Michigan Office of Administrative Hearings and Rules  
Administrative Rules Division (ARD)  
MOAHR-Rules@michigan.gov  
REGULATORY IMPACT STATEMENT  
and COST-BENEFIT ANALYSIS (RIS)  
AGENCY INFORMATION:  
Department name:  
Licensing and Regulatory Affairs  
Bureau name:  
Bureau of Professional Licensing  
Name of person filling out RIS:  
Weston MacIntosh  
Phone number of person filling out RIS:  
517-241-9269  
Email of person filling out RIS:  
MacIntoshW1@michigan.gov  
RULE SET INFORMATION:  
ARD assigned rule set number:  
2023-35 LR  
Title of proposed rule set:  
Chiropractic – General Rules  
COMPARISON OF RULE(S) TO FEDERAL/STATE/ASSOCIATION STANDARDS  
1. Compare the proposed rules to parallel federal rules or standards set by a state or national licensing agency  
or accreditation association, if any exist.  
There are no parallel federal rules or standards set by a state or national licensing agency or accreditation  
association.  
A. Are these rules required by state law or federal mandate?  
Under MCL 333.16204, if the completion of continuing education is a condition for renewal, the board shall by  
rule require an applicant for renewal to complete an appropriate number of hours or courses in pain and  
symptom management.  
Under MCL 333.16287, the department, in consultation with the board, shall promulgate rules to implement  
MCL 333.16284 and MCL 333.16285.  
Under MCL 333.16423(1), the department, in consultation with the board, shall promulgate rules to establish  
criteria for the performance and ordering of tests and the approval of analytical instruments and adjustment  
apparatus to be used for the purpose of examining and treating patients for subluxations and misalignments  
that produce nerve interference or joint dysfunction.  
Under MCL 333.16431(2), the department, in consultation with the board, shall promulgate rules requiring each  
applicant for license renewal to complete as part of the educational conferences required under MCL  
333.16431(1) an appropriate number of hours or courses in pain and symptom management.  
Under MCL 333.16431(3), the department, in consultation with the board, shall promulgate rules requiring each  
applicant for license renewal to complete as part of the educational conferences required under MCL  
333.16431(1) an appropriate number of hours or courses concerning the provisions of MCL 333.16401(1) that  
were added by the amendatory act that added MCL 333.16431(3).  
MCL 24.245(3)  
RIS-Page 2  
No federal mandate demands the rules.  
B. If these rules exceed a federal standard, please identify the federal standard or citation, describe why it  
is necessary that the proposed rules exceed the federal standard or law, and specify the costs and  
benefits arising out of the deviation.  
The rules do not exceed a federal standard or law.  
2. Compare the proposed rules to standards in similarly situated states, based on geographic location,  
topography, natural resources, commonalities, or economic similarities.  
Licensure of chiropractors is necessary in Michigan under PA 368 of 1978. The rules supply the conditions and  
requirements for licensure, relicensure, renewal, and continuing education.  
When compared to other Great Lakes states (Illinois, Indiana, Minnesota, New York, Ohio, Pennsylvania, and  
Wisconsin), Michigan’s licensure requirements are similar. All seven of the other Great Lakes states have rules  
regulating the practice of chiropractic, and all seven of the Great Lakes states have continuing education  
requirements.  
Illinois: Illinois licenses chiropractors. Applicants must graduate from a Council on Chiropractic Education (CCE)  
accredited program, or a program approved by the division. Applicants must take and pass parts I, II, III, and IV of the  
National Board of Chiropractic Examiners (NBCE) examination. Licensed chiropractors in Illinois must complete 150  
hours of continuing education every three years.  
Indiana: Indiana licenses chiropractors. Applicants must graduate from a CCE accredited program. Applicants must  
take and pass parts I, II, III, IV, and physiotherapy of the NBCE examination and pass a jurisprudence examination.  
Licensed chiropractors in Indiana must complete 24 hours of continuing education every two years.  
Minnesota: Minnesota licenses chiropractors. Applicants must graduate from a CCE accredited program. Applicants  
must take and pass parts I, II, III, IV, and physiotherapy of the NBCE examination and pass a jurisprudence  
examination. Licensed chiropractors in Minnesota must complete 20 hours of continuing education every year.  
