Nondiscriminatory insurance coverage of chiropractic services, providing an exemption from emergency rule procedures, granting rule-making authority, and providing a penalty. (FE)

Under current law, a policy is already prohibited from excluding coverage for the diagnosis and treatment of a condition or complaint by a chiropractor if the diagnosis and treatment of the condition or complaint are covered when provided by a physician, even if different nomenclature is used to describe the condition or complaint. Current law explicitly states that this prohibition does not preclude the application of deductibles or coinsurance to chiropractic and physician charges on an equal basis or the application of cost containment or quality assurance measures to chiropractic services in a manner that is consistent with cost containment or quality assurance measures that generally apply to physician services. The bill removes this statement of what is not precluded and provides that the new prohibition against excluding, restricting, or denying coverage of chiropractic services prohibits a policy, among other things, from applying cost containment measures or quality assurance or performance measures unequally to chiropractors and primary care physicians with respect to items or services that may be provided by chiropractors and primary care physicians and from requiring an insured to pay a higher copayment or coinsurance amount for services provided by a chiropractor than the copayment or coinsurance amount that the insured must pay for the same or similar services provided by a primary care physician.

Insurer requirement to provide timely access Current law prohibits an insurer, under a health insurance policy that covers chiropractic services, from doing a number of things, including establishing underwriting standards that are more restrictive for chiropractic care than for care provided by other health care providers. The bill removes this prohibition and replaces it with another related to access to chiropractic services. The bill prohibits an insurer from establishing or maintaining a policy or provider network that fails to do either of the following: 1) provide insureds with reasonable and timely access to chiropractic care or 2) apply the same standards to chiropractors that are applied to primary care physicians to ensure that insureds receive the same reasonable and timely access to chiropractors that they receive to primary care physicians, including such standards as geographic accessibility, waiting times, and provider-to-insured ratios.

Insurer report Finally, the bill requires every health insurer annually to file a report with the Office of the Commissioner of Insurance (OCI) that demonstrates the insurer's compliance in the previous year with the requirements and prohibitions related to equality of coverage between chiropractors and primary care physicians. OCI must promulgate rules for the content and format of the report and must make the filed reports publicly available on OCI's Internet site. The bill also authorizes OCI to impose on an insurer that fails to file a report when due a forfeiture of $1,000 per day for each day the report is overdue.