KSBHA -

Disclaimer: Any and all statements herein should not be construed as legal advice for any particular situation or the establishment of an attorney-client relationship. The Kansas State Board of Healing Arts does not issue advisory opinions or render legal advice or services. Any information found on this website is provided by Board staff for general guidance. Every effort has been made to offer the most current, correct, and clearly expressed information possible. Nevertheless, inadvertent errors in information may occur. The Kansas State Board of Healing Arts disclaims any responsibility and makes no warranties or representations whatsoever regarding the quality, content, completeness, or adequacy of the information provided on this website. The Kansas State Board of Healing Arts also reserves the right to make changes to the information provided at any time without notice.

QUESTION SECTION

Category - Scope of practice of the healing arts

Question: An out of state, non-licensed radiologist is able to log in and access a computer program which contains a Kansas patient's radiological test. The out of state physician does a "preliminary interpretation." The patient is not billed for the preliminary interpretation. The Kansas physician then acts upon the preliminary interpretation.

Question: Can an M.D. operate a C-arm for non-diagnostic procedures such as catheter placement during a surgical procedure? Under the direction of a M.D., is it permissible for a RN to operate a C-arm for non-diagnostic procedures?

Question: May a non-Kansas licensed physician scrub in and observe surgeries in a Kansas hospital or does that violate the healing arts act?

Question: A physician licensed in Kansas calls an out of state physician (who holds a clean, unrestricted license in another state) and asks for advice about a case and then follows that advice. Does that constitute the practice of the healing arts in Kansas by the out of state physician?

Question: Does the Kansas Board of Healing Arts have a policy, regulation, or statutes regarding restrictions on the scope of practice for HIV positive health care workers.

Question: Would the Board consider it inappropriate for a surgeon who lives in Leavenworth and practices surgery (99%) at a Leavenworth hospital to occasional drive to Topeka to perform minor operation and leave the immediate care of the patient to the patient’s primary care physician and physician assistant?

Question: I understand that acupuncture is not licensed in Kansas. I am a Kansas licensed chiropractor. May my wife open her own acupuncture office? Alternatively, may she practice acupuncture in my chiropractic office? If a chiropractor would have to be sure the acupuncturist was performing that service properly, what type of training would be required of the chiropractor?

Category - Scope of practice of naturopathy

Question: Is there a list of approved drugs (to include allergenic extracts) that Naturopaths can prescribe?

Category - Scope of practice for physician assistants

Question: Under K.A.R. 100-28a-14 “Different practice location”, it states that a Physician Assistant can practice at a different location as long as the supervising physician periodically sees patients at that location. What do they mean by periodically? Could that mean that the supervising physician can see one patient a month at that particular location? What if it is a location where the PA is the only provider that is there most of the time and the supervising Physician only comes in once a month? Is that ok?

Question: As I understand the PA regulations, a PA is required to spend 80 hours working with a physician before going to a remote site. After that the physician must from time to time see patients at the remote location. Must the 80 hours be spent under the supervision of a single supervising physician?

Category - Scope of practice of physical therapy

Question: K.S.A. 65-2914 (c) refers to supervision of PTAs but only specifies cases where PTAs must initiate treatment in a hospital setting when a PT is not available. Technically, I assume this does not apply to other cases, based on the way this paragraph is phrased. That being said, do the Kansas Rules and Regulations or Statutes actually specify how often PTs must see each patient treated by a PTA?

Question: As a new graduate, I will be working under a temporary license. Does another PT have to sign my notes?

Question: Are physical therapist assistants able to perform joint mobilization as well as sharp selective debridement in the state of Kansas?

Question: Can a physical therapist and an occupational therapist co-treat an acute care patient and can both disciplines charge the full amount of treatment? Are physical therapist assistants able to write discharge summaries? Are physical therapist assistants able to write re-certifications (Medicare form 701)?

Question: Is there a statute or regulation regarding the recertification of a physical, occupational, or speech therapist's plan of care? Medicare, in the past, ruled that a recertification had to be done every 30 days or less. As of January 1st, recertification of a therapist's plan of care is every 90 days or less. Does Kansas law require a therapist to obtain a new prescription or order every 30 days from the referring physician?

Question: When a referral is for rehabilitative services without specifying physical therapy or occupational therapy, can a patient be treated by a physical therapist and occupational therapist interchangeably if there is documentation that the treating clinician concurs with the plan of care established by the primary treating clinician?

