# COMAR Title 10 — Maryland Department of Health ## Subtitle 43 — Board of Chiropractic Examiners ### Chapter 10 — Continuing Education Requirements **Authority:** Health Occupations Article, §§3-308 and 3-313, Annotated Code of Maryland **Administrative History:** Effective date: March 9, 1998 (25:5 Md. R. 370) **Administrative History:** Regulation .02B amended effective June 9, 2003 (30:11 Md. R. 735); June 13, 2011 (38:12 Md. R. 705); January 6, 2014 (40:26 Md. R. 2164) **Administrative History:** Regulation .03B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735); October 22, 2007 (34:21 Md. R. 1915); June 13, 2011 (38:12 Md. R. 705) **Administrative History:** Regulation .03D amended effective October 22, 2007 (34:21 Md. R. 1915) **Administrative History:** Regulation .03E adopted effective January 6, 2014 (40:26 Md. R. 2164) **Administrative History:** Regulation .04 amended effective October 22, 2007 (34:21 Md. R. 1915) **Administrative History:** Regulation .04B amended effective August 6, 2001 (28:15 Md. R. 1398); June 9, 2003 (30:11 Md. R. 735) **Administrative History:** Regulation .04G amended effective June 13, 2011 (38:12 Md. R. 705) **Administrative History:** Regulation .04 repealed and new Regulation .04 adopted effective January 6, 2014 (40:26 Md. R. 2164) **Administrative History:** Regulation .05 amended effective June 13, 2011 (38:12 Md. R. 705) **Administrative History:** Regulation .05I amended effective January 6, 2014 (40:26 Md. R. 2164) **Administrative History:** Chapter and Subtitle renamed and recodified from COMAR 10.43.11 to COMAR 10.43.10, Board of Chiropractic Examiners, Continuing Education Requirements, effective January 2, 2017 (43:26 Md. R. 1446) **Administrative History:** Regulation .01 amended effective January 8, 2024 (50:26 Md. R. 1132) **Administrative History:** Regulation .02B amended effective January 2, 2017 (43:26 Md. R. 1446); January 8, 2024 (50:26 Md. R. 1132) **Administrative History:** Regulation .03 amended effective January 8, 2024 (50:26 Md. R. 1132) **Administrative History:** Regulation .04 amended effective January 8, 2024 (50:26 Md. R. 1132) **Administrative History:** Regulation .05 amended effective January 8, 2024 (50:26 Md. R. 1132) **Administrative History:** Regulation .06 adopted effective January 8, 2024 (50:26 Md. R. 1132) #### Regulation .01 Scope. *COMAR 10.43.10.01* This chapter governs continuing education for all individuals licensed to practice chiropractic or registered to practice as a chiropractic assistant in Maryland. #### Regulation .02 Definitions. *COMAR 10.43.10.02* A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Board” means the Maryland Board of Chiropractic Examiners. (2) “Credit hour” means 1 course or program hour. (3) “Licensee” means a chiropractor licensed by the Board. (4) “Pre-approved provider” means: (a) The State Chiropractic Association; (b) The American Chiropractic Association; (c) The International Chiropractors Association; (d) Schools or colleges accredited by the Council on Chiropractic Education (CCE), the Federation of Chiropractic Licensing Boards Providers of Approved Continuing Education (FCLB PACE), and the National Board of Chiropractic Examiners (NBCE); (e) Agencies approved by the Board of Physicians; or (f) Schools and organizations approved by the Board. (5) “Provider” means an individual or group who designs and develops continuing education courses or programs. (6) “Registrant” means a chiropractic assistant who is registered by the Board to perform duties authorized under COMAR 10.43.07. #### Regulation .03 Renewal Requirements. *COMAR 10.43.10.03* A. License Renewal. (1) A licensee shall satisfactorily complete 48 hours of continuing education in the 2-year period before each renewal and provide verification to the Board if requested. (2) The licensee shall: (a) Obtain a minimum of: (i) 3 hours in approved communicable-disease education, which includes AIDS/HIV, and sanitary procedures; (ii) 1 hour in diversity or cultural competency education; (iii) 3 hours in risk management; and (iv) 1 hour in professional ethics or jurisprudence; (b) Pay a renewal fee as set forth in COMAR 10.43.06; and (c) Submit to the Board a renewal application accompanied by a continuing education form that the Board requires. B. Registration Renewal. (1) A registrant shall satisfactorily complete 10 hours of continuing education in the 2-year period before each renewal and provide verification to the Board, if requested. (2) The registrant shall: (a) Pay a renewal fee as set forth in COMAR 10.43.06; and (b) Submit to the Board a renewal application accompanied by a continuing education form that the Board requires. C. Hours may be in-person, home study, or online format. D. Exemptions, Waivers, and Extensions. (1) Individuals issued initial licensure or registration within 12 months of the renewal date are exempt from the continuing education (CEU) requirements under this chapter for the first renewal cycle. (2) Licensees and registrants with documented hardships seeking an exemption, waiver, or extension from CEU requirements under this chapter shall petition the Board in writing at least 90 days before the renewal date. (3) The Board shall review the petition for an exemption, waiver, or extension, and respond in writing to the licensee or registrant within 30 days of the Board’s decision. E. The Board may deny the license or registration renewal of any chiropractor or chiropractic assistant who fails to comply with this chapter. F. The Board shall conduct an audit of licensees and registrants before or during the renewal period to ensure compliance with this chapter. G. Continuing education hours may not be carried over from one renewal period to the next. #### Regulation .04 Accreditation and Approval of Continuing Education. *COMAR 10.43.10.04* A. The Board shall: (1) Base accreditation and approval of continuing education courses and programs on their content and instructor