Professional Conduct Rules

PURPOSE: This rule explains the professional conduct of licensed chiropractic physicians. (1) Each licensed chiropractic physician shall notify the board of a change in name, business and residential address, or telephone number(s). The board must be notified within fifteen (15) days of such change. Notification may be mailed to the board at 3605 Missouri Boulevard, or PO Box 672, Jefferson City, MO 65102-0672, faxing the board office at (573) 751-0735, or sending an email to chiropractic@pr.mo.gov. (2) When closing a chiropractic practice the licensee shall take adequate measures to provide for the transfer of patient records and take reasonable steps to notify all patients, in writing, of what such patients must do to obtain their records, or to arrange for transfer to another chiropractic physician or health care provider. (3) The licensee shall retain patient records for at least seven (7) years from the date of the last visit to the licensee’s office. (4) A licensed chiropractic physician shall maintain patient records that are legible. Patient records shall include, at a minimum, the following: (A) Patient history; (B) Examination; (C) Diagnosis; (D) Prognosis and treatment; (E) When abbreviations or symbols are used, a key to the abbreviations or symbols; and (F) A licensed chiropractic physician shall follow the Subjective Objective Assessment Plan or “S.O.A.P.” method of patient record keeping as commonly taught in a chiropractic college or chiropractic program in a university. (5) A licensed chiropractic physician shall not increase charges when a patient utilizes a third-party payment program. (6) For the purpose of this rule, an advertisement shall be defined as any form of public notice, regardless of medium, using a licensee’s name, trade name, or other professional designation of the licensee or chiropractic business. (A) Any advertisement shall include the name of the licensee responsible for the content of the advertisement and the term chiropractor, doctor of chiropractic, chiropractic physician, or D.C. (7) A solicitation shall be defined as any form of contact used to entice or urge a person to utilize a chiropractic physician. (A) For the purpose of this rule, any contact, whether made in person, in writing, by telephone or “auto-dialing” or by any form of electronic medium for the purpose of soliciting or offering chiropractic treatment made on behalf of a chiropractic physician by any third party or parties, including but not limited to marketing consultants or services, shall be deemed to be contact personally made by the chiropractic physician. (B) A chiropractic physician shall not solicit any person involved in a motor vehicle accident or other type of traumatic accident, within thirty (30) days of the accident, if the chiropractic physician knows or reasonably should know that the physical, emotional, or mental state of the person makes it unlikely that the person would exercise reasonable judgment regarding a decision to seek chiropractic treatment. The burden of persuasion shall be on the licensee to establish that any such solicitation, made within thirty (30) days of a known accident, is not a violation of this rule. (C) A chiropractic physician shall not solicit or transmit a solicitation at the scene of an accident or en route to a hospital, emergency care center, or other health care facility. (D) A solicitation shall not refer to phrases such as “no outof-pocket expense,” “we accept what your insurance will pay” or any similar statement prior to the retention of services that a payment made by an insurance carrier or other third party payor with copayment or deductible features will be accepted by the licensee as payment in full. (8) Violation of the Health Care Payment Fraud and Abuse Act, Missouri Revised Statutes section 191.900 et seq. or the “anti-kickback” portions of the Medicare/Medicaid anti-fraud and abuse statute, 42 United States Code section 1320a-7b[b], by knowingly and willingly offering, paying, soliciting, or receiving remuneration in order to induce business reimbursed under the Medicare or state administered health care programs will be considered, at minimum, unprofessional or improper conduct in the practice of chiropractic. Conduct will not be considered a violation of this rule, if the ownership or investment interest in such service meets the requirements of the “safe harbor” provisions of Title 42 Code of Federal Regulations part 1001. AUTHORITY: sections 331.060 and 331.100.2, RSMo 2016.* This rule originally filed as 4 CSR 70-2.060. This version of rule filed Dec. 17, 1975, effective Dec. 27, 1975. Amended: Filed April 6, 1978, effective Aug. 11, 1978. Amended: Filed July 5, 1978, effective Oct. 13, 1978. Rescinded and readopted: Filed Dec. 9, 1981, effective April 11, 1982. Rescinded and readopted: Filed July 9, 1982, effective Nov. 11, 1982. Amended: Filed Sept. 12, 1983, effective Jan. 13, 1984. Amended: Filed June 11, 1985, effective Oct. 26, 1985. Rescinded and readopted: Filed April 18, 1989, effective July 13, 1989. Amended: Filed April 18, 1990, effective June 30, 1990. Amended: Filed Aug. 14, 1990, effective Dec. 31, 1990. Amended: Filed March 4, 1991, effective July 8, 1991. Amended: Filed Sept. 17, 1991, effective Feb. 6, 1992. Amended: Filed Dec. 3, 1991, effective April 9, 1992. Amended: Filed Jan. 23, 1992, effective June 25, 1992. Amended: Filed Feb. 4, 1992, effective June 25, 1992. Amended: Filed May 13, 1992, effective Jan. 15, 1993. Amended: Filed June 15, 1992, effective Jan. 15, 1993. Amended: Filed July 22, 1993, effective Jan. 31, 1994. Amended: Filed Dec. 21, 1995, effective June 30, 1996. Amended: Filed Nov. 6, 1996, effective May 30, 1997. Amended: Filed April 29, 1998, effective Nov. 30, 1998. Amended: Filed July 31, 2003, effective Jan. 30, 2004. Amended: Filed April 1, 2005, effective Oct. 30, 2005. Moved to 20 CSR 2070-2.060, effective Aug. 28, 2006. Amended: Filed June 27, 2007, effective Jan. 30, 2008. Rescinded and readopted: Filed Dec. 19, 2019, effective July 30, 2020. *Original authority: 331.060, RSMo 1939, amended 1969, 1971, 1972, 1981, 1987 and 331.100.2, RSMo 1939, amended 1949, 1969, 1980, 1981, 2008, 2013.