Category - Scope of occupational therapy

Question: In the state of Kansas to what degree are Occupational Therapists permitted to participate in the treatment of wounds? Are Occupational Therapists permitted to mechanically debride necrotic tissue from wounds including the use of whirlpools and similar modalities including irrigation devices and blunt and sharp debridement of necrotic tissue?

Category - Scope of practice of nuclear medicine technologist

Question: Is it within the scope of a nuclear medicine technologist’s practice to administer non-pharmaceuticals in order to complete their exams? Specific examples are kinevac (CCK) and lasix. The exams that are specific to these pharmaceuticals are gallbladder studies. The gallbladder studies are performed in many different outpatient settings, most without physicians or nursing available.

Category - Supervision

Question: Next door is a plastic surgeon who has requested that I (a family practice physician) cover for him when he is out of town. I would cover for his office when they do laser treatments. What is the opinion of the board of healing arts with the legality of doing this?

Question: Are chiropractic assistants allowed to do therapy under the supervision of the chiropractor without the chiropractor physically being in the building?

Question: I have been contacted by a professor at King Saud University in Saudi Arabia regarding the opportunity for a student physical therapist to complete a clinical rotation at our facility. (The connection is through a current student at Emporia State.) I am contacting you as I am willing to participate if there are no concerns from the Board or other agencies affected by this possible educational relationship. Please share with me your opinion.

Category - Termination of the Patient-Physician Relationship

Question: What are the rules and regulations regarding termination of the physician-patient relationship?

Category - Documentation

Question: How long must tissue specimens be kept?

Question: A physician has left a practice here in Wichita (office sharing arrangement). The physician wants all patient files for "her" patients. We believe that the files belong to the patients and should only be transferred after the patient has determined who she wants as her treating physician in the future. The physician claims that only she has a physician-patient relationship with the patients and therefore only she should contact them about the selection of their treating physician following her separation from the practice (she has not yet established a new location that we are aware of so many of her patients continue to contact the practice group). The reality is that while she may have been the primary physician, almost all these patients would have been seen at one time or another by other physicians and all have become familiar with the office staff for scheduling purposes, etc. It seems to me that the office where these patients have been seen should be contacting them and offering to either retain them as patients (with another treating physician in the practice) or transfer their care to the departed physician or another physician of the patient's choosing.

Question: Is it legal for a doctor to refuse to provide another doctor with medical records upon the patient’s request to provide them?

Question: In an outpatient imaging department in a hospital, what are the relevant Kansas rules and regulations regarding physicians directing their medical staff (i.e. nurses) to sign and/or stamp orders for diagnostic tests ordered?

Question: In an outpatient imaging department of a clinic, what are the relevant Kansas rules and regulations regarding physicians directing their medical staff (i.e. nurses) to sign and/or stamp orders for diagnostic tests ordered?

Question: What is the acceptable time in which a physician should complete a chart note in a clinic setting?

Category - Billing

Question: May nurse practitioners who do nail clippings in addition to exams for nursing home patients charge for the E&M with the clipping charge?

Category - Prescribing

Question: Are there any regulations for doctors on prescribing pain medications?

Question: Are there any concerns with regard to providing pharmaceutical samples to those with postgraduate permits?

Question: Recently a local pharmacy informed me that prescriptions may now be faxed to them for Phentermine. Before having our physicians fax such prescriptions, I’d like to see if you have a copy of the statute, etc that outlines this subject.

Category - Exempt License

Question: May a licensee who holds an exempt license do Independent Medical Exams for Worker’s Comp, disability ratings and Social Security disability reviews, and other similar reviews which may require some testifying?

Category - Senate Bill 285

Question: I am aware of Senate Bill 285 that prohibits physicians to bill for anatomic pathology. From what I have read, this law cannot be enforced by the Board until the implementing regulations are written. Can you tell me when these regulations will be written? Will the final regulations prohibit physicians from billing for Pap smears?

Category - K.A.R. 100-22-6 Notice to the Public

Question: My providers have been receiving the blue “Notice to Patients” that states “this office is maintained under the authority of a person who is licensed to practice the healing arts in Kansas”. K.A.R. 100-22-6(b) states “office” shall mean any place intended for the practice of the healing arts. This term shall not include a medical care facility as defined by K.S.A. 65-425. Does the notice need to be posted in a hospital owned clinic?

Question: The notice to the public set fort in K.A.R. 100-22-6, states that the “office” is maintained under the authority of the licensed person. We are a state entity that doesn't function under the license of any of our doctors and we are not licensed by KDHE. Our doctors are all university (state) employees, not in private practice. Are we required to post the notice to patients?

Category - Corporations

Question: Does Kansas prohibit the corporate practice of medicine?

