Section R4-7-801. Continuing Education Requirements

A.      To be eligible to renew a license, a licensee shall complete 12 credits of continuing education between January 1 and Decem- ber 31 of each year, and document compliance with continuing education requirements on the license renewal application as required by R4-7-503(C). Continuing education credit shall be given for a minimum of 50 minutes of continuous study for each class hour. No credit shall be allowed for breaks or for time expended for study outside of the classroom.

B.       Basic requirements – The primary consideration in determin- ing whether or not a specific course qualifies as acceptable continuing education is that it must be a formal program of learning which will contribute directly to the professional competence of a licensee in the practice of chiropractic. Each course shall be on subjects of clinical benefit to the consumer of chiropractic services.

1.        The content of the course, seminar or workshop must be recognized by reputable authorities as having validity, and must conform to the scope of practice for assessment, treatment and diagnosis as authorized under A.R.S. § 32- 925 and A.R.S. § 32-922.02.

2.        Instructors shall be qualified by education and/or experi- ence to provide instruction in the relevant subject matter.

3.      Each licensee is responsible for determining in advance that the course which he or she attends qualifies for continuing education credit under this Article.

C.      A licensee shall only obtain continuing education credit by:

1.        Attending a course, (which includes a seminar or work- shop), through a provider and on subjects that have been pre-approved by the Board.

2.        Participating in the development of, or proctoring the National Board of Chiropractic Examiners (NBCE) examinations. Continuing education credits earned in this manner are calculated as one credit hour for each hour of participation in the development of the NBCE examina- tion for a maximum credit of eight hours per year, and one credit hour for each hour proctoring the NBCE exam for a total of eight hours per year. A licensee shall obtain a certificate of participation from the National Board of Chiropractic Examiners to verify compliance with this provision.

3.      By teaching a post-graduate course that has been pre- approved by the Board for continuing education credit under this Section as a faculty member of a college or university that is accredited by or is in good standing with the Council on Chiropractic Education or is accredited by an accrediting agency recognized by the United States Department of Education or the Private Postsecondary Education Board during the renewal year. Continuing education credits earned in this manner are calculated as one credit of continuing education for each hour of post- graduate course instruction. A maximum of six credits of continuing education credit may be earned in this manner annually.

4.        By completing a post-graduate mediated instruction or programmed learning course pre-approved by the Board through an accredited college or university that meets the requirements of A.R.S. § 32-931(B). Mediated instruc- tion and programmed learning refers to learning transmit- ted by intermediate mechanisms such as webinar or other internet delivered courses that are structured to confirm 50 minutes of continuous instruction for each credit hour received. A licensee shall obtain a certificate of program completion from the accredited college or university to verify compliance with this provision.

D.      The following are predetermined to meet Board approval as providers for continuing education. Additional approval is not required, nor should it be expected. An application submitted for a course that falls under this subsection shall be returned to the applicant without a review and subsection (E) does not apply. Coursework provided by these entities is approved as meeting continuing education requirements only for those sub- jects listed in subsections (J) and (K) of this Section. Pre- approval does not include mediated instruction or programmed learning courses.

1.        A college or university that meets the requirements of

A.R.S. § 32-921(B)(2)(a), the American Chiropractic Association and the International Chiropractors Associa- tion, with qualified instructors and that provide courses that meet the subject requirements under subsections (J) or (K).

2.        CPR training provided or sponsored by the American Heart Association, the American Red Cross, or an entity that meets equivalent standards of the American Heart Association and the American Red Cross. A maximum of four credits of continuing education credit may be earned in this manner annually.

3.        Participation in the development of or proctoring the NBCE examinations.

E.       Prior approval is required for all course providers not men- tioned in subsection (D) and for all mediated instruction or programed learning courses regardless of subsection (D). A provider applying for approval of a continuing education course shall submit a complete application to the Board at least 60 days prior to the anticipated initial date of the course if submitted by internet, or 75 days if provided in hard copy form. The Board shall notify the applicant in writing that the package is either complete or incomplete. If the package is incomplete, the notice shall specify the information that is missing and the applicant must submit the missing information within 10 days of the notice. The Board will not approve a course if a complete application has not been submitted at least 15 business days prior to the initial date of the course identi- fied in the initial application. If the applicant changes the ini- tial date of the course or the course content or the instructors, it shall be considered a new application. A complete application shall include:

1.        The name, dates, and locations of the course.

2.        The number of hours requested for approval.

3.        The subjects of the course, broken down by the specific time of instruction in/of each subject.

4.        A course description including the content, explicit writ- ten objectives identifying expected learner outcomes for each section of the course and teaching method (i.e. lec- ture, discussion, PowerPoint, internet, webinar).