New York: New York licenses chiropractors. Applicants must graduate from a CCE accredited program or an  
equivalent program. Applicants must take and pass parts I, II, III, and IV of the NBCE examination. Licensed  
chiropractors in New York must complete 36 hours of continuing education every three years.  
Ohio: Ohio licenses chiropractors. Applicants must graduate from a board approved chiropractic college. Applicants  
must take and pass parts I, II, III, IV, and physiotherapy of the NBCE examination. Licensed chiropractors in Ohio  
must complete 36 hours of continuing education every two years.  
Pennsylvania: Pennsylvania licenses chiropractors. Applicants must graduate from a CCE accredited program.  
Applicants must take and pass parts I, II, III, and IV of the NBCE examination. Licensed chiropractors in  
Pennsylvania must complete 24 hours of continuing education every two years.  
Wisconsin: Wisconsin licenses chiropractors. Applicants must graduate from a CCE accredited program. Applicants  
must take and pass parts I, II, III, and IV of the NBCE examination and pass a jurisprudence examination. Licensed  
chiropractors must complete 40 hours of continuing education every two years.  
The proposed rules are consistent with the rules of those states that also regulate the practice of chiropractic.  
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits  
arising out of the deviation.  
Statute demands promulgation of rules related to licensure. The rules do not exceed the licensing requirements  
of other states.  
3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the  
proposed rules.  
There are no federal regulations for chiropractors. There are no laws, rules, or other legal requirements that  
duplicate, overlap, or conflict with the proposed rules.  
MCL 24.245(3)  
RIS-Page 3  
A. Explain how the rules have been coordinated, to the extent practicable, with other federal, state, and  
local laws applicable to the same activity or subject matter. This section should include a discussion of  
the efforts undertaken by the agency to avoid or minimize duplication.  
Review of applicable statutory law avoided unnecessary duplication in the rules. There are no other federal or  
local laws applicable to this activity.  
4. If MCL 24.232(8) applies and the proposed rules are more stringent than the applicable federally mandated  
standard, provide a statement of specific facts that establish the clear and convincing need to adopt the more  
stringent rules.  
There is no applicable federal mandate for these rules, therefore, MCL 24.232(8) does not apply.  
5. If MCL 24.232(9) applies and the proposed rules are more stringent than the applicable federal standard,  
provide either the Michigan statute that specifically authorizes the more stringent rules OR a statement of the  
specific facts that establish the clear and convincing need to adopt the more stringent rules.  
There is no applicable federal standard for these rules, therefore, MCL 24.232(9) does not apply.  
PURPOSE AND OBJECTIVES OF THE RULE(S)  
6. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.  
The specific topics that the proposed rules address, and the purpose of the proposed rules are set forth below:  
R 338.12016. This rule pertains to telehealth. The rule addition supplies conditions related to consent, scope of  
practice, and standard of care for telehealth services.  
R 338.12021, R 338.12031, R 338.12032, R 338.12034, R 338.12035, R 338.12036, R 338.12037, and R 338.12042  
include clean-up, organization, and typographical revisions to the language in the current rules.  
R 338.12041. This rule pertains to continuing education. The rule revision removes the requirement that a licensee  
must complete not less than two hours of continuing education in performing and ordering tests and clarifies that a  
licensee who completes implicit bias training under R 338.7004 may also use that training toward fulfillment of  
continuing education requirements.  
A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.  
Promulgation of rules related to licensure is necessary under statute. This supplies a regulatory framework for  
the practice of chiropractic. The proposed changes supply greater clarity to licensees and aid in understanding  
the requirements of the rules.  
B. Describe the difference between current behavior/practice and desired behavior/practice.  
Statute regulates the practice of chiropractic. This mandates licensure for provision of those services. Adding  
clarifications on points that may have been ambiguous under prior rules will make compliance easier for  
applicants and licensees.  
