An Act To
Maine Legislature, Session 126, LD 1236
Committee Amendment CA_A_S376 (Senate)
Amends: 24-A MRSA §2748, 24-A MRSA §2840-A, 24-A MRSA §4236

COMMITTEE AMENDMENT "A " to S.P. 430, L.D. 1236, Bill, "An Act To 
Amend the Maine Insurance Code To Ensure Fair and Reasonable Coverage and 
Reimbursement of Chiropractic Services" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §2748, as amended by PL 1993, c. 669, §2, is further 
amended to read: 
§2748. Coverage for chiropractic services 
1. Therapeutic, adjustive and manipulative services. Notwithstanding any other 
provisions of this chapter, every insurer whish that issues health care contracts providing 
coverage for the services of a "physician" or "doctor" to residents of this State shall 
provide coverage and reasonable payment for medically necessary services to any 
subscriber or other person covered under those contracts for those services when 
performed by a ohiropraetor chiropractic doctor, to the extent that the services are within 
the lawful scope of practice of a ohiropraotor chiropractic doctor licensed to practice in 
this State. Therapel:ltio All therapeutic, adjustive and manipUlative services shall must be 
covered and paid for in a reasonable and consistent manner whether performed by an 
allopathic, osteopathic or chiropractic doctor. 
2. Limits; coinsurance; deductibles. Any contract whish that provides coverage 
for the services required by this section may contain provisions for maximum benefits~ 
reasonable copayment and coinsurance requirements and reasonable limitations, 
deductibles and exclusions to the extent that these provisions are not inconsistent with the 
requirements of this section or the limitations, ooinsuranoe, deduotibles or eKolusions 
imposed on other providers and do not exceed requirements imposed in conjunction with 
other provider services. 
Insurers may not classify services provided by chiropractic 
doctors as physical therapy or place these services into other categories that unreasonably 
limit coverage or payments for such services or increase copayment, coinsurance or 
deductible requirements imposed in conjunction with other provider services. 
The 
copayment for each service provided in the course of a chiropractic office visit may not 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A "to S.P. 430, L.D. 1236 
exceed $5 or 10% of the covered payment for such service, whichever is greater. The 
total copayment for the combined services provided in the course of a chiropractic office 
visit may not exceed $30 or 10% of the combined covered payment for such services, 
whichever is greater. 
3. Reports to the Superintendent of Insurance. Every insurer subject to this 
section shall report its experience for each calendar year to the Superintendent of 
Insurance not later than April 30th of the following year. The report must be in a form 
prescribed by the superintendent and include the amount of claims paid in this State for 
the services required by this section and the total amount of claims paid in this State for 
health care contracts. The report must include complaints concerning access to services 
under this section and the results of those complaints. The report must also provide data 
and analysis of the manner in which insurers are classifying and paying for chiropractic 
services, including the copayment, coinsurance and deductible requirements, in 
compliance with the requirements of this section. The superintendent shall compile this 
data for all insurers in an annual report. 
Sec. 2. 24-A MRSA §2840-A, sub-§§l and 2, as enacted by PL 1985, c. 516, 
§5, are amended to read: 
1. Therapeutic, adjustive and manipulative services. Notwithstanding any other 
provisions of this chapter, every insurer whieh that issues group or blanket health care 
contracts providing coverage for the services of a "physician" or "doctor" to residents of 
this State shall provide coverage and reasonable payment for medically necessary 
services to any subscriber or other person covered under those contracts for those services 
when performed by a chiropractor chiropractic doctor, to the extent that the services are 
within the lawful scope of practice of a chiropractor chiropractic doctor licensed to 
practice in this State. Therapeutic All therapeutic, adjustive and manipUlative services 
shall must be covered and paid for in a reasonable and consistent manner whether 
performed by an allopathic, osteopathic or chiropractic doctor. 
2. Limits; coinsurance; deductibles. Any contract whieh that provides coverage 
for the services required by this section may contain provisions for maximum benefits 
aad, reasonable copayment and coinsurance requirements and reasonable limitations, 
deductibles and exclusions to the extent that these provisions are not inconsistent with the 
requirements of this section and do not exceed requirements imposed in conjunction with 
other provider services. 
Insurers may not classify services provided by chiropractic 
doctors as physical therapy or place these services into other categories that unreasonably 
limit coverage or payments for such services or increase copayment, coinsurance or 
deductible requirements imposed in conjunction with other provider services. 
The 
copayment for each service provided in the course of a chiropractic office visit may not 
exceed $5 or 10% of the covered payment for such service, whichever is greater. The 
total copayment for the combined services provided in the course of a chiropractic office 
visit may not exceed $30 or 10% of the combined covered payment for such services, 
whichever is greater. 
Sec. 3. 24-A MRSA §2840-A, sub-§3, as amended by PL 1993, c. 669, §3, is 
further amended to read: 
3. Reports to the Superintendent of Insurance. Every insurer subject to this 
section shall report its experience for each calendar year to the Superintendent of 
COMMITTEE AMENDMENT 
~ .• ,. 
