PURPOSE: This rule is to advise chiropractic physicians when they may perform manipulation under anesthesia.

1. (1) The Missouri State Board of Chiropractic Examiners places the following restrictions on chiropractic physicians who engage in the practice of chiropractic while the consumer of the chiropractic service is under anesthesia.

2. (2) A chiropractic physician may not engage in the practice of chiropractic while the consumer of the chiropractic service is under anesthesia, unless:

   1. (A) The manipulation under anesthesia

3. (MUA) is performed at a facility that is licensed by the Missouri Department of Health—Bureau of Hospital Licensing and Certification and approved by one (1) of the following: Joint Commission on Accreditation of Healthcare Organizations (JCAHO), American Osteopathic Association (AOA), Accreditation Association of Ambulatory Health Care (AAAHC), or Medicare; and

   1. (B) The anesthetic, sedative, or other drug is administered to the consumer by a licensed medical doctor or doctor of osteopathy who is a board-eligible or board-certified anesthesiologist or under the direct supervision of that professional; and
   2. (C) The chiropractic physician has completed a certification course in MUA of not less than twenty-four (24) didactic academic hours and completed six (6) proctored MUA procedures as part of the certification course. The MUA certification course must be sponsored by a chiropractic college accredited by the Council of Chiropractic Education (CCE); and
   3. (D) The chiropractic physician follows the appropriate protocol as adopted by rule by the Missouri State Board of Chiropractic Examiners; and
   4. (E) The consumer of chiropractic service MUA has been evaluated by a medical doctor or doctor of osteopathy, who is familiar with MUA, prior to the MUA procedure who approves the procedure and the administration of the anesthesia.
4. (3) Nothing in this rule shall be construed as to require a facility licensed by the Missouri Department of Health and Senior Services— Health Services Regulation or approved by the JCAHO, AOA, or AAAHC to grant allied hospital privileges to a chiropractic physician. AUTHORITY: section 331.100.2, RSMo 2016.* This rule originally filed as 4 CSR 70- 2.033. Original rule filed March 4, 1994, effective Oct. 30, 1994. Moved to 20 CSR 2070-2.033, effective Aug. 28, 2006. Amended: Filed March 29, 2019, effective Oct. 30, 2019. *Original authority: 331.100.2, RSMo 1939, amended 1949, 1969, 1980, 1981, 2008, 2013.