Florida Senate - 2025 SB 564 By Senator Gruters 22-00615B-25 2025564__ 1 A bill to be entitled 2 An act relating to chiropractic medicine; amending s. 3 460.403, F.S.; revising the definition of the term 4 practice of chiropractic medicine to include the 5 ordering, storing, possessing, prescribing, and 6 administering of articles of natural origin under 7 certain circumstances by certain chiropractic 8 physicians; authorizing pharmacists to fill the orders 9 of such chiropractic physicians; amending s. 460.408, 10 F.S.; deleting a requirement that all chiropractic 11 continuing education be completed in a classroom 12 setting; prohibiting the Board of Chiropractic 13 Medicine from limiting the number of hours of 14 continuing education a chiropractic physician may 15 complete through distance learning; authorizing the 16 board to make exceptions to continuing education 17 requirements during a declared state of emergency in 18 this state; specifying who may teach board-approved 19 continuing education courses; requiring, rather than 20 authorizing, the board to adopt rules; amending s. 21 460.413, F.S.; revising grounds for disciplinary 22 action to conform to changes made by the act; amending 23 s. 460.4165, F.S.; revising certification requirements 24 for certified chiropractic physicians assistants; 25 amending s. 627.736, F.S.; revising limitations on 26 medical benefits in insurance policies providing 27 personal injury protection; providing construction; 28 providing an effective date. 29 30 Be It Enacted by the Legislature of the State of Florida: 31 32 Section 1.Subsection (9) of section 460.403, Florida 33 Statutes, is amended to read: 34 460.403Definitions.As used in this chapter, the term: 35 (9)(a)Practice of chiropractic medicine means the 36 application of a noncombative principle and practice consisting 37 of the science, philosophy, and art of the adjustment, 38 manipulation, and treatment of the human body to treat any in 39 which vertebral subluxation or subluxations and other 40 malpositioned articulation or structure articulations and 41 structures that is are interfering with the normal generation, 42 transmission, and expression of nerve impulse between the brain, 43 organs, and tissue cells of the body and, thereby causing 44 disease, as applied are adjusted, manipulated, or treated, thus 45 restoring the normal flow of nerve impulse which produces normal 46 function and consequent health by chiropractic physicians using 47 specific chiropractic adjustment or manipulation techniques 48 taught in chiropractic colleges accredited by the Council on 49 Chiropractic Education to restore the normal flow of nerve 50 impulse which produces normal function and consequent health. No 51 person other than a licensed chiropractic physician may render 52 chiropractic services, chiropractic adjustments, or chiropractic 53 manipulations. 54 (b)Any chiropractic physician who has complied with the 55 provisions of this chapter may examine, analyze, and diagnose 56 the human living body and its diseases by the use of any 57 physical, chemical, electrical, or thermal method; use the X ray 58 for diagnosing; phlebotomize; and use any other general method 59 of examination for diagnosis and analysis taught in any school 60 of chiropractic. 61 (c)1.Chiropractic physicians may adjust, manipulate, or 62 treat the human body by manual, mechanical, electrical, or 63 natural methods; by the use of physical means or physiotherapy, 64 including light, heat, water, or exercise; by the use of 65 acupuncture; by the use of monofilament intramuscular 66 stimulation treatment, also known as dry needling, for trigger 67 points or myofascial pain; or by the administration of foods, 68 food concentrates, food extracts, and items for which a 69 prescription is not required and may apply first aid and 70 hygiene, but chiropractic physicians are expressly prohibited 71 from prescribing or administering to any person any legend drug 72 except as authorized under subparagraphs 2. and 3. subparagraph 73 2., from performing any surgery except as stated herein, or from 74 practicing obstetrics. 75 2.Notwithstanding the prohibition against prescribing and 76 administering legend drugs under subparagraph 1. or s. 77 499.83(2)(c), pursuant to board rule, chiropractic physicians 78 may order, store, and administer prescription medical oxygen, 79 for emergency purposes only, at the chiropractic physicians 80 office or place of business, prescription medical oxygen and may 81 also order, store, and administer the following topical 82 anesthetics in aerosol form: 83 a.Any solution consisting of 25 percent ethylchloride and 84 75 percent dichlorodifluoromethane. 85 b.Any solution consisting of 15 percent 86 dichlorodifluoromethane and 85 percent 87 trichloromonofluoromethane. 