An Act To Amend the Maine Insurance Code To Ensure Fair and Reasonable Coverage and Reimbursement of Chiropractic Services
Maine Legislature, Session 126, LD 1236
Committee: Insurance and Financial Services
Sponsors: ALFOND, CAMPBELL, CAIN, GERZOFSKY, HASKELL, TUTTLE, BECK, HOBBINS
Amends: 24-A MRSA §2748, 24-A MRSA §2840-A, 24-A MRSA §4236

Legislative Document 
No. 1236 
S.P. 430 
In Senate, March 27, 2013 
An Act To Amend the Maine Insurance Code To Ensure Fair and 
Reasonable Coverage and Reimbursement of Chiropractic Services 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
DAREK M. GRANT 
Secretary of the Senate 
Presented by President ALFOND of Cumberland. 
Cosponsored by Representative CAMPBELL of Orrington and 
Senators: CAIN of Penobscot, GERZOFSKY of Cumberland, HASKELL of Cumberland, 
TUTTLE of York, Representatives: BECK of Waterville, HOBBINS of Saco. 
Be it enacted by the People of the State of Maine as follows: 
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 which that issues health care contracts providing 
coverage for the services of a "physician" or "doctor" to residents of this State shall 
provide coverage with 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 The insurer shall provide benefits covering and paying for care by 
chiropractic doctors at least equal to and consistent with the benefits paid to other health 
care providers treating similar conditions within the scope of practice of chiropractic 
doctors.  All therapeutic, adjustive and manipulative services shall must be covered and 
paid for in a reasonable and consistent manner and using a fair and equitable 
methodology, whether performed by an allopathic, osteopathic or chiropractic doctor. 
2.  Limits; coinsurance; deductibles.  Any contract which 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, copayment and coinsurance requirements, 
deductibles or exclusions imposed on other providers.  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 impose 
copayments, coinsurance requirements or deductibles that are more burdensome or 
limiting than those imposed with respect to services provided by allopathic or osteopathic 
doctors.  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 services, 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.  Report 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 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-§§1 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 which 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 The insurer shall provide benefits covering and paying 
for care by chiropractic doctors at least equal to and consistent with the benefits paid to 
other health care providers treating similar conditions within the scope of practice of 
chiropractic doctors.  All therapeutic, adjustive and manipulative services shall must be 
covered and paid in a reasonable and consistent manner and using a fair and equitable 
methodology, whether performed by an allopathic, osteopathic or chiropractic doctor. 
2.  Limits; coinsurance; deductibles.  Any contract which that provides coverage 
for the services required by this section may contain provisions for maximum benefits 
and 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, copayment and coinsurance requirements, 
deductibles or exclusions imposed on other providers.  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 impose 
copayments, coinsurance requirements or deductibles that are more burdensome or 
limiting than those imposed with respect to services provided by allopathic or osteopathic 
doctors.  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 services, 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.  Report 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 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 providers doctors in 
accordance with this section. 
1.  Qualifications of chiropractic doctors.  The health maintenance organization 
shall determine the qualifications of chiropractic providers 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 providers doctors at least equal to and consistent with 
the benefits paid to other health care providers treating similar neuro-musculoskeletal 
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 copayments, coinsurance requirements or 
deductibles that are more burdensome or limiting than those imposed with respect to 
services provided by allopathic or osteopathic doctors.  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 services, 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 provider doctor 
by self-referral under the following conditions. 
A.  An enrollee may utilize the services of a participating chiropractic provider 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 
provider doctor shall send to the primary care provider a report containing the 
enrollee's complaint, related history, examination, initial diagnosis and treatment 
plan.  If the chiropractic provider 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 provider doctor for any unpaid fees. 
C.  If the enrollee and the participating chiropractic provider 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 provider doctor shall discontinue 
treatment and refer the enrollee to the primary care provider. 
D.  If the chiropractic provider doctor recommends treatment beyond 3 weeks or a 
maximum of 12 visits, the participating chiropractic provider 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 provider 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. 
SUMMARY 
This bill requires that coverage and payment by health insurers and health 
maintenance organizations for services within the scope of practice of chiropractic 
doctors be at least equal to and consistent with coverage for services provided by 
allopathic or osteopathic doctors.  It requires insurers to provide benefits covering and 
paying for care by chiropractic doctors at least equal to and consistent with the benefits 
paid to other health care providers treating similar conditions within the scope of practice 
of chiropractic doctors.  Under the bill, 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, or impose copayments, 
coinsurance requirements or deductibles that are more burdensome or limiting than those 
imposed with respect to services provided by allopathic or osteopathic doctors.  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 services, 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.