Question: May a Kansas doctor of chiropractic employ a Kansas physical therapist to work for him under his professional corporation, thereby entitling the DC to bill the PT’s services as services provided from the DC’s corporation?

Question: I want to start my own business to provide chiropractic services. Which is the most appropriate for me to form: LLC, PC, S corporation?

Category - Medical Spas

Question: Is it true that any and all medical spas in Kansas must be 100% owned by a physician?

QUESTION/ANSWER SECTION

Category - Scope of practice of the healing arts

Answer: KAR 100-26-1 http://www.ksbha.org/regulations/article26.html clarifies that regardless of the physician's location, the practice occurs where the patient is. The physician must then be licensed to provide a healing arts service to that patient. Reading an x-ray is a healing arts service. Thus, the person reading the image must either be licensed, or be exempted from licensure under one of the provisions of K.S.A. 65-2872 http://www.ksbha.org/statutes/haact.html#2872. The Board has consistently though informally opined that if a radiologist performs a first read of an x-ray, the service is a diagnosis and licensure is required. If the physician does an over-read to confirm or clarify the Kansas physician's initial impression, the service is consultation, and the out-of-state physician does not need a Kansas license. Kansas hospitals are licensed by the department of health and environment. KAR 28-34-12(l) dostates that interpretation of all radiological examinations must be made by physicians, a term which is defined at KAR 28-34-1a(v) to mean a person licensed to practice medicine in Kansas. As a result, images for hospitals must be first read by a Kansas licensee, but that licensee may consult with an out-of-state physician for a second read.

You specifically wanted to know whether the fact that it is only a "preliminary interpretation" and that it is not billed would change the conclusion. Even with those specific facts, the conclusion is the same. The "preliminary interpretation" is akin to a first read, which would require the physician to be licensed in the state of Kansas. The fact that the professional service is not billed is not pertinent.

Answer: The C-arm procedures are within the scope of the healing arts. If the physician is competent in the procedure, it is within the physician’s lawful practice. The physician may delegate performance to a competent person as provided at KSA 65-7304(f) http://www.ksbha.org/statutes/radioact.html#7304.

Question: May a non-Kansas licensed physician scrub in and observe surgeries in a Kansas hospital or does that violate the healing arts act?

Answer: The out-of-state physician would not be engaging in the healing arts for which licensure in this state is required.

Answer: Pursuant to K.A.R. 100-26-1, an out of state practitioner may communicate with health professionals in this state. A health professional is defined by K.A.R. 100-26-2(c) http://www.ksbha.org/regulations/article26.html. An out of state practitioner is defined by K.A.R. 100-26-2(e) http://www.ksbha.org/regulations/article26.html.

Even if the advice to the physician in Kansas is construed as giving an order, then the definition of a "valid order" in K.A.R. 100-26-2(g) http://www.ksbha.org/regulations/article26.html would apply.

Question: Does the Kansas Board of Healing Arts have a policy, regulation, or statutes regarding restrictions on the scope of practice for HIV positive health care workers.

Answer: The Board does not have a specific statute, regulation or policy on this. All physicians should practice universal precautions. If the risk of communicating the virus to a patient is increased, then the physician needs to take the steps necessary to overcome that risk. If the risk is high enough under the circumstances, then the physician may need to not perform direct patient care. As long as the physician is able to practice safely, we generally do not limit the license. We are authorized to take disciplinary action when the physician is not able to practice with reasonable skill and safety due to a mental or physical impairment, which includes a communicable disease.

Answer: The issue you raise is whether or not a practitioner of the healing arts is meeting the standard or care in the situation that you posed. The standard of care is often defined as what a reasonable and prudent practitioner in a similar situation would do. If the Board were to receive a complaint alleging that the situation does not meet the standard of care, then the matter would be investigated and it would be reviewed by peer review committees for their input regarding whether or not the standard of care has been met. If the review committees recommended that the standard of care had not been met, then the litigation staff would retain an expert witness to give an opinion on the matter with the expectation of providing expert testimony in a disciplinary proceeding. I believe the answer of whether the standard of care would be met, depends upon the facts on a case by case basis. However, even if we had the facts of a specific case available, the Board is not authorized to give advisory opinions in specific cases.