C. What is the desired outcome?  
Regulation is necessary for individuals who wish to practice as chiropractors. By improving and clarifying the  
rules, applicants and licensees should find compliance easier. This should result in fewer questions, fewer  
regulatory problems, and greater safety and protection of the public.  
7. Identify the harm resulting from the behavior that the proposed rules are designed to alter and the likelihood  
that the harm will occur in the absence of the rule.  
The proposed rule set updates the previously adopted rules. Specifically, changes include the following:  
R 338.12016 pertains to telehealth. The harm occurring is the lack of information about the conditions related to  
consent, scope of practice, and standard of care for supplying telehealth services. There is the possibility of harm to  
the patient without information about the conditions related to consent, scope of practice, and standard of care for  
supplying telehealth services.  
R 338.12041 pertains to continuing education. The harm occurring is that the current rule does not inform a licensee  
who earns implicit bias training credits may also use those credits to satisfy continuing education credits needed for  
license renewal. There is the possibility of harm to the applicant if the applicant does not understand all license  
renewal requirements.  
MCL 24.245(3)  
RIS-Page 4  
A. What is the rationale for changing the rules instead of leaving them as currently written?  
The proposed rule set supplies clarity to all rules on licensure.  
8. Describe how the proposed rules protect the health, safety, and welfare of Michigan citizens while promoting  
a regulatory environment in Michigan that is the least burdensome alternative for those required to comply.  
The proposed rules supply a regulatory mechanism for the practice of chiropractic. To protect the health, safety, and  
welfare of Michigan’s citizens, it is important that members of the profession adhere to educational and professional  
standards. The rules ensure that applicants receive proper education and training prior to licensure and that  
licensees are competent to practice. There is no less burdensome way to ensure that applicants and licensees satisfy  
minimum requirements for practice.  
9. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.  
There are no rules in this rule set that are obsolete or unnecessary.  
FISCAL IMPACT ON THE AGENCY  
Fiscal impact is an increase or decrease in expenditures from the current level of expenditures, i.e., hiring  
additional staff, higher contract costs, programming costs, changes in reimbursements rates, etc. over and  
above what is currently expended for that function. It does not include more intangible costs for benefits, such  
as opportunity costs, the value of time saved or lost, etc., unless those issues result in a measurable impact on  
expenditures.  
10. Please provide the fiscal impact on the agency (an estimate of the cost of rule imposition or potential savings  
for the agency promulgating the rule).  
There is no expected fiscal impact on the agency for promulgating the proposed rules.  
11. Describe whether or not an agency appropriation has been made or a funding source provided for any  
expenditures associated with the proposed rules.  
There has been no agency appropriation for the proposed rules because there are no expected agency expenditures  
associated with the proposed rules.  
12. Describe how the proposed rules are necessary and suitable to accomplish their purpose, in relationship to  
the burden(s) the rules place on individuals. Burdens may include fiscal or administrative burdens, or  
duplicative acts.  
The proposed rules supply a mechanism for the licensing and regulation of individuals in this state, as mandated by  
statute. Applicants and licensees will continue to have a cost related burden associated with licensing, renewal, or  
relicensure. The cost of licensure for an Educational Limited Chiropractor License is $55.00. The cost of licensure for  
a Licensed Chiropractor – By Exam is $237.10. The cost of licensure for a Licensed Chiropractor – By Endorsement  
is $237.10. The cost of licensure for a Licensed Chiropractor – Relicensure is $257.10. The cost of renewal is  
$205.50.  
A. Despite the identified burden(s), identify how the requirements in the rules are still needed and  
reasonable compared to the burdens.  
The rules are necessary to supply a mechanism for licensing and regulation of the profession. The rules are  
not more restrictive than allowed by statute. Despite the cost related burden of licensing, the rules and  
regulations are necessary to supply a framework of standards for educational and licensure requirements.  
IMPACT ON OTHER STATE OR LOCAL GOVERNMENTAL UNITS  
13. Estimate any increase or decrease in revenues to other state or local governmental units (i.e., cities,  
counties, school districts) as a result of the rule. Estimate the cost increases or reductions for other state or  
local governmental units (i.e., cities, counties, school districts) as a result of the rule. Include the cost of  
equipment, supplies, labor, and increased administrative costs in both the initial imposition of the rule and  
any ongoing monitoring.  
