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REFERENCE TITLE: chiropractic care; standards. |
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State of Arizona Senate Forty-seventh Legislature Second Regular Session 2006
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SB 1154 |
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Introduced by Senators Gray, Johnson, Miranda, Rios; Representatives Anderson, Barnes, Smith, Weiers JP: Senators Allen, Bennett, Hale, Verschoor; Representatives Biggs, Boone, Burges, Chase, Jones, Lopez L, McLain, Nichols, Paton, Pearce, Quelland, Rios P, Stump, Weiers J, Yarbrough
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AN ACT
amending sections 20-841.01, 20-1057.03, 20-1376.01 and 20-1406.01, Arizona Revised Statutes; relating to chiropractic care.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-841.01, Arizona Revised Statutes, is amended to read:
20-841.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a subscription contract of a hospital and medical service corporation provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or duly certified or licensed chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 who has a participation contract with the hospital and medical service corporation or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution. The services shall be covered in conformance with recognized standards in chiropractic as provided in section 32-925 as determined by chiropractors who are licensed in this state and as defined by recognized standards in chiropractic and generally accepted by the chiropractic profession.
Sec. 2. Section 20-1057.03, Arizona Revised Statutes, is amended to read:
20-1057.03. Chiropractic care; definitions
A. Every health care services organization shall provide coverage for chiropractic services provided by network chiropractic providers pursuant to this section. The services shall be covered in conformance with recognized standards in chiropractic as provided in section 32-925 as determined by chiropractors who are licensed in this state and as defined by recognized standards in chiropractic and generally accepted by the chiropractic profession.
B. A health care services organization is not required to provide coverage for chiropractic services obtained from a provider who is not a member of the health care services organization's provider network.
C. An enrollee may obtain medically necessary chiropractic services from a network chiropractic provider through self‑referral for a minimum of twelve visits in an annual contract period, unless the enrollee's evidence of coverage with the health care services organization allows for additional visits or benefits.
D. This section does not:
1. Require a health care services organization to provide services that are not covered by the enrollee's evidence of coverage and does not diminish or impair any preexisting condition limitation in the evidence of coverage.
2. Prohibit an enrollee from seeking chiropractic services in addition to the limits prescribed in this section from any chiropractic provider if the enrollee accepts financial responsibility for those services.
E. Nothing in this section prohibits the use of deductibles, coinsurance, copayments or other cost sharing in relation to the chiropractic benefits offered.
F. For the purposes of this section:
1. "Chiropractic services" means only nonsurgical and noninvasive treatment of neck and back pain through physiotherapy, musculoskeletal manipulation and other physical corrections of musculoskeletal conditions within the scope of the chiropractic practice.
2. "Musculoskeletal" means any function of the musculoskeletal system that is integrated with neurological function and is expressed by biological regulatory mechanisms.
3. "Network chiropractic provider" means a chiropractic physician who is licensed pursuant to title 32, chapter 8 and who is under written contract with the health care services organization to provide services pursuant to this section.
4. "Self‑referral" means obtaining treatment by a provider without referral from a primary care physician.
Sec. 3. Section 20-1376.01, Arizona Revised Statutes, is amended to read:
20-1376.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution. The services shall be covered in conformance with recognized standards in chiropractic as provided in section 32-925 as determined by chiropractors who are licensed in this state and as defined by recognized standards in chiropractic and generally accepted by the chiropractic profession.
Sec. 4. Section 20-1406.01, Arizona Revised Statutes, is amended to read:
20-1406.01. Prohibiting denial of chiropractic contract benefits; direct reimbursement
If a group disability insurance contract or blanket disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such contract may select either a physician or chiropractor to provide the examination, care or treatment for which the subscriber is eligible and which falls within the scope of practice of the chiropractor or physician. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 8 or 13 or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution. The services shall be covered in conformance with recognized standards in chiropractic as provided in section 32-925 as determined by chiropractors who are licensed in this state and as defined by recognized standards in chiropractic and generally accepted by the chiropractic profession.