88 3.Notwithstanding the prohibition against prescribing and 89 administering legend drugs under subparagraph 1. or s. 90 499.83(2)(c), pursuant to board rule, chiropractic physicians 91 who have completed a board-approved minimum of a 36-hour 92 training course may order, store, possess, prescribe, and 93 administer articles of natural origin, including vitamins, 94 minerals, amino acids, fatty acids, hyaluronic acid, enzymes, 95 saline, antioxidants, dextrose, glandulars, cellular components, 96 extracts, water, botanicals, phytonutrients, and homeopathics, 97 and may administer medical oxygen as defined in s. 499.82. 98 Pharmacists licensed under chapter 465 may fill the orders of 99 chiropractic physicians authorized to prescribe and administer 100 articles of natural origin necessary for the practice of 101 chiropractic medicine. 102 103 However, this paragraph does not authorize a chiropractic 104 physician to prescribe medical oxygen as defined in s. 105 499.82(10). 106 (d)Chiropractic physicians shall have the privileges of 107 services from the departments laboratories. 108 (e)The term chiropractic medicine, chiropractic, 109 doctor of chiropractic, or chiropractor is shall be 110 synonymous with chiropractic physician, and each term must 111 shall be construed to mean a practitioner of chiropractic 112 medicine as the same has been defined herein. Chiropractic 113 physicians may analyze and diagnose the physical conditions of 114 the human body to determine the abnormal functions of the human 115 organism and to determine whether such functions as are 116 abnormally expressed and the cause of such abnormal expression. 117 (f)Any chiropractic physician who has complied with the 118 provisions of this chapter is authorized to analyze and diagnose 119 abnormal bodily functions and to adjust the physical 120 representative of the primary cause of disease as is herein 121 defined and provided. As an incident to the care of the sick, 122 chiropractic physicians may advise and instruct patients in all 123 matters pertaining to hygiene and sanitary measures as taught 124 and approved by recognized chiropractic schools and colleges. A 125 chiropractic physician may not use acupuncture until certified 126 by the board. Certification must shall be granted to 127 chiropractic physicians who have satisfactorily completed the 128 required coursework in acupuncture and successfully passed after 129 successful passage of an appropriate examination as administered 130 by the department. The required coursework must shall have been 131 provided by a college or university which is recognized by an 132 accrediting agency approved by the United States Department of 133 Education. 134 Section 2.Section 460.408, Florida Statutes, is amended to 135 read: 136 460.408Continuing chiropractic education. 137 (1)The board shall require licensees to periodically 138 demonstrate their professional competence periodically as a 139 condition of renewal of a license by completing up to 40 contact 140 classroom hours of continuing education. 141 (a)Continuing education courses sponsored by board 142 approved continuing education providers, or by chiropractic 143 colleges whose graduates are eligible for examination under any 144 provision of this chapter, may be approved upon review by the 145 board if all other requirements of board rules setting forth 146 criteria for course approval are met. 147 (b)The board shall approve those courses that build upon 148 the basic courses required for the practice of chiropractic 149 medicine, and the board may also approve courses in adjunctive 150 modalities. Courses that include consist of instruction in the 151 use, application, prescription, recommendation, or 152 administration of a specific companys brand of products or 153 services are not eligible for approval. 154 (c)The board may not limit the number of approved 155 continuing education hours that may be completed through 156 distance learning. 157 (2)The board may provide exceptions to make exception from 158 the requirements of this section in emergency or hardship cases 159 and during a declared state of emergency in this state. 160 (3)Continuing education courses must be taught by a person 161 who has at least one of the following qualifications: 162 (a)Has a postgraduate degree, or a bachelors degree with 163 at least 2 years of experience in the subject matter being 164 taught; 165 (b)Is a current faculty member of a chiropractic college 166 or school maintaining standards approved by the board or is a 167 current faculty member at a medical or osteopathic college or a 168 university accredited by, or having status with, an accrediting 169 agency, or its successor, recognized and approved by the United 170 States Department of Education or by the Council for Higher 171 Education Accreditation or its successor; or 172 (c)Is a postgraduate-level instructor at a chiropractic 173 college or school maintaining standards approved by the board or 174 is a postgraduate-level instructor at a medical or osteopathic 175 college or a university accredited by, or having status with, an 176 accrediting agency, or its successor, recognized and approved by 177 the United States Department of Education or by the Council for 178 Higher Education Accreditation or its successor. 