qualifications; and (2) Ensure that continuing education courses and programs are directed toward improvement, advancement, and extension of professional skill and knowledge related to chiropractic. B. Pre-Approved Providers. (1) Pre-approved providers shall submit continuing education courses or programs to the Board within 30 days before commencement of the course or program date. (2) A course or program conducted by a pre-approved provider is considered approved without further review, provided that the course or program meets the subject-matter requirements of §D of this regulation. (3) The Board shall post the list of pre-approved providers on the Board's website for public view. C. Non-Pre-Approved Providers. (1) Non-pre-approved providers shall submit continuing education courses or programs to the Board 60 days prior to commencement of course or program date for review. (2) The Board shall formally respond to submittals in a timely manner. (3) The process for submission for approval shall be published on the Board’s website. (4) The Board shall post the list of approved courses or programs from non-pre-approved providers on the Board's website for public view. D. For license renewal credit, the Board may approve a course or program consisting of one of the following subjects or a combination of these subjects: (1) Chiropractic principles and adjusting techniques; (2) Chiropractic ethics and jurisprudence; (3) X-ray quality assurance program; (4) Diagnostic imaging; (5) Physical diagnosis; (6) Clinical laboratory diagnosis; (7) Orthopedic diagnosis; (8) Neurological diagnosis; (9) Rehabilitative procedures; (10) Nutritional diagnosis; (11) Physical therapy; (12) Risk management; (13) Cultural competency or diversity awareness; or (14) A subject with clinical application approved by the Board. E. Term of Approval. (1) The Board shall approve a course or program for a period of 5 years. (2) At the expiration of the 5-year approval period, the provider: (a) May resubmit the course or program; and (b) Shall meet the approval requirements of this regulation. F. A licensee may: (1) Submit a request for review of continuing education from the Board if the: (a) Continuing education is not already approved or disapproved by the Board; and (b) Licensee submits a request to the Board at least 60 days prior to the commencement of the course or program containing, but not exclusive to, information set forth in this chapter; and (2) Achieve up to 12 hours for verified participation as an instructor, volunteer, or mentor under structured, sponsored courses or programs reviewed and approved by the Board. G. A continuing education processing review fee shall be paid in accordance with COMAR 10.43.06.02. H. A continuing education course may not exceed 12 hours during any renewal period. I. In addition to the required hours of continuing education set forth in this chapter, a licensee or registrant shall maintain a current CPR certification at the healthcare provider level from a Board-approved CPR provider for each renewal period. J. Approved credits are not transferable and are acceptable toward fulfillment of the continuing education requirement only in the renewal period in which the approved credits are earned. #### Regulation .05 Substantiation of Credits. *COMAR 10.43.10.05* A. The licensee or registrant shall keep accurate records of attendance at approved continuing education courses or programs and be able to substantiate those records upon request. B. The Board shall conduct a random audit before or during the license or registration renewal period to ensure compliance with this chapter. C. The Board shall disallow the continuing education credits for a licensee or registrant who is unable to substantiate the credits and may deny the license or registration renewal if credits are disallowed. D. The Board may require additional verification for any information received regarding content and certification of, and attendance at, a continuing education course or program. E. The Board may grant an extension of time for the licensee or registrant to obtain required continuing education credits if the licensee or registrant presents evidence satisfactory to the Board that failure to comply was due to circumstances beyond the licensee's or registrant’s control. F. The Board may not accept continuing education credits from a previous renewal period. G. The Board shall renew a license or registration for the first renewal period following the issuance of the original license or registration without requiring continuing education credits if the original license or registration was issued 1 year or less before the expiration date of the license or registration. H. A licensee or registrant shall maintain complete and accurate records of the licensee's or registrant’s continuing education credits for the preceding 4 years and present them to the Board upon request. I. Upon licensee or registrant petition, the Board may waive the continuing education requirements when it determines that the licensee or registrant was unable to comply due to hardship. J. The Board may institute disciplinary action, pursuant to Health Occupations Article, §3-313, Annotated Code of Maryland, against a chiropractor or chiropractic assistant who submits fraudulent information to the Board. K. Failure to substantiate continuing education hours if requested by the Board shall result in denial of: (1) License or registration renewal; or (2) Reinstatement of a license or registration. #### Regulation .06 Reinstatement Requirements. *COMAR 10.43.10.06* A. A licensee shall satisfactorily complete a minimum of 48 continuing education hours as set forth under Regulation .03A(2)(a) of this chapter in the 2-year period immediately preceding reinstatement. B. A registrant shall satisfactorily complete a minimum of 10 continuing education hours as set forth under Regulation .03B of this chapter in the 2-year period immediately preceding reinstatement.