5.        A detailed, hour by hour syllabus identifying the subject of instruction for each hour, with the instructor for each section identified. If less than an hour is dedicated to a subject, the syllabus shall identify the number of minutes dedicated to instruction on that subject.

6.        A resume or curriculum vitae for each instructor and an attestation of the following:

a.         Licenses for all instructors are currently in good standing.

b.        No instructor has had a license placed on probation or restricted within the past five years in this or any other jurisdiction.

c.         No instructor has ever had a license suspended or surrendered for unprofessional conduct or revoked in this or any other jurisdiction.

d.        No instructor has had a license application or renewal denied for unprofessional conduct.

e.         No instructor has been convicted of a misdemeanor involving moral turpitude or a felony in this or any other jurisdiction.

7.        Documentation of license in good standing for each instructor for each state in which the instructor has or cur- rently holds a license, if applicable. If an instructor is cur- rently under investigation by a regulatory agency or is under investigation for, or been charged with, a criminal

offence, the applicant shall disclose the investigation or charge and shall provide all relevant records.

8.        One letter of reference for each course instructor from a person familiar with the instructor’s qualifications as an instructor and education and/or experience in the relevant subject.

9.        Identification of a sponsor, if applicable, and disclosure of any connection between the provider and/or instructor and/or sponsor of any commercial relationship and/or any external entity giving financial support to the course. If the course does have a sponsor, a completed sponsor/pro- gram provider agreement for continuing education, signed and notarized by a responsible party must be pro- vided with the application.

10.     Documentation of the method by which attendance will be monitored, confirmed and documented.

11.     The name and contact information for the attendance cer- tifying officer with an attestation that the certifying offi- cer is supervised by the applicant provider and a description of the supervision method employed to con- firm that the certifying officer is performing the duty of monitoring and confirming attendance.

12.     Attestation that each course hour consists of no less than 50 minutes of continuous instruction and that credit is not provided for breaks.

13.     The non-refundable fee required under R4-7-1301 for each course, whether individual or included in a program of multiple courses.

14.     The name, address, telephone number, fax number and e- mail of a contact person.

15.     Any other information required or requested by the Board.

16.     If the course is a mediated instruction or programmed learning course, a detailed description of the method used to confirm that the participant was engaged in 50 minutes of continuous instruction for each credit hour awarded.

17.     The Board may require that the applicant provide addi- tional information in support of the application if the course qualifications are not clearly demonstrated through the materials provided.

F.       The Board shall approve a continuing education course if the applicant has submitted a complete application to the Board’s satisfaction within the time-frame required by this Chapter and has demonstrated the following:

1.        The course complies with this Chapter.

2.        The course instructors is faculty with an accredited col- lege or university that meets the requirements of A.R.S. § 32-921(B)(2)(a) or demonstrates equivalent qualifica- tions through postgraduate study and experience teaching postgraduate coursework. An instructor must:

a.         Hold an applicable license in good standing.

b.        Shall not have had a license placed on probation within the last five years.

c.         Shall not ever had a license suspended, surrendered for unprofessional conduct or revoked.

d.        Shall not have had a license application or renewal denied for unprofessional conduct.

e.         Shall not or been convicted of a felony in this or any other jurisdiction.

3.        The course instructor is qualified by education and expe- rience to provide instruction in the relevant subject mat- ter.

4.        The subject of the course  qualifies under subsections (D)(2) and (3), (J) and (K).

5.        The course demonstrates attendance and/or monitoring procedures.    Monitoring    procedures    must    provide

confirmation that a licensee was engaged in 50 minutes of continuous study for each credit hour.

G.      The Board shall not approve a continuing education course if the applicant fails to submit a complete application within the time-frame required by this Chapter or if:

1.        The course does not qualify under this Chapter.

2.        The course subject does not qualify for continuing educa- tion credit under subsections (D)(2) and (3), (J) and (K).

3.        The instructor does not qualify as per subsection (F)(2).

4.        The instructor’s references do not support the qualifica- tions of the instructor as per subsection (F).

5.        The course primary focus is to promote a product or ser- vice.

6.        The course requires participants to purchase a product or service.

7.        The course has no significant relationship to the assess- ment, diagnosis or treatment of patients within the scope of practice of chiropractic as defined under A.R.S. §§ 32- 925 and 32-922.02.

8.        The content cannot be verified.

9.        The course refutes generally accepted medical care and treatment and/or instructs participants to encourage patients to stop taking medication and/or stops participat- ing in generally accepted medical care or fails to qualify under subsection (K).

