A staple of the annual meeting of the Congress of Chiropractic State Association leaders is a review of state legislative activities. This year, Nelson Robinson of the West Virginia Chiropractic Society facilitated the discussions. Other presentations were given by Gary Cuneo of the ACA, Ron Hendrickson of the ICA, and Colleen Cousineau of the Southern Legislative Conference, a regional arm of the council of state governments.
Of those states submitting a report for the convention, seven states either introduced in 1998 or plan to introduce in 1999 legislation dealing with protection of manipulation. Six states dealt with managed care; three states with IMEs; one state with chiropractic prescriptive rights; and three state with acupuncture. Here is a recapitulation of legislation reported from across the country.
Alabama
Chiropractic peer review legislation failed to pass. It would have set up a committee under the board of examiners to perform reviews upon the request of carriers, attorneys, providers or patients.
The legislature raised the ceiling on fees for annual license renewals.
Future proposals include defeating legislation granting direct access to PTs, which is expected to be introduced in 1999; spinal manipulation protection legislation; physician definition legislation; and legislation eliminating the special exemption from insurance laws granted to Blue Cross.
Alaska
Manipulation protection legislation passed that was aimed at preventing PTs from performing spinal manipulation.
Legislation is pending that would prevent gag rules from appearing in managed care contracts.
Arizona
Acupuncturists are now licensed and regulated by a new board.
A law was passed pertaining to HSOs. If the HSO fails to pay, the enrollee is not liable to the provider and prohibits the provider from attempting to collect from the enrollee.
The chiropractic board was granted authority to issue restricted licenses and permits to persons contracted with a recognized charitable clinic or organization; services must be performed without compensation.
Bills that failed to pass included: requiring HSOs to cover services rendered by chiropractors; requirement that providers seek a lien to file in the county where the provider is located, not where the injury occurred.
Colorado
A bill passed that requires DCs take Part IV of the national boards.
Legislation passed requiring insurance companies to disclose that a managed care option is available.
Legislation that failed to pass: a bill to reduce PIP coverage and PIP disclosure; a bill granting prescriptive authority to DCs; legislation to abolish no fault insurance.
Connecticut
Working through the department of health on securing authority for chiropractors to perform high school athletic physicals.
Managed care reform is expected in 1999.
Florida
PIP managed care legislation was amended to include: provisions requiring doctors to take assignment within 30 days of treat mentor forfeit payment (unless the doctor files the insurer notification within 21 days of the first treatment; the doctor then has 60 days to submit the bill). The amendment also defines prevailing party for arbitration in favor of the doctor if the awarded fee is more than half of what the insurer offers at arbitration, or in favor of the insurer if the awarded fee is less than half of what the insurer offers at arbitration. Each party pays their own attorney fees if neither party prevails.
The Health Kids act passed, stipulating that qualified children will have access to Medicaid equivalent chiropractic benefits, which in Florida are 24 annual chiropractic treatments.
Legislation passed creating a standardized credentialing system to save physicians' time and money when applying to MCOs. The Florida Board of Chiropractic Examiners given back authority to issue wall certificates. A "reviser's bill" made uniform the use of term chiropractic physician through all of Florida law. The measure also changed the name of the chiropractic board to the "Board of Chiropractic Medicine."
There was $250,000 appropriated for the second year in a row to fund chiropractic research in the college of human sciences at Florida State University. HMOs were prevented from denying applications of otherwise qualified health care providers. The measure also provides that groups of employers joining to offer one group health plan must provide reasonable access to providers, meaning they may not discriminate solely on their category of licensure.
Georgia
The Good Samaritan act passed limiting liability of volunteer chiropractors. The continuing education hours increased from 12 to 20. A provision to add massage to chiropractic scope was defeated.
Iowa
A drug testing bill passed that includes chiropractors as "medical review officers."
The Palmer "forgivable loan" program was successfully funded for another year.
A bill passed creating an advisory committee for operators of radiation machines. A DC will be one of four physicians on the nine-member committee.
The "Healthy and Well Kids of Iowa" program (Medicaid) passed, but does not include chiropractic care.
Not passed: physician lien law; unsuccessful at including DCs in volunteer immunity program.
Maryland
Legislation passed requiring insurers to establish an internal grievance process for its members, and to file a copy of that process with the insurance commissioner.
Legislation passed authorizing chiropractors to submit medical records without their personal presence in court.
Massachusetts
An HMO inclusion bill was defeated.
Michigan
Law passed requiring that under "coordinated benefit plans, "automobile insurers must pay reasonable charges for reasonably necessary services if these services are not covered by the injured person's primary health care plan.
Priorities for the future: Medicaid reimbursement, enhancing workers' compensation coverage, adding a chiropractor to the Blue Cross board of directors, and regulating IME and utilization review policies.
Missouri
Law passed enabling DCs to issue physician's statements for "physically disabled" license plates.
Legislature placed limits on who can obtain police reports for 60 days.
Law passed requiring insurance companies and HMOs to pay qualified claims within 45 days.
Acupuncturists are licensed under the board of chiropractic examiners with chiropractors being exempt.
Massage therapists prohibited from manipulating, diagnosing or performing any service that requires a license to practice chiropractic.
Failed to pass: bills to license person using ionizing radiation; to establish lien rights for providers; and PT direct access.
New York
The attorney general prepared and distributed to the profession and the general public the pamphlet "New York State's Chiropractic Law -- Your Rights to Chiropractic Care."
Future priorities: legislation to protect manipulation; enhancing workers' compensation benefits and mandatory continuing education.
North Carolina
Legislation was introduced to require any person who reviews a patient's records for the purpose of determining if the chiropractic treatment was necessary, shall be deemed to be engaged in the practice of chiropractic.
Legislation introduced requiring direct access to optometrists, podiatrists, chiropractors and psychologists under health benefit plans including HMOs. Plans would be required to inform participants of the provision.
A bill was introduced that defines spinal manipulation and limits the performance of same to providers with 500 hours of classroom instruction in spinal manipulation, and a minimum of 900 hours of supervised clinical training at a facility where spinal manipulation or adjustment is a primary method of treatment. Violators may have their licenses suspended, revoked or refused by their licensing board.
Ohio
A comprehensive revision of the chiropractic practice act was introduced. The intent of the bill is to modernize the practice act to be consistent with other regulated professions in Ohio, and to give the board the ability to better regulate the chiropractic profession.
Pennsylvania
Direct access legislation failed by a slim margin.
Rhode Island
Legislation licensing acupuncturists and massage therapists passed.
Failed to pass: manipulation protection legislation and freedom of choice under workers' compensation.
Tennessee
Point of service legislation passed that requires HMOs to include a POS plan allowing enrollees to go outside of network to see the physician of their choice. Networks must have adequate numbers of providers including providers of all types. Chiropractors can no longer be discriminated against by networks. If dismissed, chiropractors must be allowed 120 days to treat patients.
West Virginia
Comprehensive legislation passed which, among other thinks, identified who may perform spinal manipulation. The law requires all persons performing spinal manipulation to have first received 400 hours of classroom instruction in spinal manipulation and a minimum of 800 hours of supervised clinical training at a facility where spinal manipulation is a primary method of treatment.
The 1999 Congress meeting will be held on November 4-7 in San Diego. For more information, please contact Janet Jordan in the Congress office at:
P.O. Box 2054
Lexington, South Carolina 29071
Phone: 803-356-6809
Fax: 803-356-6826
jjordan@chirolink.com
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