An Act Regarding Copayment and Coinsurance Issues for Chiropractors
Maine Legislature, Session 130, LD 0556
Committee: Health Coverage, Insurance and Financial Services
Sponsors: DOORE
Amends: 24-A MRSA §2748, 24-A MRSA §2840-A, 24-A MRSA §4236

Legislative Document
No. 556
H.P. 401
House of Representatives, February 24, 2021
An Act Regarding Copayment and Coinsurance Issues for 
Chiropractors
Received by the Clerk of the House on February 22, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed pursuant to Joint Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative DOORE of Augusta.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2748, sub-§2, as enacted by PL 1985, c. 516, §3, is amended 
to read:
2.  Limits; coinsurance; copayments; deductibles.  Any Except as provided in this 
subsection, any contract which that provides coverage for the services required by this 
section may contain provisions for maximum benefits and coinsurance and reasonable 
limitations, deductibles and exclusions to the extent that these provisions are not 
inconsistent with the requirements of this section or the limitations, coinsurance, 
deductibles or exclusions imposed on other providers.  A contract may not contain a 
provision for a copayment or coinsurance requirement for a health care service or procedure 
provided by a chiropractic provider unless the copayment or coinsurance requirement does 
not exceed the copayment or coinsurance requirement applicable to the same service or 
procedure provided by a primary care provider in the insurer's provider network.  A 
profession-specific manipulation code may not authorize a copayment or coinsurance 
requirement that exceeds the copayment or coinsurance requirement for an evaluation and 
management service when performed by a primary care provider in the insurer's provider 
network.
Sec. 2.  24-A MRSA §2748, sub-§5, as enacted by PL 2015, c. 111, §1 and affected 
by §4, is amended to read:
5.  Reimbursement; discrimination.  An insurer subject to this section may not refuse 
to reimburse a chiropractic provider who participates in the insurer's provider network for 
providing a health care service or procedure covered by the insurer as long as the 
chiropractic provider is acting within the lawful scope of that provider's license in the 
delivery of the covered service or procedure.  Consistent with reasonable medical 
management techniques specified under the insurer's contract with respect to the method, 
treatment or setting for a covered service or procedure, the insurer may not discriminate 
based on the chiropractic provider's license.  This subsection does not require an insurer to 
accept all chiropractic providers into a network or govern the amount of the reimbursement 
paid to a chiropractic provider, except as provided in subsection 2.
Sec. 3.  24-A MRSA §2840-A, sub-§2, as enacted by PL 1985, c. 516, §5, is 
amended to read:
2.  Limits; coinsurance; copayments; deductibles.  Any Except as provided in this 
subsection, any contract which that provides coverage for the services required by this 
section may contain provisions for maximum benefits and coinsurance and reasonable 
limitations, deductibles and exclusions to the extent that these provisions are not 
inconsistent with the requirements of this section.  A contract may not contain a provision 
for a copayment or coinsurance requirement for a health care service or procedure provided 
by a chiropractic provider unless the copayment or coinsurance requirement does not 
exceed the copayment or coinsurance requirement applicable to the same service or 
procedure provided by a primary care provider in the insurer's provider network.  A 
profession-specific manipulation code may not authorize a copayment or coinsurance 
requirement that exceeds the copayment or coinsurance requirement for an evaluation and 
management service when performed by a primary care provider in the insurer's provider 
network.
Sec. 4.  24-A MRSA §2840-A, sub-§5, as enacted by PL 2015, c. 111, §2 and 
affected by §4, is amended to read:
5.  Reimbursement; discrimination.  An insurer subject to this section may not refuse 
to reimburse a chiropractic provider who participates in the insurer's provider network for 
providing a health care service or procedure covered by the insurer as long as the 
chiropractic provider is acting within the lawful scope of that provider's license in the 
delivery of the covered service or procedure.  Consistent with reasonable medical 
management techniques specified under the insurer's contract with respect to the method, 
treatment or setting for a covered service or procedure, the insurer may not discriminate 
based on the chiropractic provider's license.  This subsection does not require an insurer to 
accept all chiropractic providers into a network or govern the amount of the reimbursement 
paid to a chiropractic provider, except as provided in subsection 2.
Sec. 5.  24-A MRSA §4236, sub-§2, as amended by PL 2015, c. 111, §3 and 
affected by §4, is further amended to read:
2.  Benefits; discrimination.  The health maintenance organization shall provide 
benefits covering care by chiropractic providers at least equal to and consistent with the 
benefits paid to other health care providers treating similar neuro-musculoskeletal 
conditions.  A health maintenance organization may not refuse to reimburse a chiropractic 
provider who participates in the health maintenance organization's provider network for 
providing a health care service or procedure covered by the health maintenance 
organization as long as the chiropractic provider is acting within the lawful scope of that 
provider's license in the delivery of the covered service or procedure. Consistent with 
reasonable medical management techniques specified under the health maintenance 
organization's contract with respect to the method, treatment or setting for a covered service 
or procedure, the health maintenance organization may not discriminate based on the 
chiropractic provider's license. This subsection does not require a health maintenance 
organization to accept all chiropractic providers into a network or govern the 
reimbursement paid to a chiropractic provider, except as provided in subsection 4.
Sec. 6.  24-A MRSA §4236, sub-§4 is enacted to read:
4.  Copayments; coinsurance.  A health maintenance organization contract may not 
contain a provision for a copayment or coinsurance requirement for a health care service 
or procedure provided by a chiropractic provider unless the copayment or coinsurance 
requirement does not exceed the copayment or coinsurance requirement applicable to the 
same service or procedure provided by a primary care provider in the health maintenance 
organization's provider network.  A profession-specific manipulation code may not 
authorize a copayment or coinsurance requirement that exceeds the copayment or 
coinsurance requirement for an evaluation and management service when performed by a 
primary care provider in the health maintenance organization's provider network.
Sec. 7.  Application.  The requirements of this Act apply to all individual and group 
policies, contracts and certificates issued for delivery, continued or renewed in this State 
on or after January 1, 2022.  For purposes of this Act, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
SUMMARY
This bill provides that the copayment or coinsurance amount paid by a patient for 
services provided by a chiropractor may not exceed the copayment or coinsurance amount 
for services provided by a primary care provider.  The bill applies to individual and group 
health insurance policies and to individual and group health maintenance organization 
contracts issued or renewed on or after January 1, 2022.