HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 1063 Practice of Chiropractic Medicine
SPONSOR(S): Health & Human Services Committee, Healthcare Regulation Subcommittee, Hunschofsky
TIED BILLS: IDEN./SIM. BILLS: SB 1474
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N, As CS DesRochers McElroy
2) Health & Human Services Committee 16 Y, 3 N, As CS DesRochers Calamas
SUMMARY ANALYSIS
Dry needling is a technique that acupuncturists, physical therapists, and other trained healthcare providers use
to treat musculoskeletal pain and movement issues. Healthcare providers may incorporate dry needling as a
part of a larger pain management point that could include exercise, stretching, massage, and other techniques.
Dry needling may help relieve pain and increase range of motion. Depending on the state, dry needling may be
performed by licensed physical therapists, athletic trainers, chiropractors, or medical doctors who have been
trained in the procedure.
Under current law, the practice of chiropractic medicine is a noncombative principle and practice consisting of
the science, philosophy, and art of the adjustment, manipulation, and treatment of the human body.
Specifically, chiropractic medicine targets vertebral subluxations and other malpositioned articulations and
structures that interfere with the normal generation, transmission, and expression of nerve impulse between
the brain, organs, and tissue cells of the body.
The Florida Board of Chiropractic Medicine (Board) ensures that every chiropractic physician practicing in
Florida meets minimum requirements for safe practice. The Board is responsible for the licensure and quality
control of chiropractic professionals to assure competency and safety. Any person desiring to be licensed as a
chiropractic physician must apply to DOH to take the licensure examination. The Board has not opined on
whether dry needling is within the scope of practice for chiropractic physicians.
CS/CS/HB 1063 authorizes chiropractic physicians to adjust, manipulate, or treat the human body by the use
of monofilament intramuscular stimulation, also known as dry needling, treatment for trigger points or
myofascial pain. To perform dry needling, chiropractic physicians must first complete a 40-hour certification
course approved by the Board of Chiropractic Medicine.
Current law requires DOH to examine each applicant whom the Board certifies meets the necessary
matriculation prerequisites. The bill gives the Board authority to recognize chiropractic physician applicants for
licensure if they provide a credential evaluation report from a board-approved organization that the Board
deems is equivalent to a bachelor’s degree. The effect of this change is to create a licensure pathway for
chiropractic physicians to practice in Florida when they obtained their bachelor’s level degree at a non-U.S.
educational institution of higher education.
The bill has no fiscal impact on state or local governments.
The bill takes effect upon becoming law.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Dry Needling
Dry needling is a technique that acupuncturists, physical therapists, and other trained healthcare
providers use to treat musculoskeletal pain and movement issues. Healthcare providers may
incorporate dry needling as a part of a larger pain management point that could include exercise,
stretching, massage, and other techniques. With dry needling, a healthcare provider inserts thin, sharp
needles through a patient’s skin to treat underlying myofascial1 trigger points. Trigger points are
knotted, tender areas that develop in muscles which are highly sensitive and can be painful when
touched.2
When health providers apply dry needling to muscles and tissues, needles may decrease tightness,
increase blood flow, and reduce local and referred pain. Providers use solid needles that do not contain
any kind of medication – hence “dry” needling. Dry needling may also be known as intramuscular
stimulation. The visual graphic below illustrates how dry needling works. 3
When a patient overexerts their muscle, the muscle experiences an energy crisis where the muscle
fibers cannot access an adequate supply of blood. Without normal blood supply to the muscle, the
muscle cannot get the oxygen and nutrients that allow the muscle to return to its normal resting state.
1 In the word “myofascial,” “myo” means “muscle.” Fascia is the thin, white connective tissue that wraps around muscles.
2 The Cleveland Clinic, Dry Needling, (last reviewed Feb. 20, 2023) https://my.clevelandclinic.org/health/treatments/16542-dry-needling
(last visited Jan. 21, 2024).
3 Id.
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Dry needling may stimulate the trigger point to help draw normal blood supply back to flush out the area
and release tension.4
Dry needling may help relieve pain and increase range of motion. Conditions that dry needling may
treat include:5
Joint issues.
Disk issues.
Tendonitis.
Migraine and tension-type headaches.
Jaw and mouth problems, such as temporomandibular joint (TMJ) disorders.
Whiplash.
Repetitive motion disorders, such as carpal tunnel syndrome.
Spinal issues.
Pelvic pain.
Night cramps.
Phantom limb pain.
