1. Certified Chiropractic Therapy Assistants Clinical

2. Public Protection Perspective Boards do NOT hear complaints – reluctant to change Why isn’t this covered by delegation clauses? – Doctor’s license is responsible 5.1% of malpractice claims involve patient injuries

3. NINE US boards currently have some type of regulatory authority over CAs who help with therapies Ranges from little or no defined training hours to fairly robust programs Public Protection Perspective

4. At a Glance Vacuum cleaners are coming: $93,000 removed from AZ DC last month Without a national certification program, boards and insurance companies will create their own requirements Insurance regulators are demanding that insurance companies only allow credentialed people to touch patients

5. Building a National Program Post grad deans developed core curriculum components Task force built on core: – clinical competencies – model statute and regs Discussions with stakeholders – Summits – FCLB regional meetings – COCSA, ACA, CCE – FCLB Baltimore meetings

6. Core Program Values Credible Affordable Gets CA to work quickly Portable credentials

7. At a Glance Certified to assist with Therapies (CCCA) Billing Front Desk Supplies Customer Relations Business Management Certified to assist with X-rays (ACCRT)

8. NBCE 2009 Practice Analysis 55% of respondents employ 1 or more CAs who have direct patient contact Previous surveys (2003 and 1998) showed 41% delegate therapies to assistants 44% think their state requires licensure or certification – These CAs are full-time in 28.8% of offices

9. NBCE 2009 Practice Analysis

11. At a Glance

12. Program Components Eligibility Criteria – 18 yrs, High school or equiv – Criminal background check Didactic Training – 20 to 40 hrs – On-line, in person, combination OK – Offered by PACE Approved Providers – Providers may offer short refresher course – CE hours

13. Program Components Examination – Offered by NBCE – Available frequently – Modest cost – Available to new trainees, those out of practice for a while, or grandfathering experienced people

14. Program Components Clinical Internship – Register with the board – Log progress regularly on website – Minimum # hours – Doctor certifies specific competencies – Billable services while training

15. Regulation Experience with violations – what do CCTAs do wrong? – Exceed scope of authority – On own initiative or at direction of DC Additional revenue source for boards Possible resistance to regulating additional group of people

16. National / International Registry Web-based Facilitates mobility Grandfathering Provision Based on NBCE exam How much previous background to qualify How to reinstate status after absence

17. Boards’ regulatory authority over clinical CAs – Which boards have authority now? – Which boards can get authority in the future? – Which boards will never be able to have authority? Insurance companies will regulate by contract Today’s Issue

18. Comments Welcome Materials posted on FCLB website – Brochure Expanded handout – Clinical competencies – Model statute and regulation

19. We must change We can change We are not alone