H.      A course approved by the Board pursuant to subsections (E) and (F) shall be issued an approval number. Once approved, a course provider shall:

1.        Provide course attendees with a certificate confirming course participation. The certificate shall:

a.         Include the name of the college or university through which the course was completed,  or the course approval code issued by the Board, if appli- cable;

b.        The name and Arizona license number of the attendee;

c.         The name of the course provider, the course subject matter;

d.        The name of the course if different than the subject matter listed;

e.         The date and location of the course; and

f.         The number of hours of continuing education com- pleted.

2.        Maintain a list of all course attendees for a minimum of five years after each date that the course is held, and shall provide a copy of the list to the board within 10 days of a written request to do so.

3.        Maintain a copy of the course syllabus and stated learning objectives, a list of instructors and documentation of the name, location and date of the course for a minimum of five years and shall provide the Board with a copy of these materials within 10 days of a written request to do so.

4.        Monitor course attendance by each attendee in a manner that confirms that the attendee was present and participat- ing in the course for a continuous 50 minutes for each hour of continuing education credited.

5.        Notify the Board immediately of concerns or problems that may arise regarding the approved course, to include discipline being imposed on the license of an instructor or an instructor being convicted of a criminal offense.

6.        Reapply for Board approval every two years no later than the first day of the month in which the course was ini- tially approved, and every time the subject of the course changes and/or there is a change in instructors that does not include an instructor already approved by the Board.

Failure to reapply as per this subsection shall disqualify the course for ongoing continuing education credit.

7.        Not represent that the course is sanctioned or promoted by the state of Arizona Board of Chiropractic Examiners. The provider may state that the course meets the continu- ing education requirements as per A.R.S. § 32-931. If the course has been directly approved by the Board, the pro- vider may display the Board’s course approval number.

I.        The Board may monitor a continuing education provider’s compliance with continuing education statutes and rules as fol- lows:

1.        The Board may request any or all documentation as per Section (H) of this rule from a board-approved continuing education provider for any course registered for license renewal to ensure compliance with this rule.

2.        A representative of the Board may attend any approved continuing education course for the purpose of verifying the content of the program and ensuring compliance with the Board’s continuing education rules at no charge to the Board representative.

3.        If the Board finds that a course or provider is not compli- ant with the continuing statutes or rules, has misrepre- sented course content or instructors in an application, failed to obtain new approval for a course with a change in subject or instructor or failed to pay the course fee, the Board may withdraw its approval for continuing credit for the course and/or the provider. The withdrawal of approval shall be effective upon written notification to the provider’s contact of record by the Board.

4.        The Board shall notify a provider that it will consider withdrawal of course approval and provide the date, time and location of the meeting at which the matter will be discussed and possible action taken.

5.        If approval is withdrawn, the Board shall notify the pro- vider of the reasons for withdrawal of approval.

6.        The provider shall notify all Arizona licensees who attended the course that any course hours obtained through the course cannot be used for continuing educa- tion credit of license renewal in the state of Arizona. If a provider fails to provide appropriate notice to Arizona licensed attendees, within ten business days of written notice from the Board that course approval has been with- drawn, that provider shall not be considered for approval of continuing education credit in the future. The notice to the Arizona licensed attendees must be made by certified mail in order to establish documentation that the require- ment was met.

J.        Course subjects approved for continuing education for renewal of an Arizona chiropractic license are:

1.        Adjusting techniques;

2.        Spinal analysis;

3.        Physical medicine modalities and therapeutic procedures as defined in A.R.S. § 32-900(7) and (8);

4.        Recordkeeping and documentation;

5.        Ethics;

6.        CPR;

7.        Public health;

8.        Communicable diseases;

9.        Sexual boundaries;

10.     Emergency procedures;

11.     Acupuncture;

12.     Nutrition;

13.     Examination;

14.     Assessment and diagnostic procedures to include physi- cal, orthopedic, neurological procedures;

15.     Radiographic technique;

16.     Diagnostic imaging and interpretation;

17.     Laser as permitted by law;

18.     Clinical laboratory procedures limited to urine collection, fingerpicks and venipuncture (not to be confused with evaluation of lab reports);

19.     Anatomy;

20.     Physiology;

21.     Bacteriology;

22.     Chiropractic orthopedics and neurology;

23.     Chemistry;

24.     Pathology;

25.     Patient management;

26.     Evidence-based clinical interventions models;

27.     Symptomatology;

28.     Arizona jurisprudence, and;

29.     Participation in National Board of Chiropractic Examin- ers examination development or administration of examinations.