Postherpetic neuralgia, a complication of shingles.
There are certain groups of people who should not receive dry needling. Providers do not recommend
the procedure for children under the age of 12 because it can be painful. Other groups who should
consult with their physician before receiving dry needling include people who: 6
Are pregnant.
Are not able to understand the treatment.
Are very afraid of needles (trypanophobia).
Have compromised immune systems.
Have just had surgery.
Are on blood thinners.
The most common side effect of dry needling is soreness during and after treatment. Other side effects
are typically minor. They may include:7
Stiffness.
Bruising at or near the insertion site.
Fainting.
Fatigue.
Risk of infection.
While both dry needling and acupuncture use needles to treat pain, acupuncture treats musculoskeletal
pain and dry needling treats muscle tissue with the goal of pain mitigation, deactivating trigger points,
and improving movement.8 Depending on the state, dry needling is performed by licensed physical
therapists, athletic trainers, chiropractors, or medical doctors who have been trained in the procedure.
On November 9, 2023, the Florida Board of Chiropractic Medicine convened a board meeting to
discuss, in part, the Florida Chiropractic Association (FCA)’s petition for a declaratory statement 9 that
asked whether dry needling is within the scope of practice for chiropractic physicians. The Florida
Chiropractic Physician Association (FCPA) appeared in support of adding drying needling to the scope
4 Id.
5 Id.
6 Id.
7
Id.
8 Id.
9 Florida Chiropractic Association’s Petition for Declaratory Statement Before the Department of Health / Board of Chiropractic Medicine
(Oct. 30, 2023) https://www.fcachiro.org/wp-content/uploads/2023/08/Petition-for-Declaratory-Statement-dry-needling-1.pdf (last visited
Jan. 21, 2024).
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of practice. The Florida Chiropractic Society (FCS) appeared in opposition to adding dry needling to the
scope of practice. After debate, the FCA withdrew their declaratory statement petition, and the Board
suspended discussion of whether dry needling is within the scope of practice for chiropractic
physicians.10
Chiropractic Medicine
The Practice of Chiropractic Medicine
Under current law s. 460.403, F.S., the practice of chiropractic medicine is a noncombative principle
and practice consisting of the science, philosophy, and art of the adjustment, manipulation, and
treatment of the human body. Specifically, chiropractic medicine targets vertebral subluxations and
other malpositioned articulations and structures that interfere with the normal generation, transmission,
and expression of nerve impulse between the brain, organs, and tissue cells of the body. Left
untreated, these abnormalities may cause disease. To mitigate the occurrence of disease,
chiropractors adjust, manipulate, and treat the human body to restore the normal flow of nerve impulse
which produces normal function and consequent health. The practice of chiropractic medicine further
contemplates that chiropractic physicians use specific chiropractic adjustment or manipulation
techniques taught in chiropractic colleges accredited by the Council on Chiropractic Education. No
person other than a licensed chiropractic physician may render chiropractic services, chiropractic
adjustments, or chiropractic manipulations.11
Chiropractic physicians may adjust, manipulate, or treat the human body by:
Manual, mechanical, electrical, or natural methods;
The use of physical means or physiotherapy, including light, heat, water, or exercise;
The use of acupuncture; or
The administration of foods, food concentrates, food extracts, and items for which a prescription
is not required.
In addition, chiropractic physicians may apply first aid and hygiene. However, chiropractic physicians
are expressly prohibited from prescribing or administering to any person any legend drug except, in
emergencies, prescription medical oxygen or topical anesthetics in aerosol form. Chiropractic
physicians cannot perform any surgery or practice obstetrics. 12
Practicing or offering to practice beyond the scope permitted by law or accepting and performing
professional responsibilities which the chiropractic physician knows or has reason to know that she or
he is not competent to perform constitutes grounds for denial of a license or disciplinary action.13
The Florida Board of Chiropractic Medicine
The Florida Board of Chiropractic Medicine (Board) ensures that every chiropractic physician practicing
in Florida meets minimum requirements for safe practice. The Board is responsible for the licensure
and quality control of chiropractic professionals to assure competency and safety. 14 The Board is a
division of the Florida Department of Health (DOH) and consists of seven members appointed by the
Governor and confirmed by the Senate.15 Five board members must be licensed chiropractic
physicians who are Florida residents and have practiced chiropractic medicine for at least 4 years. The
other two board members must be Florida residents who are not, and never have been, licensed as
10 Florida Board of Chiropractic Medicine, Board Meeting Minutes, Novemb er 9, 2023, Florida Department of Health (Nov. 9, 2023)
https://ww10.doh.s tate.fl.us/pub/hcpr/Chiropractor/2023/Chiro%20Draft%20Minutes%2011.9.23.pdf (last visited Jan. 21, 2024).