Answer: Acupuncture is within the scope of the healing arts and may be performed by a doctor of chiropractic or a person to whom that doctor delegates authority through supervision and direction. In order to delegate, that doctor must be professionally competent in the delegated service. We do not have a standard that specifies the course of study or the number of hours in education must be completed in order to be professionally competent. There is no additional certification required. Under our model of regulation, a licensed individual’s professional competency in a specific service is the responsibility of the individual, and is not determined by the Board unless the Board finds after a hearing that there have been repeated instances of negligence or other evidence of manifest incapacity to practice with reasonable skill and safety. You might find recommendations from other doctors of chiropractic helpful when selecting a course of study. As for opening an office, only a licensed practitioner may open and maintain an office. The services provided in that office are the ultimate responsibility of the licensed practitioner.

Question: We would like to provide our clients with "in-home" services to ensure more privacy to the individual. These services are Botox and IPL administered by myself and/or my physician assistant, as well as, microdermabrasion administered by my aesthetician. Are there any rules at this time regarding traveling with any of these services? Additionally, we are curious if there are any laws against providing these services in "my" home?

Answer: K.A.R. 100-27-1 http://www.ksbha.org/regulations/article27.html. The regulation applies to all classes. The standards in subsection (b) must be met. There is a stricter standard for class III and IV. The additional standard is in subsection (c).

Under subsection (b), you may not delegate authority to another person unless the service is provided in a location that you maintain as an office. This regulation would permit you to provide the service at the patient’s home, but not a person, including the P.A., who receives authority from you.

This rule applies only to the light-based devices and not to other devices or drugs. We do not have specific rules regarding home-based services. The ordinary rules regarding standard of care, competency, professionalism, etc. would apply.

Category - Scope of practice of naturopathy

Question: Is there a list of approved drugs (to include allergenic extracts) that Naturopaths can prescribe?

Answer: According to K.S.A. 65-7202(a)(2)(A) http://www.ksbha.org/statutes/ndact.html#7202, naturopathic doctors may prescribe, recommend or administer "food, food extracts, vitamins, minerals, enzymes, whole gland thyroid, botanicals, homeopathic preparations, nonprescription drugs, plant substances that are not designated as prescription drugs or controlled substances, topical drugs...." K.S.A. 65-7202(a)(9) http://www.ksbha.org/statutes/ndact.html#7202 defines topical drugs to include analgesics, antiseptics, scabicides, antifungals and antibacterials that are not prescription only drugs.

The naturopathic formulary for drugs that are approved for intramuscular or intravenous administration by a naturopathic doctor pursuant to a protocal with a physician is set out in K.A.R. 100-72-8.

Category - Scope of practice for physician assistants

Question: Under K.A.R. 100-28a-14 http://www.ksbha.org/regulations/article28a.html “Different practice location”, it states that a Physician Assistant can practice at a different location as long as the supervising physician periodically sees patients at that location. What do they mean by periodically? Could that mean that the supervising physician can see one patient a month at that particular location? What if it is a location where the PA is the only provider that is there most of the time and the supervising Physician only comes in once a month? Is that ok?

Answer: The Board has not expanded on what the regulation means by "periodically." That language would likely be interpreted in light of subsection (a), which requires the location to be maintained or utilized by a physician to "regularly meet patients or to receive calls." There is no definition of the word "regularly." In a legal sense that means that the event is usual or customary and not subject to unexplained or irrational variation. The opposite of "regular" is "casual" or "occasional." (K.A.R. 100-28a-14) http://www.ksbha.org/regulations/article28a.html

Answer: K.A.R. 100-28a-14 http://www.ksbha.org/regulations/article28a.html does not expressly limit the minimum 80 hour supervision requirement to a single physician. I believe the intent of the regulation is to prevent newly licensed PAs from practicing at different practice locations without ever having had the immediate or physical supervision and direction. However, the supervision and direction should be by the responsible physician(s). A physician assistant can have more than one responsible physician. Although, a physician may not be the responsible physician for more than two PAs at the same time without Board approval pursuant to K.A.R. 100-28a-17 http://www.ksbha.org/regulations/article28a.html.

Category - Scope of practice of physical therapy

Question: K.S.A. 65-2914 (c) http://www.ksbha.org/statutes/ptact.html#2914 refers to supervision of PTAs but only specifies cases where PTAs must initiate treatment in a hospital setting when a PT is not available. Technically, I assume this does not apply to other cases, based on the way this paragraph is phrased. That being said, do the Kansas Rules and Regulations or Statutes actually specify how often PTs must see each patient treated by a PTA?

Answer: With regards to K.S.A. 65-2914(c) http://www.ksbha.org/statutes/ptact.html#2914, the general rule is that a physical therapist shall see all patients initially and evaluate the patients periodically. Neither the statutes or regulations define or give further guidance as to what constitutes "periodically." The exception to this general rule is in a hospital setting, if the physical therapist is not immediately available, then the physical therapist assistant may initiate patient care after telephone contact with the physical therapist. The physical therapist must thereafter evaluate the patient as soon as possible with a minimum of weekly review.