179 (4)The board shall may adopt rules necessary to implement 180 within the requirements of this section that are necessary for 181 its implementation. 182 Section 3.Paragraph (p) of subsection (1) of section 183 460.413, Florida Statutes, is amended to read: 184 460.413Grounds for disciplinary action; action by board or 185 department. 186 (1)The following acts constitute grounds for denial of a 187 license or disciplinary action, as specified in s. 456.072(2): 188 (p)Prescribing, dispensing, or administering any medicinal 189 drug except as authorized by s. 460.403(9)(c)2. or 3. s. 190 460.403(9)(c)2., performing any surgery, or practicing 191 obstetrics. 192 Section 4.Paragraph (b) of subsection (13) of section 193 460.4165, Florida Statutes, is amended to read: 194 460.4165Certified chiropractic physicians assistants. 195 (13)CERTIFIED CHIROPRACTIC ASSISTANT CERTIFICATION 196 RENEWAL.The certification must be renewed biennially. 197 (b)Each certified chiropractic physicians assistant shall 198 biennially complete 24 hours of continuing education courses 199 sponsored by chiropractic colleges accredited by the Council on 200 Chiropractic Education and approved by the board. The board 201 shall approve those courses that build upon the basic courses 202 required for the practice of chiropractic medicine, and the 203 board may also approve courses in adjunctive modalities. The 204 board may make exception from the requirements of this section 205 in emergency or hardship cases. The board may adopt rules 206 necessary to implement within the requirements of this section 207 which are necessary for its implementation. 208 Section 5.Paragraph (a) of subsection (1) of section 209 627.736, Florida Statutes, is amended to read: 210 627.736Required personal injury protection benefits; 211 exclusions; priority; claims. 212 (1)REQUIRED BENEFITS.An insurance policy complying with 213 the security requirements of s. 627.733 must provide personal 214 injury protection to the named insured, relatives residing in 215 the same household unless excluded under s. 627.747, persons 216 operating the insured motor vehicle, passengers in the motor 217 vehicle, and other persons struck by the motor vehicle and 218 suffering bodily injury while not an occupant of a self 219 propelled vehicle, subject to subsection (2) and paragraph 220 (4)(e), to a limit of $10,000 in medical and disability benefits 221 and $5,000 in death benefits resulting from bodily injury, 222 sickness, disease, or death arising out of the ownership, 223 maintenance, or use of a motor vehicle as follows: 224 (a)Medical benefits.Eighty percent of all reasonable 225 expenses for medically necessary medical, surgical, X-ray, 226 dental, and rehabilitative services, including prosthetic 227 devices and medically necessary ambulance, hospital, and nursing 228 services if the individual receives initial services and care 229 pursuant to subparagraph 1. within 14 days after the motor 230 vehicle accident. The medical benefits provide reimbursement 231 only for: 232 1.Initial services and care that are lawfully provided, 233 supervised, ordered, or prescribed by a physician licensed under 234 chapter 458 or chapter 459, a dentist licensed under chapter 235 466, a chiropractic physician licensed under chapter 460, or an 236 advanced practice registered nurse registered under s. 464.0123 237 or that are provided in a hospital or in a facility that owns, 238 or is wholly owned by, a hospital. Initial services and care may 239 also be provided by a person or entity licensed under part III 240 of chapter 401 which provides emergency transportation and 241 treatment. 242 2.Upon referral by a provider described in subparagraph 243 1., follow-up followup services and care consistent with the 244 underlying medical diagnosis rendered pursuant to subparagraph 245 1. which may be provided, supervised, ordered, or prescribed 246 only by a physician licensed under chapter 458 or chapter 459, a 247 chiropractic physician licensed under chapter 460, a dentist 248 licensed under chapter 466, or an advanced practice registered 249 nurse registered under s. 464.0123, or, to the extent permitted 250 by applicable law and under the supervision of such physician, 251 osteopathic physician, chiropractic physician, or dentist, by a 252 physician assistant licensed under chapter 458 or chapter 459 or 253 an advanced practice registered nurse licensed under chapter 254 464. Follow-up Followup services and care may also be provided 255 by the following persons or entities: 256 a.A hospital or ambulatory surgical center licensed under 257 chapter 395. 