The 1999 meeting of the Congress of Chiropractic State Associations in San Diego, California this past November included, as always, a review of legislative activity from the various state associations. There were verbal reports on state legislation, but 30 state associations also submitted written reports on legislative activity in their respective states. This is a brief recapitulation of those state reports.
Alabama
- A bill to allow chiropractor referrals to occupational therapists was passed. A similar bill to allow referrals to physical therapists failed, primarily due to unexpected opposition from the physical therapists, who attempted to use the bill as a vehicle for expanding their own scope of practice. Amendments sought by the PTs including giving them the right to diagnose, treat, evaluate, develop plans of care, and have direct access to patients.
- Language was clarified in the cosmetology statute that had previously provided for "manipulation" by cosmetologists.
- A bill to restore the Alabama State Board of Chiropractic's authority to issue specialty certificates failed.
Arizona - A very complicated HMO reform bill to provide patient access to chiropractors failed to pass. A task force was established in the House and Senate to address the issue in 2000. Chiropractors are on both task forces.
California - A bill addressing "silent PPOs" passed. The bill seeks to rein in insurers who sell doctors' names and their reduced rate to entities that don't provide any patient "steerage" back to the doctor. The bill allows doctors to decline to be included on panels that don't provide patient steerage.
- Among the health care reform bills passed, one bill establishes an independent medical review system for patients to dispute claims when treatment has been delayed, denied or modified by their health plan. A state agency devoted exclusively to the licensing and regulation of health care service plans was established. This bill also creates the Office of the Patient Advocate to assist HMO enrollees with their complaints. Other bills passed grant patients the right to sue their health plan for harm caused by failure to provide ordinary care under the plan and require health care service plans to review treatment requests by physicians in a timely manner.
Colorado - A bill for the protection of spinal manipulation passed the Senate but stalled in the House.
- IME is going well in Colorado, but efforts to clean up the IME bill failed. Scheduling agents were limiting scheduling to about 12 doctors statewide, diluting the ability of chiropractors in communities from performing IMEs. These chiropractors were charging triple for the fee, eliminating patients from requesting IMEs in certain areas. A compromise bill minimizes these fees and only allows two chiropractors (previously four) on an IME panel.
Connecticut - Legislation passed that requires insurance companies to make payment on claims within 45 days. The provider must be notified within 30 days if there is a problem with the claim.
- A declaratory rule has been requested to determine if the practice of reviewing a chiropractic claim constitutes practicing chiropractic.
Florida - Efforts to include PIP in managed care were defeated.
- Legislation creating certification for chiropractic assistants was passed.
Georgia - Legislation to increase continuing education hours from 12 to 20 passed; chiropractic philosophy remains as a choice for CE credits.
- Legislation was enacted to allow DCs to serve as team chiropractors.
Iowa - Efforts by PTs to eliminate chiropractic physiotherapy procedures from the chiropractic scope of practice were defeated.
- Efforts by the Iowa Medical Society to eliminate chiropractic physicians' rights to serve as medical review officers for drug testing purpose were defeated.
- Funding was increased at Palmer College for "forgivable" student loans.
Kansas - Legislation to establish a department of professional licensing is being carried over for the 2000 session.
- Legislation to license respiratory therapists passed. Similar bills are pending for physical therapists, naturopaths and acupuncturists.
Maine - Legislation passed that incorporates acupuncture within the chiropractic scope of practice.
- Legislation passed to increase chiropractic reimbursement under Medicaid from $99 to $20.
- Efforts by HMOs to gut Maine's direct access laws failed.
- Efforts by Maine's business community to exempt business from complying with mandated benefits laws failed.
- Legislation passed to set standards for doing workers' compensation reviews.
Maryland - Legislation passed that allows chiropractors to issue handicapped parking permits.
- Legislation passed that changes the requirement that an applicant for chiropractic licensure obtain a bachelor's degree before entrance into an approved school. Applicants must still obtain the degree, but at any time before application for licensure.
- Legislation passed to establish a classification of registered massage practitioners under the regulation of the state board of chiropractic examiners.
- Patient protection legislation passed to require insurance companies (including HMOs) to provide health care practitioners with a written copy of: (1) a schedule of applicable fees for up to the 20 most common services billed in that specialty; (2) a description of the coding guidelines used by the insurance company that are applicable to the services billed by that specialty; and (3) the methodology for increasing or reducing levels of reimbursement.
Massachusetts - A bill has been introduced that would include chiropractic coverage in HMOs.
Michigan - Chiropractic coverage in Medicaid was maintained.
- Legislation passed to increase the maximum penalty for those found guilty of practicing as a health professional without a license.
- Efforts are underway to require Parts III and IV for licensure.
Minnesota - Legislation passed that requires HMOs to grant referrals to a chiropractor in the network if requested by the policyholder.
- Legislation passed that allows chiropractors to incorporate with medical doctors, advanced practice nurses, optometric doctors and podiatrists.
- Legislation passed that gives chiropractors a 30-day window to review and opt in or out of new lines of workers' compensation and/or personal injury insurance that may be added to their general health contracts. This law prohibits the network from dropping chiropractors simply because they opt out of the additional new line of insurance.
