Facility Standards

(1) Places for Treatment. Chiropractic Treatment may only be delivered at a place, office, clinic or establishment holding a current, valid Chiropractic Facility license issued by the Board. (2) License Required. Each Chiropractic Facility within the Commonwealth shall be licensed by the Board before providing Chiropractic Treatment and shall annually renew its license with the Board using an application provided by the Board. (a) If one Chiropractic Facility consists of more than one location, building, lot of land, or address, said locations, buildings, lots or addresses must be adjoining and connecting. (b) The Board will consider the following in determining whether two or more places, offices, clinics or establishments (establishments) delivering Chiropractic Treatment at the same address constitute one or more Chiropractic Facilities: 1. The business structure of each establishment, including but not limited to overlap in areas of financing, management, or ownership; 2. The resources shared by the establishments, including but not limited to office space, staff, record storage and maintenance facilities; and 3. The overall impression created by advertising, signage, stationery, and office layouts. (3) Exceptions. (a) Solo Practices are exempted from the Chiropractic Facility requirements but are held to all standards, rules and regulations of individual Chiropractors. In order for a chiropractic practice to constitute an exempt solo practice, it must meet each of the criteria set forth in 233 CMR 2.01: Solo Practice. To determine whether a chiropractic practice meets such criteria, the Board shall consider, but shall not be limited to considering, the following factors: 1. whether any individual or entity, other than the licensee, has the right or ability to direct or control any of the following: a. the licensee's exercise of professional chiropractic judgment, including but not limited to, the scope, type and frequency of services provided; b. the scheduling of patients; c. the fees charged by the licensee; or d. the financial arrangements between the licensee and his or her patients. 2. whether any individual or entity, other than the licensee, has the right or ability to control the financial operation of the licensee's practice, including but not limited to, how income is received, distributed, deposited and reported to the Internal Revenue Service, how profits or losses are determined, whether expenses are reimbursed and the purchasing, maintenance and use of equipment and supplies. 3. the existence of any lease, contract or any agreement which subjects the licensee to control or undue influence of another entity. (b) Chiropractic Facility licenses are not required for the following: 1. Hospitals, clinics and other healthcare facilities licensed by the Massachusetts Department of Public Health; (MA REG. # 1333, Dated 2-24-17) 2. Chiropractic Treatment that is rendered outside of a Chiropractic Facility when: a. such Chiropractic Treatment is provided on a limited basis; and b. no more than 15% of the Chiropractic Facility’s annual revenue is generated by the off-site Chiropractic Treatment; 3. Board approved continuing education programs; and 4. Peer Reviews that are performed in the confines of a Solo Practice. (c) The Board may require any place, office, clinic or establishment (establishment) at which Chiropractic Treatments are delivered to provide satisfactory evidence why it is eligible for the exception from Chiropractic Facility licensure requirements. The burden of proving eligibility shall rest with the establishment. (4) Required Displays. True copies of the following must be conspicuously displayed for the benefit of the public at each Chiropractic Facility. (a) The Chiropractic Facility’s license; (b) The license of each licensed chiropractor and of every other licensed health care provider who provides any Chiropractic or other services at the Chiropractic Facility, whether licensed by this Board or any other licensing Board or licensing entity; and (c) The most recent inspection report completed by the Board or its agents. (5) Chiropractor of Record. Each Chiropractic Facility must have a Chiropractor of Record. (a) A Chiropractic Facility shall designate a Chiropractor of Record, and such designation is subject to Board approval. (b) A Chiropractic Facility must notify the Board in writing within five business days of any change in its designation of a Chiropractor of Record. Employee Record. A copy of the Chiropractic Facility’s Employee Record must be provided to the Board upon application for licensure, and upon request by the Board or its designee(s). (7) Record Retention. Patient Records and Business Records shall be stored in a manner that protects them from foreseeable damage or destruction. (a) A Chiropractic Facility shall maintain Patient Records on the premises for each active patient. (b) Business Records shall be maintained for a minimum of seven years. (c) For a patient who is younger than two years old when he or she receives Chiropractic Treatment, the Patient Record shall be maintained at least until the patient reaches the age of nine. (d) For a patient who receives Chiropractic Treatment on or after the patient reaches the age of two, the Patient Record shall be maintained for a minimum of seven years from the date of the last patient encounter. (e) If a chiropractor terminates his or her relationship with a Chiropractic Facility, the arrangements for storage and retrieval of Patient Records shall be set out in writing between them. A copy of any such agreement shall be available to the Board upon request. (f) Patient or Business Records stored electronically shall have an established system of weekly back-up. Copies of the back-up records shall be maintained safely and securely at an off-site location, and back-ups shall be delivered weekly to the off-site location. (8) Physical Conditions. The Chiropractic Facility shall be equipped with proper and adequate lighting and ventilation and kept in clean, orderly, and sanitary condition. (9) Transfer of Ownership. (a) Transfer of controlling ownership interest in a Chiropractic Facility warrants a new Chiropractic Facility license. 1. The Board must be notified in writing at least 60 days prior to the sale or change in controlling ownership interest in a Chiropractic Facility. 2. Upon transfer of a controlling interest in a Chiropractic Facility, the license for the Chiropractic Facility expires and the person or entity holding the controlling interest must apply for a new Chiropractic Facility license. (b) Transfer of 10% or more of pecuniary or ownership interest in a Chiropractic Facility requires Board approval. 1. The Board must be notified in writing at least 60 days prior to the transfer of 10% or more of pecuniary or ownership interest in a Chiropractic Facility. 2. The Board may refuse to approve the transfer of 10% or more of a pecuniary or ownership interest to any individual who the Board determines pursuant to 233 CMR 5.04(5) lacks the good moral character or current suitability to operate a Chiropractor Facility. (10) Change in Location. A facility license is valid only for the location stated on the license and is not transferable or assignable. (a) The Board must be notified in writing at least 60 days prior to a change in location of a Chiropractic Facility. (b) Upon approval of the new location by the Board, the license for the previous location will be cancelled and the Chiropractor of Record shall request a new facility license for the new location, that is subject to Board approval. (11) An individual participating in the operation of a Chiropractic Facility, including but not limited to the Chiropractor of Record, an officer, a director and an individual having more than 10% ownership interest must not engage in any activities that raise a question of his or her good moral character as outlined in 233 CMR 2.04: Good Moral Character Requirement. (12) A Chiropractic Facility that is a Limited Liability Company (LLC) or a Limited Liability Partnership (LLP) must adhere to the insurance requirements set forth in 233 CMR 4.04: Insurance Requirements for Limited Liability Companies and Limited Liability Partnerships. (13) At each Chiropractic Facility the following must be maintained: (a) general liability insurance; (b) professional liability insurance for all licensed health care providers who provide treatment at the Chiropractic Facility; and (c) documentation that establishes that each individual chiropractor associated with the Chiropractic Facility has professional liability insurance.