258 b.An entity wholly owned by one or more physicians 259 licensed under chapter 458 or chapter 459, chiropractic 260 physicians licensed under chapter 460, advanced practice 261 registered nurses registered under s. 464.0123, or dentists 262 licensed under chapter 466 or by such practitioners and the 263 spouse, parent, child, or sibling of such practitioners. 264 c.An entity that owns or is wholly owned, directly or 265 indirectly, by a hospital or hospitals. 266 d.A physical therapist licensed under chapter 486, based 267 upon a referral by a provider described in this subparagraph. 268 e.A health care clinic licensed under part X of chapter 269 400 which is accredited by an accrediting organization whose 270 standards incorporate comparable regulations required by this 271 state, or 272 (I)Has a medical director licensed under chapter 458, 273 chapter 459, or chapter 460; 274 (II)Has been continuously licensed for more than 3 years 275 or is a publicly traded corporation that issues securities 276 traded on an exchange registered with the United States 277 Securities and Exchange Commission as a national securities 278 exchange; and 279 (III)Provides at least four of the following medical 280 specialties: 281 (A)General medicine. 282 (B)Radiography. 283 (C)Orthopedic medicine. 284 (D)Physical medicine. 285 (E)Physical therapy. 286 (F)Physical rehabilitation. 287 (G)Prescribing or dispensing outpatient prescription 288 medication. 289 (H)Laboratory services. 290 3.Reimbursement for services and care provided in 291 subparagraph 1. or subparagraph 2. up to $10,000 if a physician 292 licensed under chapter 458 or chapter 459, a dentist licensed 293 under chapter 466, a physician assistant licensed under chapter 294 458 or chapter 459, or an advanced practice registered nurse 295 licensed under chapter 464 has determined that the injured 296 person had an emergency medical condition. 297 4.Reimbursement for services and care provided in 298 subparagraph 1. or subparagraph 2. is limited to $2,500 if a 299 provider listed in subparagraph 1. or subparagraph 2. determines 300 that the injured person did not have an emergency medical 301 condition. 302 5.Medical benefits do not include massage therapy as 303 defined in s. 480.033 or acupuncture as defined in s. 457.102, 304 regardless of the person, entity, or licensee providing massage 305 therapy or acupuncture, and a licensed massage therapist or 306 licensed acupuncturist may not be reimbursed for medical 307 benefits in such licensed capacities under this section. A 308 person licensed as a massage therapist under chapter 480 or as 309 an acupuncturist under chapter 457 may be reimbursed for medical 310 benefits under this section only if he or she holds 311 qualifications or licensure, other than as a massage therapist 312 or an acupuncturist, which independently authorizes his or her 313 services or care to be eligible for reimbursement as specified 314 in subparagraph 1. or subparagraph 2. 315 6.The Financial Services Commission shall adopt by rule 316 the form that must be used by an insurer and a health care 317 provider specified in sub-subparagraph 2.b., sub-subparagraph 318 2.c., or sub-subparagraph 2.e. to document that the health care 319 provider meets the criteria of this paragraph. Such rule must 320 include a requirement for a sworn statement or affidavit. 321 322 Only insurers writing motor vehicle liability insurance in this 323 state may provide the required benefits of this section, and 324 such insurer may not require the purchase of any other motor 325 vehicle coverage other than the purchase of property damage 326 liability coverage as required by s. 627.7275 as a condition for 327 providing such benefits. Insurers may not require that property 328 damage liability insurance in an amount greater than $10,000 be 329 purchased in conjunction with personal injury protection. Such 330 insurers shall make benefits and required property damage 331 liability insurance coverage available through normal marketing 332 channels. An insurer writing motor vehicle liability insurance 333 in this state who fails to comply with such availability 334 requirement as a general business practice violates part IX of 335 chapter 626, and such violation constitutes an unfair method of 336 competition or an unfair or deceptive act or practice involving 337 the business of insurance. An insurer committing such violation 338 is subject to the penalties provided under that part, as well as 339 those provided elsewhere in the insurance code. 340 Section 6.This act shall take effect July 1, 2025.