On April 17, 1997, Maine Governor Angus S. King Jr. signed bill LD 234 to give the state's HMO members direct access to chiropractor care without a referral from a gatekeeper. Under the terms of the bill, chiropractors can treat enrollees in an HMO up to 12 times in a three week period, and up to 36 times over a year's time without approval from a primary care provider.
The passage of the bill was propelled forward by the lobbying efforts of the Maine Chiropractic Association (MCA), and of course by those legislators who championed the bill. A great deal of thanks also goes to the support that came from the business community and chiropractic patients.
The bill is an amendment to an earlier bill, and reads in part:
"3. Self-referrals for chiropractic care. A health maintenance organization must provide benefits to an enrollee who utilizes the services of a chiropractic provider by self-referral under the following conditions.
"A. An enrollee may utilize the services of a participating chiropractic provider within the enrollee's health maintenance organization for 3 weeks or a maximum of 12 visits, whichever occurs first, of acute care treatment without the prior approval of a primary care provider of the health maintenance organization. For purposes of this subsection, "acute care treatment" means treatment for the accidental bodily injury or sudden, severe pain that affects the ability of the enrollee to engage in the normal activities, duties or responsibilities of daily living.
"B. Within 3 working days of the first consultation, the participating chiropractic provider shall send to the primary care provider a report containing the enrollee's complaint, related history, examination, initial diagnosis and treatment plan. If the chiropractic provider fails to send a report to the primary care provider within 3 working days, the health maintenance organization is not obliged to provide benefits for chiropractic care and the enrollee is not liable to the chiropractic provider for any unpaid fees.
"C. If the enrollee and the participating chiropractic provider determine that the condition of the enrollee has not improved after 3 weeks of treatment or a maximum of 12 visits, the participating chiropractic provider shall discontinue treatment and refer the enrollee to the primary care provider.
"D. If the chiropractic provider recommends treatment beyond 3 weeks or a maximum of 12 visits, the participating chiropractic provider shall send to the primary care provider a report containing information on the enrollee's progress and outlining a treatment plan for extended chiropractic care of up to 5 more weeks or a maximum of 12 more visits, whichever occurs first.
"E. Without the approval of the primary care provider, an enrollee may not receive benefits for more than 36 visits to a participating chiropractic provider in a 12-month period. After a maximum of 36 visits, an enrollee's continuing chiropractic treatment must be authorized by the primary care provider.
"In the provision of chiropractic services under this subsection, a participating chiropractic provider is liable for a professional diagnosis of a mental or physical condition that has resulted or may result in the chiropractic provider 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."
Dr. Richard M. Bruns, president of the MCA, stated to Dynamic Chiropractic that while the bill "is not ideal, as it represents a long process of compromise," that it is "certainly a far sight better than what would exist otherwise."
But there is optimism about the bill's impact. Dr. Bruns believes the bill "will prove ... that chiropractic has a place in the managed care arena and that chiropractic physicians are the ones who should manage chiropractic care," a point that is obvious to chiropractors and their patients, but not always to administrators and gatekeepers. The bill, he adds, "allows the doctor of chiropractic to compete in a system whose intent is to lower costs through competition."
The Maine Chiropractic Association is thus looking forward to future cost and utilization statistics. Dr. Bruns believes that analysis of the statistics will show that "chiropractic is cost effective, (with) high patient satisfaction and excellent long-term outcomes." As Dr. Bruns succinctly concluded, "No one loses."
On a national perspective, the Maine bill should motivate other states to push for guaranteed access to chiropractic treatment under the managed care juggernaut, and provide patients the freedom to choose what type of health care provider will treat them.
For more information on LD 234, you may contact the Maine Chiropractic Association at (207) 622-5421, or by fax at (207) 623-8394. The state of Maine also has its own World Wide Web page (www.state.me.us), where you may want to leave an e-mail message thanking the legislators and Governor King for their support.
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