Question: As a new graduate, I will be working under a temporary license. Does another PT have to sign my notes?

Answer: Neither the statutes or regulations require co-signing your notes when you are issued a temporary license.

Question: Are physical therapist assistants able to perform joint mobilization as well as sharp selective debridement in the state of Kansas?

Answer: Physical therapy is defined by K.S.A. 65-2901(a) http://www.ksbha.org/statutes/ptact.html#2901 to include therapeutic exercise, manual therapy, debridement and wound care. A physical therapist may delegate physical therapy to a physical therapist assistant who the physical therapist believes to be qualified by training or experience to perform such physical therapy. Improper delegation of physical therapy to an individual who is not qualified is unprofessional conduct pursuant to K.A.R. 100-29-12(a)(23) http://www.ksbha.org/regulations/article29.html. Pursuant to K.A.R. 100-29-16(c) http://www.ksbha.org/regulations/article29.html, "[t]he determination by the physical therapist to utilize a physical therapist assistant for selected components of physical therapy interventions shall require the education, expertise, and professional judgment of the physical therapist." The regulation goes on to provide several factors that a physical therapist shall consider. That provision should be read in conjunction with K.A.R. 100-29-16(d)http://www.ksbha.org/regulations/article29.html, which identifies the services which only a physical therapist can perform. K.A.R. 100-29-16(e) http://www.ksbha.org/regulations/article29.html sets forth the factors that help determine when it may be safe and legal to delegate tasks to a PTA. Additionally, when delegating to a PTA, the physical therapist has the duty to adequately supervise that PTA. Failure to adequately supervise is unprofessional conduct pursuant to K.A.R. 100-29-12(a)(6) http://www.ksbha.org/regulations/article29.html .

Answer: K.A.R. 100-29-16(d) http://www.ksbha.org/regulations/article29.html , identifies those tasks that a PT may not delegate to a PTA. To the extent that the questions you raise are not answered by this regulation, reimbursement rules will control. As for the co-treatment and billing, please contact the reimbursement authority. While billing fraud would be prohibited, I do not know whether this particular practice would be considered false or misleading, or if it might be considered appropriate.

Answer: K.S.A. 65-2921 http://www.ksbha.org/statutes/ptact.html#2921 sets forth four situations where the physical therapist may evaluate and treat a patient for no more than 30 consecutive days without a referral.

Answer: Pursuant to K.S.A. 65-2901 http://www.ksbha.org/statutes/ptact.html#2901 physical therapy is defined as, “examining, evaluating and testing individuals with mechanical, anatomical, physiological and developmental impairments, functional limitations and disabilities or other health and movement-related conditions in order to determine a diagnosis solely for physical therapy, prognosis, plan of therapeutic intervention and to assess the ongoing effects of physical therapy intervention.” (Emphasis added.)

Upon receipt of a referral or order that fails to specify if it is for occupational therapy or physical therapy, the provider should attempt to communicate with the physician to determine if the physician actually intended one discipline over the other. The provider’s attempts to communicate with the physician to clarify the order should be documented.

If the patient was initially seen and evaluated by an OT, then the OT would have established an occupational therapy plan of care. A PT cannot fill in and perform therapy according to the occupational therapy plan of care that is in place. The two disciplines are not interchangeable, even though some areas of their respective disciplines may overlap. If the PT is going to treat the patient then there needs to be an order for physical therapy, an initial evaluation for physical therapy and a physical therapy plan of care.

This same analysis would apply to hospital patients as well. It is possible that a hospital patient may require treatment from both disciplines, but they are not interchangeable.

Category - Scope of occupational therapy

Answer: Wound debridement is not specified in the occupational therapy act as being inherently an occupational therapy service. Thus, the authority to perform the service must be delegated. For example, this delegation might come from a physician who orders occupational therapy services and specifies debridement in the order, or a physician who employs an O.T. might direct and supervise the debridement. These examples are not an exhaustive list.

Category - Scope of practice of nuclear medicine technologist

Answer: The statutes and regulations with the jurisdiction of the Board of Healing Arts do not prohibit a nuclear medicine technologist from administering a drug or product, but neither do they grant independent authority to do so. The Board has jurisdiction to enforce the radiologic technologists practice act. Radiologic technology is defined to include nuclear medicine technology. A nuclear medicine technologist is defined as a person who uses radio pharmaceutical agents on humans for diagnostic or therapeutic purposes. The act then establishes a licensure requirement for persons who perform radiologic technology procedures for diagnostic or therapeutic purposes. There are exceptions to this licensure requirement, one of which is the performance of procedures in a hospital under the supervision of a physician or a physician’s designee. Specific requirements for supervision, such as personal presence, are not dictated in the Board’s statutes or regulations, and thus would be determined by the facility and by the physician who is ultimately responsible.