There is no expected increase or decrease in revenues to other state or local government units, nor are there cost  
increases or reductions on other state or local government units expected because of the proposed rules.  
MCL 24.245(3)  
RIS-Page 5  
14. Discuss any program, service, duty, or responsibility imposed upon any city, county, town, village, or school  
district by the rules.  
The proposed rules do not impose any program, service, duty, or responsibility upon any city, county, town, village, or  
school district.  
A. Describe any actions that governmental units must take to be in compliance with the rules. This section  
should include items such as record keeping and reporting requirements or changing operational  
practices.  
No action is necessary for governmental units to follow the rule(s).  
15. Describe whether or not an appropriation to state or local governmental units has been made or a funding  
source provided for any additional expenditures associated with the proposed rules.  
State and local government units will incur no added expenditures because of implementing the proposed rules.  
Therefore, no appropriation or funding source is necessary.  
RURAL IMPACT  
16. In general, what impact will the rules have on rural areas?  
There is no expected disparate impact on rural areas because of the proposed rules.  
A. Describe the types of public or private interests in rural areas that will be affected by the rules.  
There is no expected disparate impact on public or private interests in rural areas because of the proposed  
rules.  
ENVIRONMENTAL IMPACT  
17. Do the proposed rules have any impact on the environment? If yes, please explain.  
No, the proposed rules will have no impact on the environment.  
SMALL BUSINESS IMPACT STATEMENT  
18. Describe whether and how the agency considered exempting small businesses from the proposed rules.  
The Michigan Public Health Code authorizes the board and the department to regulate individuals with chiropractic  
licenses, not small businesses. Even if a licensee’s practice qualified as a small business, the department could not  
exempt the licensee’s small business because it would create disparity in the regulation of the profession.  
19. If small businesses are not exempt, describe (a) the manner in which the agency reduced the economic  
impact of the proposed rules on small businesses, including a detailed recitation of the efforts of the agency  
to comply with the mandate to reduce the disproportionate impact of the rules upon small businesses as  
described below (in accordance with MCL 24.240(1)(a-d)), or (b) the reasons such a reduction was not lawful  
or feasible.  
There is no expected economic impact on small businesses because of the proposed rules. The proposed rules  
affect individual licensees rather than small businesses.  
A. Identify and estimate the number of small businesses affected by the proposed rules and the probable  
effect on small businesses.  
The department does not collect or have access to information that would allow it to find and estimate the  
potentially affected number of small businesses. It is impossible to estimate the number of small businesses  
affected by the proposed rules. The only small businesses affected by these rules are health practitioners  
practicing in small business settings. The department does not track or have access to this type of information  
since it is not a data repository. The rules do not affect the operation of the small business. The probable  
impact on small business is small.  
B. Describe how the agency established differing compliance or reporting requirements or timetables for  
small businesses under the rules after projecting the required reporting, record-keeping, and other  
administrative costs.  
MCL 24.245(3)  
RIS-Page 6  
Because the proposed rules pertain to individuals and not small businesses, they do not have differing  
compliance or reporting requirements or timetables for small businesses. They are unnecessary for the  
proposed rules.  
C. Describe how the agency consolidated or simplified the compliance and reporting requirements for  
small businesses and identify the skills necessary to comply with the reporting requirements.  
The proposed rules do not impose any reporting requirements.  
D. Describe how the agency established performance standards to replace design or operation standards  
required by the proposed rules.  
The agency did not set up performance standards to replace design or operation standards.  
20. Identify any disproportionate impact the proposed rules may have on small businesses because of their size  
or geographic location.  
The proposed rules affect individual licensees rather than small businesses. Therefore, there is no expected  
disproportionate impact on small businesses based on size or geographic location because of the rules.  
21. Identify the nature of any report and the estimated cost of its preparation by small businesses required to  
comply with the proposed rules.  
The proposed rules do not need any reports. There are no reports that a small business would have to complete.  
22. Analyze the costs of compliance for all small businesses affected by the proposed rules, including costs of  
equipment, supplies, labor, and increased administrative costs.  
