SB 0313 Requires HMOs to provide for 24 chiropractic visits and requires insurance policies to cover chiropractic services
LR Number:1323L.01I Fiscal Note:1323-01
Committee:Insurance and Housing
Last Action:02/20/01 - Hearing Conducted S Insurance & Housing Committtee Journal page:
Effective Date:August 28, 2001
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Current Bill Summary

SB 313 - This act requires managed care organizations to provide benefits to enrollees who utilize the services of a chiropractic physician. The managed care organization must provide benefits for 24 self-referral visits under certain specified conditions. After the initial visit to the chiropractor must send its findings to the managed care organization within ten days. After the 24 self-referral visits, further visits by the enrollee may be subject to utilization review. If continued care is recommended beyond 24 visits, the chiropractor must send the managed care organization information concerning the enrollee's progress and need for continued care. If the managed care organization does not respond within 7 business days, the recommendation shall be deemed authorized. A chiropractor who does not provide the required documentation will not be able to seek unpaid fees from the enrollee.

This act also requires every policy issued by a health carrier which covers physician services or major medical to provide coverage for chiropractic care as part of its basic health care services. An enrollee shall have the opportunity to select a participating provider from a list of participating chiropractors. The enrollee shall have the right to obtain clinically necessary and appropriate initial and follow-up care without prior approval. Health carriers must notify enrollees that chiropractic care benefits are available.

Health carriers shall reimburse a chiropractic physician equally for similar services and shall not discriminate against the physician based on his or her licensure.