As a result, a facility may authorize radiologic technologists to administer a drug or product according to its own rules and supervision requirements. Those rules and requirements would be subject to general requirements, including the rule pertaining to medical care facilities that drugs be administered written and signed orders of person who is authorized to order the drug and who is qualified according to medical staff bylaws, and the requirements of K.A.R. 28-34-12, which requires supervision by a radiologist.

Category - Supervision

Answer: The standards for supervising light-based treatments appear in K.A.R. 100-27-1 http://www.ksbha.org/regulations/article27.html. The primary issue to consider is your own training and experience in performing procedures using these devices, as that will define your ability to supervise. Also, the laser classification is important, as the intensity of supervision is greater for class III and IV lasers. You should consider whether your practice as a family practice physician permits you to leave the patient examining room without delay, or whether you perform procedures that can not be interrupted. As a practical matter, I suspect that the individuals operating the devices are well trained, competent, and intend to provide good patient care, but they and the patient might have occasion to rely upon you in a difficult situation, and that is what you would be responsible for.

Question: Are chiropractic assistants allowed to do therapy under the supervision of the chiropractor without the chiropractor physically being in the building?

Answer: There are no specific statutes or regulations that address your question. Professional services may be performed under the supervision of a licensee, but the word "supervision" is not defined. The standards for supervision appear at K.S.A. 65-28,127, and include the following conditions that the supervising licensee must satisfy:
     "(1) Be actively engaged in the practice of the healing arts in Kansas;      . . .
      (3) direct, supervise, order, refer, enter into a practice protocol with, or delegate to such persons only those acts and functions which the responsible licensee knows or has reason to believe such person is competent and authorized by law to perform;
      (4) direct, supervise, order, refer, enter into a practice protocol with, or delegate to other persons only those acts and functions which are within the normal and customary specialty, competence and lawful practice of the responsible licensee;
      (5) provide for a qualified, substitute licensee who accepts responsibility for the direction, supervision, delegation and practice protocols with such persons when the responsible licensee is temporarily absent. . . ."
The Board has not officially opined on the subject, but I believe there has been a consistent consensus that performing chiropractic manipulation requires a more intensive level of supervision than some other tasks, and delegating while being off of the premises might constitute practice below the standard of care.

Answer: K.S.A. 65-2913(c)(9) http://www.ksbha.org/statutes/ptact.html#2913 would allow supervision of this person if the university program is accredited. The supervision standards appear in our regulation KAR 100-29-16 http://www.ksbha.org/regulations/article29.html. While the statute does not identify an accrediting body, the statute anticipates the program to be accredited by an organization that would impose standards of accreditation at least as stringent as those required for a program attended by an applicant for licensure.

Category - Termination of the Patient-Physician Relationship

Question: What are the rules and regulations regarding termination of the physician-patient relationship?

Answer: No Kansas statute or regulation exists specifically in regard to terminating the physician-patient relationship. In accordance with the American Medical Association’s guidelines, the practitioner may wish to:
(1) provide the patient with reasonable notice of termination, such as 30 days, to allow the patient to seek another provider;
(2) provide only emergency services for that 30-day time period; and
(3) provide the patient’s treatment records to the new provider.

Category - Documentation

Question: How long must tissue specimens be kept?

Answer: The Healing Arts Act and related regulations are silent with regard to how long tissue specimens must be kept. We only have the regulation requiring that patient records be maintained for ten years. However, if the clinic has its own laboratory then you may wish to check with the regulatory agency for the lab.

Answer: The healing arts act addresses the responsibilities of physicians, as opposed to business entities. The first issue you ask is who owns the patient records. As you eluded to, who owns the patient records this is going to depend on the nature of the contractual relationship.

You have indicated that the leaving physician has a physician-patient relationship with some of the patients. K.A.R. 100-24-2 http://www.ksbha.org/regulations/article24.html addresses the responsibilities of each licensee with regard to maintaining patient records. The leaving physician may maintain the patient records or she may work out an agreement with the practice to maintain the records for her in accordance with KAR 100-24-2 http://www.ksbha.org/regulations/article24.html. It would be wise to notify the patients who they can contact to request a copy of their records.

