For the past year, the Tennessee Chiropractic Association has been meeting with more than a dozen other health care provider groups throughout the state. The goal of this consortium was to get legislation passed in Tennessee to change the managed care environment by expanding patients' rights and giving them greater options in health care providers.
On May 18, the TCA's efforts finally paid off. Two weeks after receiving near-unanimous approval from the state legislature, Governor Don Sundquist signed House Bill 2949 into law. The bill, called the Consumer Health Care Advocacy Act, is an important step forward for chiropractic at the state level.
Among the bill's highlights:
- For the first time in the state's history, chiropractors are protected against discriminated from managed care networks. Under the "Scope of Services" section of the new law, MCOs "shall not discriminate with respect to participation, referral, reimbursement of covered services or indemnification as to any provider within a class of providers who is acting within the scope of the provider's license or certification under state law, solely on the basis of such license or certification."
- Networks must have "adequate" numbers of providers in their networks, including practitioners of all types.
- Practitioners must also be accessible within a reasonable time and distance. Under the "Network Adequacy" section of the law, networks must demonstrate an "adequate number of primary care providers within not more than 30 miles or 30 minutes travel time at a reasonable speed."
- Practitioners dismissed from a network must be allowed an additional 120 days to treat patients in that network. Doctors dismissed or not renewed by a network must be told why they were dropped from that network. The bill also lays out a procedure for recourse if a doctor is dropped from a network without cause.
- Practitioners cannot be terminated for communicating with patients about their health status or treatment options, as long as the provider is acting in good faith and within the provider's scope of practice.
- An important section of the Consumer Health Care Advocacy Act mandates that all HMOs operating in Tennessee include a point-ofþservice (PSO) plan in their offerings that allows enrollees to go outside of their network to see the physician of their choice.
- For those choosing the POS option, any premiums, co-payments and other cost-sharing features must be "fair and reasonable in relation to the benefits provided." All current enrollees in a managed care plan must be informed of the new POS option and given the opportunity to select it.
Because the POS option is a major new offering that has been mandated on the state's insurance companies, the Tennessee legislature has deemed that the law will not take effect until January 1, 1999. Nevertheless, the passage of the Consumer Health Care Advocacy Act is a significant step forward that gives the chiropractic profession more equal footing in the managed care arena.
For more information on the new law, contact the TCA at (615) 255þ4292, or send an e-mail to tca-tnchiro.com.