Missouri - New legislation allows the Missouri State Chiropractic Association to submit names directly to the governor for consideration to fill seats on the Missouri Chiropractic Board of Examiners.
- Efforts to prevent physical therapists from expanding their practice and gaining direct access were successful.
- Legislation that required licensure of x-ray technicians was defeated.
- Third-party lien legislation passed.
Montana - Legislation passed to require that MCOs provide written notice to injured workers of their right to choose the initial treating physician. The bill also provides that workers receive written notice of referral to a preferred provider. The notice must cite the right of the worker to choose the initial treating physician.
Nevada - Legislation to allow athletic trainers to perform physical therapy modalities, including soft tissue and joint mobilization, failed.
- There are plans to introduce manipulation protection legislation in the 2002 legislative session.
New Hampshire - Legislation passed to define who can practice chiropractic and to create better enforcement powers against those who practice without a license. The bill more clearly defines manipulation and adjustments as chiropractic techniques.
- Legislation currently being considered would allow patients direct access to chiropractic care through their HMO. The bill also mandates like fees for like services.
New Mexico - A watered-down version of an open access bill for chiropractic in the managed care system passed both houses but was vetoed by the governor.
- A bill that allows chiropractors to receive Medicaid reimbursement passed both houses but was also vetoed by the governor.
New York - Various bills were introduced to define spinal manipulation and who can perform it. These bills were in direct response to an attorney general's opinion that physical therapists can perform spinal manipulation.
- There is pending legislation to address inequities in the fees paid to chiropractors (68% of those paid to medical providers) under workers' compensation.
- There is a proposal to update the chiropractic enabling law. It was last updated in 1963.
- A bill was introduced to require 45 hours of continuing education every triennium; no hours are currently required.
- There is pending legislation to allow chiropractors that obtain a certain degree of training to perform acupuncture.
- Legislation was introduced to require that members of the state board of chiropractic examiners must be chiropractors. The current board comprises four chiropractors, one medical physician, one osteopath and one academician.
- There's legislation to allow reimbursement of chiropractors under Medicaid.
- There's legislation to allow chiropractors to analyze specimens. Chiropractors are already licensed to draw specimens.
North Carolina - Direct access legislation failed.
- There is legislation to require that anyone who reviews chiropractic claims be a licensed chiropractor.
- There is legislation to permit managed care insureds, enrollees and health care providers to recover fees from collateral sources.
- Legislation passed that requires that owners of chiropractic clinics be licensed chiropractors.
- Spinal manipulation protection legislation was introduced, but was vehemently opposed by physical therapists and medical doctors. The bill's future remains uncertain.
North Dakota - Legislation to license x-ray technologists failed.
- Legislation designed to allow patients to assign their benefits under a health insurance policy (regardless of whether the practitioner is par or nonpar) was reduced to a study resolution.
- Legislation passed that requires medical providers to provide a free copy of a patient's medical records to another medical provider designated by the patient if the records are requested for the purpose of transferring that patient's medical care to the other provider. The bill also requires medical providers to provide a copy of a patient's medical records requested for any other purpose. They may charge a maximum fee of $20 for the first 25 pages and $.75 per page for every page beyond 25. This fee includes any administrative costs, retrieval costs and postage expense.
Ohio - Legislation introduced by physical therapists would allow direct access to patients.
- Legislation was introduced to allow patients to seek treatment from out-of-network providers.
Pennsylvania - Legislation was introduced that will provide direct access for patients, uniform billing and protection of manipulation/adjustment.
- Legislation passed to allow patients under a medical assistance state plan to self-refer to a chiropractor.
- There is legislation to allow veterinarians to perform spinal manipulation on animals.
Rhode Island - Spinal protection legislation was introduced and opposed by physical therapists.
South Carolina - Both a medical lien law and spinal manipulation protection legislation were introduced and are being carried over to the 2000 session.
- Legislation passed that eliminates the requirement for a referral from a medical doctor for a Medicaid patient to receive chiropractic care. These patients now have direct access to a chiropractor.
Texas - Legislation passed to provide a quarter-million dollars in state funding over the next two years to each of the two chiropractic colleges in Texas.
- CHIP (Child Health Insurance Plan) legislation passed, with chiropractic benefits included.
- Legislation to restrict ownership of a licensed chiropractic clinic to a chiropractor was defeated.
- Legislation to create liens for service died in committee.
- Manipulation protection legislation failed to pass.
- Physical therapist direct access legislation failed to pass.
- A bill to restrict the rights of injured workers' to select the doctor of their choice failed. Passage of the bill would have moved the Texas workers' compensation toward managed care.
Washington - In their sunrise review, physical therapists are asking that the current statute be replaced by a "model law," which would include manipulation.
Editor's note: For more information on the COCSA meeting, please see "Chiropractic Organizations Embrace a Unified Vision at Annual COCSA Meeting" in the December 15, 1999 issue of DC, or on line at
www.ChiroWeb.com/archives/17/26/02.html.