There is no expectation of an effect on small businesses because of the proposed rules, nor are there any added  
costs, because the proposed rules apply to individuals and not businesses.  
23. Identify the nature and estimated cost of any legal, consulting, or accounting services that small businesses  
would incur in complying with the proposed rules.  
The proposed rules, which apply to individuals and not businesses, should not create a need for any legal, consulting,  
or accounting services for small businesses to be able to follow the proposed rules.  
24. Estimate the ability of small businesses to absorb the costs without suffering economic harm and without  
adversely affecting competition in the marketplace.  
Since the rules affect individual licensees rather than small businesses, there is no expected cause of economic harm  
or for the rules to adversely affect a small business’ competition in the marketplace.  
25. Estimate the cost, if any, to the agency of administering or enforcing a rule that exempts or sets lesser  
standards for compliance by small businesses.  
The proposed rules impose requirements on individual licensees rather than small businesses. Even if a licensee’s  
practice qualifies as a small business, the department could not exempt the licensee’s small business because it  
would create disparity in regulation of the profession. Therefore, exempting or setting lesser standards of  
competence for small businesses is not in the best interest of the public.  
26. Identify the impact on the public interest of exempting or setting lesser standards of compliance for small  
businesses.  
The department is not able to exempt licensees that own a small business. If the department exempted small  
businesses, it would create a disparity in the regulation of a profession and have a negative impact on public safety.  
27. Describe whether and how the agency has involved small businesses in the development of the proposed  
rules.  
The department worked with the Michigan Board of Chiropractic in the development of the proposed rules. The board  
is composed of professional and public members. Some members of the board may work in a small business, but the  
members were not involved in the development of the rules as representatives of small businesses.  
A. If small businesses were involved in the development of the rules, please identify the business(es).  
No small businesses took part in the development of the rules.  
COST-BENEFIT ANALYSIS OF RULES (INDEPENDENT OF STATUTORY IMPACT)  
28. Estimate the actual statewide compliance costs of the rule amendments on businesses or groups.  
There are no estimated compliance costs with these rule amendments on businesses or groups.  
MCL 24.245(3)  
RIS-Page 7  
A. Identify the businesses or groups who will be directly affected by, bear the cost of, or directly benefit  
from the proposed rules.  
The proposed rules directly affect licensees. Licensees bear the cost of, and directly benefit from the proposed  
rules.  
B. What additional costs will be imposed on businesses and other groups as a result of these proposed  
rules (i.e., new equipment, supplies, labor, accounting, or recordkeeping)? Please identify the types and  
number of businesses and groups. Be sure to quantify how each entity will be affected.  
There will be no expected added costs imposed upon licensees because of compliance with these proposed  
rules.  
29. Estimate the actual statewide compliance costs of the proposed rules on individuals (regulated individuals or  
the public). Include the costs of education, training, application fees, examination fees, license fees, new  
equipment, supplies, labor, accounting, or recordkeeping.  
Applicants and licensees will continue to have a cost related burden associated with licensing, renewal, or relicensure.  
The cost of licensure for an Educational Limited Chiropractor License is $55.00. The cost of licensure for a Licensed  
Chiropractor – By Exam is $237.10. The cost of licensure for a Licensed Chiropractor – By Endorsement is $237.10.  
The cost of licensure for a Licensed Chiropractor – Relicensure is $257.10. The cost of renewal is $205.50.  
As of February 8, 2024, there are 3,115 licensed chiropractors. If all 3,115 licensed chiropractors continue to renew  
their licenses, the estimated actual statewide compliance cost would be 3,115 X $205.50 = $640,132.50.  
A. How many and what category of individuals will be affected by the rules?  
The rules affect all individuals who seek licensure as chiropractors.  
B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?  
There are no other qualitative or quantitative impacts as it relates to the actual statewide compliance costs of  
the proposed rules because the proposed rules create no expected increased or decreased costs for education,  
training, experience, application fees, examination fees, or licensure fees.  
30. Quantify any cost reductions to businesses, individuals, groups of individuals, or governmental units as a  
result of the proposed rules.  
