An Act To Amend the Maine Insurance Code To Ensure Fair and Reasonable Coverage and Reimbursement of Chiropractic Services
Sec. 1. 24-A MRSA §2748, as amended by PL 1993, c. 669, §2, is further amended to read:
§ 2748. Coverage for chiropractic services
Sec. 2. 24-A MRSA §2840-A, sub-§§1 and 2, as enacted by PL 1985, c. 516, §5, are amended to read:
Sec. 3. 24-A MRSA §2840-A, sub-§3, as amended by PL 1993, c. 669, §3, is further amended to read:
Sec. 4. 24-A MRSA §4236, as amended by PL 1997, c. 99, §1, is further amended to read:
§ 4236. Chiropractic doctors in health maintenance organizations
Every health maintenance organization shall include in every plan for health care services chiropractic services delivered by qualified chiropractic providers doctors in accordance with this section.
In the provision of chiropractic services under this subsection, a participating chiropractic provider doctor is liable for a professional diagnosis of a mental or physical condition that has resulted or may result in the chiropractic provider doctor performing duties in a manner that endangers the health or safety of an enrollee.
The provisions of this subsection apply to all health maintenance organization contracts, except a contract between a health maintenance organization and the State Employee Health Insurance Program.
This subsection takes effect January 1, 1996.
This bill requires that coverage and payment by health insurers and health maintenance organizations for services within the scope of practice of chiropractic doctors be at least equal to and consistent with coverage for services provided by allopathic or osteopathic doctors. It requires insurers to provide benefits covering and paying for care by chiropractic doctors at least equal to and consistent with the benefits paid to other health care providers treating similar conditions within the scope of practice of chiropractic doctors. Under the bill, these carriers may not classify services provided by chiropractic doctors as physical therapy or place these services into other categories that unreasonably limit coverage or payments for such services, or impose copayments, coinsurance requirements or deductibles that are more burdensome or limiting than those imposed with respect to services provided by allopathic or osteopathic doctors. The copayment for each service provided in the course of an office visit to a chiropractic doctor may not exceed $5 or 10% of the covered payment for such services, whichever is greater. The total copayment for the combined services provided in the course of an office visit to a chiropractic doctor may not exceed $30 or 10% of the combined covered payment for such services, whichever is greater.