COMMITTEE AMENDMENT" An to S.P. 430, L.D. 1236 
Insurance not later than April 30th of the following year. The report must be in a form 
prescribed by the superintendent and include the amount of claims paid in this State for 
the services required by this section and the total amount of claims paid in this State for 
health care contracts. The report must include complaints concerning access to services 
under this section and the results of those complaints. The report must also provide data 
and analysis of the manner in which insurers are classifying and paying for chiropractic 
services, including the copayment, coinsurance and deductible requirements, in 
compliance with the requirements of this section. The superintendent shall compile this 
data for all insurers in an annual report. 
Sec. 4. 24-A MRSA §4236, as amended by PL 1997, c. 99, §1, is further amended 
to read: 
§4236. Chiropractic doctors in health maintenance organizations 
Every health maintenance organization shall include in every plan for health care 
services chiropractic services delivered by qualified chiropractic pre'liEiers doctors in 
accordance with this section. 
1. Qualifications of chiropractic doctors. The health maintenance organization 
shall determine the qualifications of chiropractic pre'liEiers doctors using reasonable 
standards that are similar to and consistent with the standards applied to other providers. 
2. Benefits. The health maintenance organization shall provide benefits covering 
and paying for care by chiropractic preyiEiers doctors at least equal to and consistent with 
the benefits paid to other health care providers treating similar ReUfe HR:lseuleskeletal 
conditions within the scope of practice of chiropractic doctors. The health maintenance 
organization may not classify services provided by chiropractic doctors as physical 
therapy or place these services into other categories that unreasonably limit coverage or 
payments for such services or impose copayment, coinsurance or deductible requirements 
that exceed those imposed with respect to services of other providers. The copayment for 
each service provided in the course of a chiropractic office visit may not exceed $5 or 
10% of the covered payment for such service, whichever is greater. The total copayment 
for the combined services provided in the course of a chiropractic office visit may not 
exceed $30 or 10% of the combined covered payment for such services, whichever is 
greater. 
3. Self-referrals for chiropractic care. A health maintenance organization must 
provide benefits to an enrollee who utilizes the services of a chiropractic pre'liEier doctor 
by self-referral under the following conditions. 
A. An enrollee may utilize the services of a participating chiropractic pre'liEier doctor 
within the enrollee's health maintenance organization for 3 weeks or a maximum of 
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 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 
pre'lider doctor shall send to the primary care provider a report containing the 
COMMITTEE AMENDMENT 
1\.'" 
COMMITTEE AMENDMENT "A" to S.P. 430, L.D. 1236 
enrollee's complaint, related history, examination, initial diagnosis and treatment 
plan. If the chiropractic flrovider doctor fails to send a report to the primary care 
provider within 3 working days, the health maintenance organization is not obligated 
to provide benefits for chiropractic care and the enrollee is not liable to the 
chiropractic flrevider doctor for any unpaid fees. 
e. If the enrollee and the participating chiropractic flrevider doctor determine that 
the condition of the enrollee has not improved after 3 weeks of treatment or a 
maximum of 12 visits~ the participating chiropractic flrevider doctor shall discontinue 
treatment and refer the enrollee to the primary care provider. 
D. If the chiropractic flrovider doctor recommends treatment beyond 3 weeks or a 
maximum of 12 visits, the participating chiropractic flrevider doctor 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 doctor 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 doctor is liable for a professional diagnosis of a mental or physical condition that 
has resulted or may result in the chiropractic flfOvider doctor 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. 
This subsection takes effect January 1, 1996. 
Sec. 5. Application. The requirements of this Act apply to all policies, contracts 
and certificates executed, delivered, issued for delivery, continued or renewed in this 
State on or after January 1,2015. For the purposes of this Act, all contracts are deemed 
to be renewed no later than the next yearly anniversary of the contract date.' 
SUMMARY 
This amendment is the minority report of the committee and replaces the bill. The 
amendment requires coverage and reasonable payment by health insurers and health 
maintenance organizations for medically necessary services within the scope of practice 
of chiropractic doctors. It requires insurers to provide benefits covering and paying for 
care by chiropractic doctors. Under the amendment, these carriers may not classify 
services provided by chiropractic doctors as physical therapy or place these services into 
other categories that unreasonably limit coverage or payments for such services. It also 
prohibits the imposition of unreasonable patient copayment, coinsurance or deductible 
requirements that exceed those patient obligations imposed with respect to other provider 
services. The copayment for each service provided in the course of an office visit to a 
chiropractic doctor may not exceed $5 or 10% of the covered payment for such service, 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A "to S.P. 430, L.D. 1236 
whichever is greater. The total copayment for the combined services provided in the 
course of an office visit to a chiropractic doctor may not exceed $30 or 10% of the 
combined covered payment for such services, whichever is greater. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 01127 114 
~ac:.. 
LD 1236 
LR 1885(02) 
An Act To Amend the Maine Insurance Code To Ensure Fair and Reasonable Coverage and 
Reimbursement of Chiropractic Services 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment '~' (S-- 57l.1) 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the State Employee Health Insurance Program are expected to be minor and can be absorbed 
within existing budgeted resources. Additional costs to the Bureau of Insurance in the Department of Professional a: 
Financial Regulation are expected to be minor and can be absorbed within existing budgeted resources. 
LR1885(02) - Fiscal Note - Page 1 of 1