11 S. 460.403(9)(a), F.S.
12 S. 460.403(9)(c), F.S.
13 S. 460.413(1)(t), F.S.
14 The Florida Board of Chiropractic Medicine, Homepage, Florida Department of Health, https://floridaschiropracticmedicine.gov/ (last
visited Jan. 21, 2024).
15 S. 460.404(1), F.S.
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chiropractic physicians or members of any closely related profession. At least one board member must
be 60 years of age or older.16
Any person desiring to be licensed as a chiropractic physician must apply to DOH to take the licensure
examination. The nonrefundable application fee is capped at $100, and the National Board of
Chiropractic Examiners (NBCE) administers the examination. The examination fee must not exceed
$500 plus the actual per applicant cost to DOH for purchase of portions of the examination from
NBCE.17
DOH examines each application whom the Board certifies has met all of the following criteria: 18
Completed the application form and remitted the appropriate fee.
Submitted proof satisfactory to DOH that the applicant is not less than 18 years of age.
Submitted proof satisfactory to DOH that the applicant is a graduate of a chiropractic college
which is accredited by or has status with the Council on Chiropractic Education or its
predecessor agency.
Regarding matriculation at a chiropractic college, the following requirements apply:
o Matriculation before July 2, 1990: completed at least 2 years of residence college work,
consisting of a minimum of one-half the work acceptable for a bachelor’s degree granted
on the basis of a 4-year period of study, in a college or university accredited by an
institutional accrediting agency recognized and approved by the United States
Department of Education.
o Matriculation after July 1, 1990: granted a bachelor’s degree, based upon 4 academic
years of study, by a college or university accredited by an institutional accrediting
agency that is a member of the Commission on Recognition of Postsecondary
Accreditation.
o Before matriculation effective July 1, 2000: completed at least 3 years of residence
college work, consisting of a minimum of 90 semester hours leading to a bachelor’s
degree in a liberal arts college or university accredited by an institutional accrediting
agency recognized and approved by the United States Department of Education. In
addition, the applicant must have been granted a bachelor’s degree from an institution
holding accreditation for that degree from an institutional accrediting agency that is
recognized by the United States Department of Education. 19
Passed the NBCE certification examination in parts I, II, III, and IV with a score approved by the
Board.
Passed the NBCE physiotherapy examination with a score approved by the Board.
Submitted to DOH a set of fingerprints on a form and under procedures specified by DOH,
along with payment in an amount equal to the costs incurred by DOH for the criminal
background check of the applicant.
Current law requires applicants to have a bachelor’s degree from a school accredited by an agency
recognized and approved by the U.S. Department of Education. This prevents chiropractic physicians
who obtained their bachelor’s level degree at a non-U.S. educational institution of higher education
from being considered for licensure in Florida, even if they graduated from a U.S. chiropractic school.
Effect of the Bill
CS/CS/HB 1063 authorizes chiropractic physicians to adjust, manipulate, or treat the human body by
the use of monofilament intramuscular stimulation, also known as dry needling, treatment for trigger
points or myofascial pain. To perform dry needling, chiropractic physicians must first complete a 40-
hour certification course approved by the Board of Chiropractic Medicine.
16 S. 460.404(2), F.S.
17 S. 460.406(1), F.S.
18 S. 460.406(1), F.S.
19 The applicant’s chiropractic degree must consist of credits earned in the chiropractic program and may not include academic credi t
for courses from the bachelor’s degree.
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Current law requires DOH to examine each applicant whom the Board certifies meets the necessary
matriculation prerequisites. The bill gives the Board authority to recognize chiropractic physician
applicants for licensure if they provide a credential evaluation report from a board-approved
organization that the Board deems is equivalent to a bachelor’s degree. The effect of this change is to
create a licensure pathway for chiropractic physicians to practice in Florida when they obtained their
bachelor’s degree at a non-U.S. educational institution of higher education.
The bill takes effect upon becoming law.
B. SECTION DIRECTORY:
Section 1: Amending s. 460.403, F.S., relating to definitions.
Section 2: Amending s. 460.406, F.S., relating to licensure by examination.
Section 3: Providing an effective date of July 1, 2024.