The State of Chiropractic Legislation -- Coast to Coast

One of the primary functions of state associations is to promote and protect their members through the legislative process. Nowhere is the state association more important to a profession than in chiropractic. With the onslaught of managed care threatening to curtail patient access to chiropractors, and the continuous encroachment of other providers into the practice of chiropractic, strong state association legislative programs are more important than ever.

Unfortunately, the same factors that threaten the profession are causing declines in association memberships, making it necessary for state associations to do more with less. Consequently, many state associations are turning to the Congress of Chiropractic State Associations (henceforth referred to as the Congress) for assistance. While state laws, economies, and regional practice styles differ, the basic challenges faced by state associations are the same, making the networking aspects of Congress more important than ever.

Even though the 1998 legislative sessions of most states are still fairly young, the two biggest challenges already seen across the country are attempts by physical therapists to expand their scopes of practice and efforts by chiropractors to protect manipulation. For example, legislation recently introduced in Missouri would not only give PTs direct access, but would allow them to perform manipulation and make it unlawful for anyone other than a PT to provide physical therapy services. Both Arizona and Indiana have already defeated similar legislation.

A number of states are grappling with the task of drafting legislation of their own to protect manipulation for chiropractors, but are finding it more difficult to develop appropriate language than they had first anticipated. It will be interesting to find out in November, when state associations meet in Atlanta for the 1998 Congress convention, just who has been successful in this endeavor.

According to reports received from state associations at the 1997 Congress convention, these are not the only issues state associations are dealing with. Following is just a glimpse of what has been taking place in the halls of government across the country.

• Arizona passed legislation clarifying that DCs may collect blood and urine. They were unsuccessful in passing a direct access point-of-service bill. A workers' compensation HMO bill relating to state employees also failed to pass.


• California has pending legislation addressing cash discounts for the uninsured. They successfully defeated legislation that would have eliminated DCs as "physicians" in workers' compensation; defeated legislation that would have defined utilization review as the "practice of medicine"; and also lobbied against legislation that omitted chiropractic care from newly established low-income health care programs.


• Colorado passed legislation requiring like providers to perform IMEs (independent medical examinations). They also were successful in passing a consumer protection act. This allows patients to go out of network without penalty if there are no providers of the type necessary to provide covered services, and prohibits retrospective denial of benefits which have been pre-authorized. Legislation providing for prescriptive authority for DCs was defeated.


• Florida passed legislation providing for cash discounts and access to DCs under HMOs for a limited number of visits. Also included in this legislation was a provision specifying that chiropractic adjustment or manipulation techniques taught in chiropractic colleges be performed solely by chiropractors.


• Georgia passed legislation establishing a statutory standard of care that DCs must refer to the appropriate health care provider when necessary. A provision of this bill requires adjustment only be administered by a doctor of chiropractic; however, the provision does not prevent any other health care provider from administering techniques authorized within their scope. Other legislation passed making chiropractors' medical narrative reports admissible as evidence.


• Iowa passed legislation making it permissible for DCs to grant seat-belt exemptions.


• Kansas was unsuccessful in passing legislation to define chiropractors as physicians in workers' compensation law.


• Maine passed legislation requiring HMOs to accept self-referrals to DCs for up to 36 visits.


• Massachusetts has pending legislation to require HMOs to include chiropractic benefits. They also dealt with a devastating amendment which makes it unlawful to take a private payment from a Medicare-eligible patient if the provider has billed Medicare for any service rendered in the previous two years.


• Michigan has pending legislation to prohibit anyone from claiming to provide chiropractic adjustments or chiropractic services unless they are a chiropractor. They are also supporting independent medical examination accountability legislation.


• Missouri has patient protection legislation pending.


• Montana passed legislation mandating that HMOs offer a point-of-service option to each purchaser of health care services.


• New Hampshire amended legislation so as to delete manual therapy from the acupuncture act.


• New York passed an insurance equality act.


• North Carolina passed legislation eliminating the tax on nutritional supplements prescribed by chiropractors.


• Pennsylvania has pending patient protection legislation, which includes point-of-service and utilization review provisions. They are also dealing with potential passage of massage therapy and athletic trainer legislation.
• Rhode Island has passed manipulation protection legislation, which has not been signed by the governor.


• South Carolina has pending legislation requiring closed panel plans to offer open panels as well. Also pending is a measure allocating funding for chiropractic under Medicaid. They are battling legislation providing for direct access to PTs with an amendment requiring that the patient be referred back to the MD/DC in 30 days. A lien law is pending as well.

For more information on state association activity or to report activities in your area, contact feel free to contact me.

Janet Jordan, DC,
President, Congress of Chiropractic State Associations (COCSA)
P.O. Box 2054
Lexington,
South Carolina 29071
(803) 356-6809
jjordan-chirolink.com