That leads me to your next question regarding who should give notice to the patients. There is no clear statutory or regulatory authority stating who should give the notice. However, the physician would want to avoid a situation of patient abandonment as this could potentially be a violation of the healing arts act as unprofessional and/or dishonorable conduct pursuant to K.S.A. 65-2836(b) http://www.ksbha.org/statutes/haact.html#2836.

The physician leaving the practice must also update the Board with regard to her new address.

Question: Is it legal for a doctor to refuse to provide another doctor with medical records upon the patient’s request to provide them?

Answer: K.A.R. 100-22-1(b) http://www.ksbha.org/regulations/article22.html, as you correctly cited, does prohibit a licensee from conditioning the release of patient records to another licensee based on payment from the patient. However, the licensee can condition the release of patient records upon payment when the request comes directly from the patient. In that case, K.S.A. 65-4971 http://www.ksbha.org/statutes/clact.html#4971 sets forth the maximum fees that may be charged. These amounts are adjusted annually.

Answer: For x-ray exposure, the Kansas Department of Health and Environment (KDHE) regulations apply. For MRIs, there is no specific rule. The rules for authentication of an order are also in the regulations promulgated by the KDHE.

Answer: There are no specific state regulations that apply. That being the case, state statutes and regulations would not prohibit signing for or using a stamp for the physician’s signature when directed on an individual basis. An electronic signature is also appropriate. More stringent requirements might be imposed by others as a condition to reimbursement.

Question: What is the acceptable time in which a physician should complete a chart note in a clinic setting?

Answer: The Healing Arts Act which is the licensure act for MDs, DOs, and DCs does not set forth a specific time frame, but it does provide that failure to keep accurate medical records describing the services rendered, the patient history, pertinent findings, examination results and test results constitutes unprofessional conduct which may be grounds for disciplinary action. See K.S.A. 65-2836(b) http://www.ksbha.org/statutes/haact.html#2836 and K.S.A. 65-2837(b)(25) http://www.ksbha.org/statutes/haact.html#2837b. The issue becomes when has so much time passed that it impacts the accuracy of the medical records? This will depend upon the facts in each case. Additionally, K.A.R. 100-24-1 http://www.ksbha.org/regulations/article24.html sets forth the minimal requirements that must be maintained in the patient records.

Category - Billing

Question: May nurse practitioners who do nail clippings in addition to exams for nursing home patients charge for the E&M with the clipping charge?

Answer: Nurse practitioners are regulated by the state board of nursing. For those professions that we regulate, the question comes down to the rules of the reimbursing entity or authority, if there is one. There might be a question as to whether the service is one that is medically necessary, or whether the service is one for which the patient has consented.

Category - Prescribing

Question: Are there any regulations for doctors on prescribing pain medications?

Answer: The Board has guidelines for the treatment of pain which are available on our website at: www.ksbha.org. There are several factors that would indicate whether prescriptions are appropriate in a given circumstance.

Question: Are there any concerns with regard to providing pharmaceutical samples to those with postgraduate permits?

Answer: The samples would be authorized only if received and distributed within the scope of the post graduate training program. This is consistent with the federal rules because the post grad is authorized to prescribe, though in a limited setting, and thus is a practitioner under federal law. The postgraduate program itself would be able to say whether and in what manner the samples may be received.

Answer: Generally, class III through V drugs may be faxed as provided by K.A.R. 18-20-18(d). However, K.S.A. 65-2837a http://www.ksbha.org/statutes/haact.html#2837a previously limited the manner in which scheduled amphetamines were ordered, requiring the order to be in the physician’s own handwriting. As a result, faxing the order was not allowed. The handwriting requirement was removed in the 2007 legislative session, and it appears that a faxed order would be appropriate. Phentermine may still be used only for the purposes identified in K.S.A. 65-2837a, http://www.ksbha.org/statutes/haact.html#2837a and if for obesity, must be in accordance with K.A.R. 100-23-1 http://www.ksbha.org/regulations/article23.html.

Category - Exempt License

Answer: K.A.R. 100-10a-4(a)(1) http://www.ksbha.org/regulations/article10.html, allows persons with an exempt license to perform disability determinations and expert opinions. SRS disability reviews and workers comp IMEs would similarly be permissible.

Category - Senate Bill 285

Answer: The statute is self implementing, which means that Board regulations are not required in order for the statute to be reinforced. The statute prohibits billing for the pathological services which the provider did not perform. However, this statute does not prevent a provider from billing for handling the laboratory specimen. The Board is currently working on drafting an interpretative policy to help answer frequently asked questions about this bill.

