasonable and documented effort to obtain all records of the attending chiropractor relevant to the chiropractic care or condition under evaluation before rendering an opinion concerning the prior chiropractic care, the need for continued chiropractic care or the need for diagnostic testing; 2) If the reviewer states that prior chiropractic care was not documented, they must clearly note the specific deviations from the patient record regulation requirements; 3) opinions which state that prior chiropractic care was not necessary, not required or palliative must clearly state the rationale upon which the opinion is based; 4) an opinion that diagnostic testing, referrals or consultations were not properly documented or performed must clearly note the specific deviations from the rules that govern record keeping and referrals; 5) an opinion that states that prior diagnostic testing, referrals or consultations were not necessary must clearly state the rationale upon which the opinion is based; 6) an opinion rendered regarding the evaluation of prior chiropractic care, the termination of chiropractic care, or the necessity of diagnostic testing and/or referrals or consultation shall be consistent with the chiropractic scope of practice laws and regulations. The regulation which governs chiropractic paper reviews, N.J.A.C. 13:44E-2.6(A), expressly states that the violation of any of these requirements constitutes professional misconduct punishable by the Board. Q What are the minimum requirements that a chiropractor in New Jersey performing Independent Chiropractic Examinations must comply with? A The New Jersey chiropractic Independent Chiropractic Examination (“ICE”) regulations require the examining doctor to meet all of the following criteria: 1) they must hold a valid license to practice chiropractic in the State of New Jersey; 2) they must have at least two years of clinical experience; 3) they must complete a patient record in accordance with the record keeping regulation, N.J.A.C. 13:44E-2.2; 4) they must document in the patient record and report the nature and extent of records reviewed, including other information presented such as results of diagnostic imaging and/or diagnostic testing; 5) they must perform and document in the patient record and in any resulting report a history, clinical examination and a chiropractic analysis or diagnosis, which includes the specific tests, examinations or observations performed, and the results and evaluation of these specific tests, examinations or observations, together with a review of the patient’s response to prior care; 6) they must document the clinical rationale for an opinion expressed with respect to the patient’s present condition in the patient record and report; 7) they cannot make any recommendations directly to the patient for alterations in care by the attending chiropractor except that, if the examination discloses abnormalities or conditions not known to the patient, they can recommend consultation with another health care provider for treatment and document the referral in the treatment record; 8) they cannot solicit the patient for care; and 9) they must author and sign the independent chiropractic examination report. The ICE regulation, N.J.A.C. 13:44E-2.14, does not expressly state that the violation of these requirements constitutes professional misconduct punishable by the Board like the record review regulation states, but a violation could still form the basis of sanctioning by the Board. Q Who Can Perform a utilization management on chiropractic claims in the State of New Jersey? A On Jan. 18, 2010, former Governor Corzine signed into law a new chiropractic scope of practice statute which updated the chiropractic scope of practice which had not been substantively amended since the 1950s. The legislation, codified at N.J.S.A. §45:9-14.5 et. seq., imple- mented a global change in chiropractic utilization management from the date of enactment prospectively. In pertinent, Section “d” of the statute states: “It shall be unlawful for any person, not duly licensed in this State to practice chiropractic,. . . to render a utilization management decision that limits, restricts or curtails a course of chiropractic care.” Thus, as of Jan.18, 2010, any utilization management decision regarding chiropractic care must be made by a New Jersey licensed chiropractor or is in violation of the law. Jeffrey Randolph, Esq. (the author of these two articles) is an independent person of the ANJC and his views are not authorized, sponsored, or otherwise approved by the ANJC. The information provided is for general guidance on matters of interest only and may not take into account particular facts relevant to your individual situation. The application and impact of laws and health care can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in these materials. Accordingly, the information you receive is provided with the understanding that the author and the ANJC are not herein engaged in rendering legal, accounting, tax, health care or other professional advice and services nor are they providing specific advice with regard to your practice, the treatment of any specific illness, disease, deformity or condition, or any other matter that affects trade, commerce, or legal rights of others. As such, this article should not be used as a substitute for consultation with professional accounting, tax, legal, health care, or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional. Legislative Update LEGAL Q&A CHIRO ASSIST TECHNIQUE Council OUR HEALTH By Jeffrey Randolph ANJC Legal Counsel