K.      In addition to the subjects in subsections (A), (C), (D) and (J), courses for the purpose of recognizing, assessing and deter- mining appropriate referral or collaborative treatment of com- plex conditions, including but not limited to cancer, autism, multiple sclerosis, diabetes, and developmental disorders, for the purpose of co-management of the patient’s condition with qualified medical providers shall qualify for continuing educa- tion credit.

L.       The following subjects shall not qualify for continuing educa- tion for the purpose of license renewal and shall not be approved by the Board:

1.        Billing, coding;

2.        Malpractice defense;

3.        Practice management;

4.        Risk management;

5.        Promotion of a product or a service or a requirement that attendees purchase a product or service;

6.        Strategies to increase insurance payments;

7.        Administrative or economic aspects of a practice;

8.        Motivational courses;

9.        Legal courses other than pre-approved Board jurispru- dence;

10.     Anti-aging;

11.     Hormone treatment;

12.     Aroma therapy;

13.     Stress management;

14.     Psychological treatment;

15.     HIPAA;

16.     Homeopathic practice that exceeds A.R.S. § 32-925;

17.     Professional or business meetings, speeches at luncheons, banquets, etc.;

18.     Subject matter that exceeds the assessment, diagnosis and treatment of patients within the scope of practice of chiro- practic as defined in this Chapter;

19.     Any course without a significant relationship to the safe and effective practice of chiropractic under A.R.S. § 32- 925 and A.R.S. § 32-922.02;

20.     And any course that involves a distance learning format or materials if the course has not been pre-approved by the board and issued a board approval number;

M.     A licensee’s compliance with subsections (A), and (C), shall include the following coursework in order to renew a license.

1.        Each licensee shall complete a minimum of two hours of continuing education in recordkeeping for every even numbered year.

2.        Each person who is issued a new license to practice chiro- practic in Arizona on or after January 1, 2013, is required to attend three hours of a single regularly scheduled Board meeting within the first year of residence in Ari- zona. The licensee cannot distribute the three hours of

Board meeting attendance over two or more Board meet- ings. The licensee shall notify the Board in writing within ten days of moving to Arizona. The meeting attendance must be pre-scheduled and pre-approved by Board staff. Continuing education credit will not be awarded if the licensee is attending the meeting as a subject of an inves- tigation or other Board review or if the licensee fails to properly schedule attendance as per this Section. This subsection does not pertain to any person who has had a license to practice chiropractic in Arizona issued prior to January 1, 2013.

N.      The Board shall grant an extension of 90 days to comply with the continuing education requirements to a qualified licensee. To qualify for an extension, a licensee shall:

1.        Timely file a license renewal application and renewal fee; and

2.        Submit a written request for an extension no later than December 1 of the current renewal year, including evi- dence of good cause why the continuing education requirements cannot be met by December 31 of the cur- rent renewal year.

O.      The following reasons constitute good cause for the Board to grant an extension of time to comply with the continuing edu- cation requirements:

1.        The licensee lived in a country where there was no accredited chiropractic college, or a college that meets the requirements of R4-7-702, for at least seven months during the year that the continuing education require- ments are to be met;

2.        The licensee was in active military service for at least seven months during the year that the continuing educa- tion requirements are to be met; or

3.        The licensee was not able to complete the continuing edu- cation requirements because of a documented disability of the licensee or the licensee’s spouse, child, or parent.

P.       If the Board grants an extension of time  to complete the required 12 hours of continuing education requirements, 12 hours of required continuing education credits obtained during the 90-day extension shall be applied to meet only the require- ments for which the extension is granted. A licensee shall not report those 12 hours of continuing education credit earned during a 90-day extension for a subsequent renewal year.

Historical Note

Adopted as an emergency effective Oct. 7, 1977 (Supp. 77-5). Former Section R4-7-60 repealed, New Section R4-7-60 adopted effective December 29, 1977 (Supp. 77-

6). Repealed effective May 14, 1980 (Supp. 80-3). For- mer Section R4-7-60 renumbered as Section R4-7-801 effective September 27, 1985 (Supp. 85-5). Adopted

effective June 19, 1997 (Supp. 97-2). Amended by final

rulemaking at 7 A.A.R. 2821, effective June 12, 2001 (Supp. 01-2). Amended by final rulemaking at 13 A.A.R. 1848, effective July 10, 2007 (Supp. 07-2). Amended by final rulemaking at 18 A.A.R. 2554, effective November 19, 2012 (Supp. 12-3).