HS HCS HB 121 -- INSURANCE COVERAGE FOR CHIROPRACTIC CARE
(Portwood)

This substitute requires health insurers to provide coverage for
chiropractic care delivered by a licensed chiropractor acting
within the scope of Chapter 331, RSMo.

The coverage will include initial diagnosis and clinically
appropriate and medically necessary services and supplies
required to treat a diagnosed disorder, subject to conditions of
the policy.  The coverage may be limited to chiropractors within
the health carrier's network.  Health carriers are not required
to contract with a chiropractor outside the health carrier's
network nor are carriers required to reimburse for services
provided by a non-network chiropractor, unless prior approval has
been obtained from the health carrier by the enrollee.

Enrollees may access chiropractic care within the health
carrier's network for a total of 20 chiropractic office visits
per policy period and may be required to provide the health
carrier with notice prior to any additional visits as a condition
of coverage.  In addition, health carriers may require prior
authorization or notification before any follow-up diagnostic
tests are ordered by a chiropractor or for any office visits for
treatments in excess of 20 office visits in a policy period.

Certificates of coverage for any health benefit plan are required
to state the availability of chiropractic coverage under the
policy and any exclusions, limitations, or conditions of
coverage.  The insurance coverage contained in the substitute
excludes benefits provided under the Medicaid program and other
specified insurance policies.

Health carriers are prohibited from establishing rates, terms,
and conditions of coverage for enrollees which cause a greater
financial burden than for enrollees who access treatment for
other physical conditions.  Deductibles or out-of-pocket limits
required by health carriers or a health benefit plan will be
comprehensive for coverage of all health conditions.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
Unknown exceeding $70,000 in FY 2004, FY 2005, and FY 2006.
Estimated Net Cost to Highway Fund of Unknown in FY 2004, FY
2005, and FY 2006.  Estimated Net Income to Insurance Dedicated
Fund of $8,000 in FY 2004, $0 in FY 2005, and $0 in FY 2006.
Estimated Net Effect on Other Funds of Unknown exceeding $11,500
in FY 2004, FY 2005, and FY 2006.

Missouri House of Representatives
Last Updated July 25, 2003 at 10:10 am