3 Colo. Code Regs. § 707-1.9
Current through Register Vol. 47, No. 22, November 25, 2024
Section 3 CCR 707-1.9 - SCOPE OF PRACTICEThis Rule is promulgated pursuant to sections 12-20-204 and 12-215-105(1)(a), C.R.S.
A. Practices that are not within the scope of chiropractic practice and invoke the duty to refer provision in section 12-215-115(1)(aa), C.R.S., include, but are not limited to:1. Treatment of the disease cancer. This does not preclude screening and diagnostic procedures for the prevention and early detection of cancer or the chiropractic treatment of other concomitant conditions that the patient may have. In addition, a qualified chiropractor may collaboratively treat cancer in conjunction with allopathic and osteopathic medical care, which may include drugs, surgery, chemotherapy, or immunotherapy.4. Administration of anesthetics, with the exception of topical or over-the-counter anesthetics.5. Prescription of drugs not referenced in Rule 1.9(C).6. Hypnosis unless used as a procedure to augment the treatment of the neuromusculoskeletal system and unless the practitioner presents evidence to the Board of having obtained education in hypnosis from an institution whose accreditation is recognized by the United States Department of Education or a Board approved program.B. A chiropractor must have the knowledge, skill, ability, and documented competency to perform an act that is within the chiropractic scope of practice. Procedures with specific clinical, didactic requirements and qualifications include, but are not limited to: 1. Paraspinal Surface Electromyography a. Ten hours of initial training with demonstrated competency.b. Procedures may be delegated to a qualified technician and must be supervised and interpreted by an on-site qualified and licensed doctor of chiropractic.c. Procedures must be performed in a manner consistent with generally accepted parameters, including any relevant standards of the Center for Communicable Diseases and meet safe and professional standards.2. Surface Electromyography excluding paraspinal, Nerve Conduction Velocity (NCV) and Needle Electromyography a. One hundred and twenty hours of initial clinical and didactic training with demonstrated competency in electromyography (paraspinal surface electromyography excluded).b. Procedures may not be delegated to a technician and must be directly performed by a qualified and licensed doctor of chiropractic.c. Procedures must be performed in a manner consistent with generally accepted parameters, including clean needle techniques, and standards of the Center for Communicable Diseases and meet safe and professional standards.3. Electrocardiography (EKG/ECG) a. One hundred and twenty hours of initial and related clinical with didactic training and demonstrated competency in cardiac medicine.b. Procedures may not be delegated to a technician and must be directly performed by a qualified and licensed doctor of chiropractic.c. Procedures must be performed in a manner consistent with generally accepted parameters, including any relevant standards of the Center for Communicable Diseases and meet safe and professional standards.4. Manipulation Under Anesthesia (MUA)a. Thirty-six hours of didactic and clinical training, successful completion of a competency examination, and nationally recognized certification.b. Professional liability insurance coverage to specifically include MUA.c. Procedures must be performed in a manner consistent with generally accepted parameters and standards of practice.d. Procedures shall be performed at either an ambulatory surgical center or outpatient hospital facility.e. The role of the chiropractor shall be limited to the scope of chiropractic practice as defined in section 12-215-103(4), C.R.S.5. Intramuscular stimulation/Dry Needling.a. Dry needling is a physical intervention that uses a filiform needle to stimulate trigger points, diagnose and treat neuromuscular pain and functional movement deficits; requires an examination and diagnosis, and treats specific anatomic entities selected according to physical signs. Dry needling does not include the stimulation of auricular or distal points and cannot be presented as acupuncture.b. Dry needling as defined pursuant to this rule is within the scope of practice of chiropractic.c. A chiropractor must have an electrotherapy certification, knowledge, skill, ability and documented competency to perform an act that is within the chiropractor's scope of practice.d. To be deemed competent to perform dry needling, a chiropractor holding electrotherapy certification and acupuncture certification must meet the following requirements:(1) Document successful completion of a dry needling course of study including a minimum of twenty-four hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training.(2) Practiced acupuncture as a licensed chiropractor for at least two years prior to using the dry needling technique.e. To be deemed competent to perform dry needling a chiropractor with electrotherapy certification but without acupuncture certification must meet the following requirements:(1) Document successful completion of a dry needling course of study including a minimum of forty-six hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training.(2) Practiced as a licensed chiropractor for at least two years prior to using the dry needling technique.f. A provider of a dry needling course of study must meet the educational and clinical requirements in dry needling of a body recognized by the US Department of Education or similar agency of a foreign country and demonstrate a minimum of two years of dry needling practice techniques. The provider is not required to be a chiropractor.g. A chiropractor performing dry needling must have written, informed consent for each patient where this technique is used. The patient must sign and be given a copy of the informed consent form. The form must, clearly state the risks and benefits of dry needling.h. Any dry needling performed must be clearly documented in the procedure notes, which must indicate how the patient tolerated the technique and the outcome after the procedure.i. Dry needling shall not be delegated and must be directly performed by a qualified, licensed chiropractor with electrotherapy certification who meets the standards in this rule.C. Nutritional Remedial Measures as referenced in section 12-215-103(4), C.R.S., means that a doctor of chiropractic may administer, prescribe, recommend, compound, sell and distribute homeopathic and botanical medicines, vitamins, minerals, phytonutrients, antioxidants, enzymes, glandular extracts, non-prescription drugs, durable and non-durable medical goods and devices.D. Physical Remedial Measures as referenced in section 12-215-103(4), C.R.S., includes but is not limited to: 1. Tests (physical, functional, mechanical, computerized).2. Exercise therapeutics (instruction, passive, active, resistive, cardiovascular).4. Gait/locomotion training.5. Manual therapies (massage, mobilization, manipulation).8. Biofeedback (when done to facilitate chiropractic care).9. Functional activities with or without assistive devices.10. Postural re-education.E. Patient assessment may include, but is not limited to the following: 5. Range of motion examination.8. Gait/movement analysis.9. Activities of daily living.10. Psychometric questionnaires.12. Cardiac, pulmonary, and vascular examination.14. Work site assessment.16. Photosensitivity testing.17. Impairment or disability ratings.18. Functional capacity evaluation.19. Radiography and other diagnostic imaging42 CR 08, April 10, 2019, effective 5/25/201942 CR 12, June 25, 2019, effective 7/15/201942 CR 20, October 25, 2019, effective 11/14/201943 CR 18, September 25, 2020, effective 8/25/202043 CR 21, November 10, 2020, effective 11/30/202044 CR 08, April 25, 2021, effective 5/15/202145 CR 22, November 25, 2022, effective 10/26/202245 CR 23, December 10, 2022, effective 11/11/202245 CR 20, October 25, 2022, effective 11/14/202246 CR 02, January 25, 2022, effective 1/9/202346 CR 20, October 25, 2023, effective 11/14/2023