There are no expected reductions in costs to businesses, individuals, groups of individuals, or governmental units  
because of the proposed rules.  
31. Estimate the primary and direct benefits and any secondary or indirect benefits of the proposed rules. Please  
provide both quantitative and qualitative information, as well as any assumptions.  
The proposed rules use clear, concise language, and implement the statutory requirements for licensing. The clear,  
concise language allows the public, licensees, and schools to better understand the requirements for licensure.  
32. Explain how the proposed rules will impact business growth and job creation (or elimination) in Michigan.  
There is no expected significant impact on business growth, job growth, or job elimination because of the rules.  
33. Identify any individuals or businesses who will be disproportionately affected by the rules as a result of their  
industrial sector, segment of the public, business size, or geographic location.  
The department does not expect any disproportionate effect on any individuals or businesses by their industrial  
sector, segment of the public, business size, or geographical location.  
34. Identify the sources the agency relied upon in compiling the regulatory impact statement, including the  
methodology utilized in determining the existence and extent of the impact of the proposed rules and a cost-  
benefit analysis of the proposed rules.  
Council on Chiropractic Education  
https://www.cce-usa.org/  
National Board of Chiropractic Examiners  
https://www.nbce.org/  
American Chiropractic Association  
https://www.acatoday.org/  
International Chiropractors Association  
https://www.chiropractic.org/  
MCL 24.245(3)  
RIS-Page 8  
Michigan Association of Chiropractors  
https://chiromi.com/  
Illinois  
https://idfpr.illinois.gov/profs/chiropractor.html  
Indiana  
https://www.in.gov/pla/professions/chiropractors-home/  
Minnesota  
https://mn.gov/boards/chiropractic-examiners/  
New York  
https://www.op.nysed.gov/chiropractic  
Ohio  
https://chirobd.ohio.gov/  
Pennsylvania  
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Chiropractic/Pages/default.aspx  
Wisconsin  
https://dsps.wi.gov/Pages/Professions/Chiropractor/Default.aspx  
A. How were estimates made, and what assumptions were made? Include internal and external sources,  
published reports, information provided by associations or organizations, etc., that demonstrate a need  
for the proposed rules.  
Since statute mandates the rules, no estimate was necessary.  
ALTERNATIVE TO REGULATION  
35. Identify any reasonable alternatives to the proposed rules that would achieve the same or similar goals.  
Since statute mandates the rules, there are no reasonable alternatives to the proposed rules.  
A. Please include any statutory amendments that may be necessary to achieve such alternatives.  
Since statute mandates the rules, there are no reasonable alternatives to the proposed rules.  
36. Discuss the feasibility of establishing a regulatory program similar to that proposed in the rules that would  
operate through private market-based mechanisms. Please include a discussion of private market-based  
systems utilized by other states.  
Since statute mandates the rules, private market-based systems cannot serve as an alternative. The licensing and  
regulation of chiropractors are state functions, so a regulatory program independent of state intervention cannot be  
set up. One could consider chiropractic professional associations as regulatory mechanisms that are independent of  
state intervention; however, these professional organizations would provide the public with significantly less protection  
because membership in these organizations is voluntary. This means an individual who meets the membership  
requirements, but does not join, would still be able to practice and there would be no way to ensure the individual’s  
competency or hold the individual accountable for harm done to clients.  
No other states in the Great Lakes region use a private, market-based system to regulate licensed chiropractors.  
37. Discuss all significant alternatives the agency considered during rule development and why they were not  
incorporated into the rules. This section should include ideas considered both during internal discussions  
and discussions with stakeholders, affected parties, or advisory groups.  
Since statute mandates the rules, there are no reasonable alternatives to the proposed rules. There were no  
alternatives that the department considered to achieve the intended changes. They are necessary for the  
administration and enforcement of the licensing process.  
MCL 24.245(3)  
RIS-Page 9  
ADDITIONAL INFORMATION  
38. As required by MCL 24.245b(1)(c), please describe any instructions regarding the method of complying with  
the rules, if applicable.  
The rules include the instructions for compliance.  
MCL 24.245(3)  
;