Category - K.A.R. 100-22-6 Notice to the Public

Question: My providers have been receiving the blue “Notice to Patients” that states “this office is maintained under the authority of a person who is licensed to practice the healing arts in Kansas”. K.A.R. 100-22-6(b) http://www.ksbha.org/regulations/article22.html states “office” shall mean any place intended for the practice of the healing arts. This term shall not include a medical care facility as defined by K.S.A. 65-425. Does the notice need to be posted in a hospital owned clinic?

Answer: A “medical care facility” as used in the regulation is a licensed hospital or ambulatory surgical center. Whether a hospital-owned clinic is considered part of the hospital and thus exempt from the posting requirement depends on whether the clinic is a hospital department for outpatient hospital services authorized by the hospital’s license. There is no bright-line test to make this determination in all cases. If the clinic supports the nonemergency health care of the hospital, then the clinic would most likely be considered a medical care facility. If the clinic is a practice location for physicians to see patients who are not receiving hospital services, then the clinic is most likely not a medical care facility and regulation would require posting the notice.

Question: The notice to the public set fort in K.A.R. 100-22-6 http://www.ksbha.org/regulations/article22.html, states that the “office” is maintained under the authority of the licensed person. We are a state entity that doesn't function under the license of any of our doctors and we are not licensed by KDHE. Our doctors are all university (state) employees, not in private practice. Are we required to post the notice to patients?

Answer: If the location where the practice of healing arts occurs does not fall within the exemption for a medical care facility as defined by K.S.A. 65-425, then you are required to post the notice.

Category - Corporations

Question: Does Kansas prohibit the corporate practice of medicine?

Answer: The common law rule does prohibit the corporate practice of medicine. The core of that doctrine is that a general business entity may not engage in a learned profession, such as that of physicians, chiropractors, attorneys and dentists, either through employment of or by contract with one of those licensed professionals. An exception to that doctrine is when the entity is otherwise permitted by state statute to engage in the profession. For example, a hospital is licensed to provide medical services, and thus may employ physicians. Another exception applies to professional corporations or professional L.L.C.s owned by qualified persons.
Additionally, the statute K.S.A. 65-2867 http://www.ksbha.org/statutes/haact.html#2867, prohibits a person other than one who is licensed under the healing arts act to open and maintain a location for the practice of the healing arts.
Some business relationships among physicians and corporations are proper. Physicians often engage management organizations to administer their business activities. The key component of that relationship is that the physician uses the efforts of the other organization to accomplish the professional purpose rather than the other using the efforts of the physician.

Answer: The general rule is that a professional corporation can be formed for only one professional purpose. The exception is that a professional corporation can be formed by a physical therapist and a chiropractor so long as the articles of incorporation indicate the dual purpose. If the corporate purpose includes the practice of physical therapy, then a licensed physical therapist must be a shareholder in the corporation. The PT shareholder could then employ another PT and bill accordingly for the PT services rendered.

If the corporate purpose is solely to provide chiropractic services, then the chiropractor could employ a PT but it may impact how the services of the PT can be billed.

Question: I want to start my own business to provide chiropractic services. Which is the most appropriate for me to form: LLC, PC, S corporation?

Answer: Kansas law does not allow members of learned professions to offer services through general corporations. Licensed professionals are permitted to practice in professional business entities, including professional corporations and professional LLCs. Only “qualified persons” are allowed to own shares in professional business entities. The form of business that is right for you will depend upon factors in which the Board cannot provide advice. It is important to seek counsel from an attorney.

Category - Medical Spas

Question: Is it true that any and all medical spas in Kansas must be 100% owned by a physician?

Answer: The corporate practice doctrine is established in case law from the Kansas Supreme Court. The corporate practice doctrine prevents an unlicensed individual or entity from employing a physician. The concern is an unlicensed individual infringing upon the physician's medical judgment. If an unlicensed individual either by a proprietorship or through a corporation offers to the public medical services, they could potentially be in violation of K.S.A. 65-2869 http://www.ksbha.org/statutes/haact.html#2869.

Additionally, physicians licensed in Kansas are governed by the Healing Arts Act. Such act allows the Kansas State Board of Healing Arts to take disciplinary action for unprofessional conduct, which is defined to include fee splitting with unlicensed individuals or entities. (See K.S.A. 65-2837(b)(19) http://www.ksbha.org/statutes/haact.html#2837.

With both the corporate practice doctrine and the prohibition against fee splitting, the end conclusion is that unlicensed entities cannot have an ownership interest in a medical practice.