HB 202 requires a health benefit plan or limited health benefit plan that provides coverage for chiropractic services to clearly state the availability of chiropractic coverage in the plan and all limitations, conditions and exclusions. Cost-sharing or copayment cannot be imposed in excess of 50 percent of the reimbursable amount for any single covered service, and cannot require more than one coinsurance or copayment per date of service. A provider contract with a doctor of chiropractic which restricts or denies benefits otherwise covered under the plan is an unfair trade practice. Chiropractic services within a health benefit plan or limited health benefit plan must be reimbursed at no less than the current fee established by the Workers' Compensation Medical Fee Schedule for physicians, or the actual fee whichever is less. If the Workers' Compensation Medical Fee Schedule for Physicians does not include reimbursement for chiropractic services, the reimbursement must be no less than the amount provided in the most recent Workers' Compensation Medical Fee Schedule for Physicians that included reimbursement for chiropractic services.
HB202
12RS
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AN ACT relating to chiropractic. Create new sections of Subtitles 17A and 17C of KRS Chapter 304 to require a health benefit plan or limited health benefit plan that provides coverage for chiropractic services and procedures to clearly state the availability of chiropractic coverage in the plan and all limitations, conditions and exclusions; provide that chiropractic services and procedures may be made subject to a deductible, copayment, or coinsurance, shall not impose cost-sharing or copayment in excess of 50 percent of the reimbursable amount for any single covered service, and shall not require more than one coinsurance or copayment per date of service; require the plan to reimburse a doctor of chiropractic for services and procedures within the doctor's scope of practice if duly licensed, the services and procedures are covered under the plan, and the services and procedures are performed by the doctor of chiropractic or by another licensed health care provider who provides the services under the direction and supervision of the doctor of chiropractic; amend KRS 304.17A-150 to provide that a provider contract or agreement with a doctor of chiropractic which restricts, reduces, or negates benefits otherwise covered under the plan or denies payment of benefits directly to the provider upon receipt of a duly executed assignment of benefits with a participating doctor of chiropractic is an unfair trade practice; except an insurer performing a utilization review; amend KRS 304.17A-527 and 304.17C-060 to require managed care plans and limited health benefit plans that provide chiropractic services coverage to file sample copies with the commissioner of insurance that include a clause stating that chiropractic services within a health benefit plan or limited health benefit plan shall be reimbursed at no less than the current fee established by the Workers' Compensation Medical Fee Schedule for physicians, or the actual fee whichever is less; provide that if the Workers' Compensation Medical Fee Schedule for Physicians does not include reimbursement for chiropractic services, the reimbursement shall be no less than the amount provided in the most recent Workers' Compensation Medical Fee Schedule for Physicians that included reimbursement for chiropractic services.
HB 202 - AMENDMENTS
Jan 4-introduced in House Jan 5-to Health & Welfare (H) Jan 6-reassigned to Banking & Insurance (H); posted in committee Feb 15-reported favorably, 1st reading, to Calendar with Committee Substitute Feb 16-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Tuesday, February 21, 2012; floor amendments (1) and (2) filed to Committee Substitute, floor amendment (3-title) filed Mar 1-3rd reading, passed 77-15 with Committee Substitute Mar 2-received in Senate Mar 5-to Appropriations & Revenue (S) Mar 7-reassigned to Licensing, Occupations, & Administrative Regulations (S) Mar 16-reassigned to Banking & Insurance (S)
