CHAPTER 14
SB 147 - FINAL VERSION
5/20/99 1196s
5/20/99 1347s
6/8/99 1484s
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2/10/00 3350eba
2000 SESSION
SENATE BILL 147
AN ACT relative to self-referrals for chiropractic care under managed care organizations.
SPONSORS: Sen. Wheeler, Dist 21; Sen. Larsen, Dist 15; Rep. Robb-Theroux, Sull 9; Rep. Bradley, Carr 8
This bill establishes procedures for self-referrals for chiropractic care under managed care organizations.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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5/20/99 1347s
6/8/99 1484s
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2/10/00 3350eba
99-0373
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand
AN ACT relative to self-referrals for chiropractic care under managed care organizations.
Be it Enacted by the Senate and House of Representatives in General Court convened:
14:1 New Section; Chiropractic Care. Amend RSA 420-J by inserting after section 6-a the following new section:
420-J:6-b Self-referrals for Chiropractic Care. A health benefit plan under this chapter offering chiropractic benefits shall provide benefits to a covered person who utilizes services of a chiropractic provider (doctor of chiropractic) by self-referral for 12 visits under the following conditions:
I. Unless otherwise provided for by the health benefits plan, self-referral visits shall not apply to wellness care visits.
II. A covered person may utilize the services of a doctor of chiropractic as defined in RSA 316-A, without discrimination relative to access and fees, subject to the terms and conditions of the policy.
III. The health benefit plan shall fully disclose to the certificate holder in clear and understandable language the exact terms and conditions of each option that the certificate holder has purchased along with the co-payments or other cost-sharing features of each option.
IV. Within 10 working days of the first visit or consultation, the doctor of chiropractic shall send to the health benefit plan, or its designee, the chiropractic case findings. This shall be sufficient documentation for the initial 12 visits.
V. After 12 self-referral visits, a covered person who is continuing chiropractic care may be subject to utilization review from the health plan, or its designee, for the purpose of continued care. A provider of the same specialty shall be consulted when making any utilization review determination under this section.
VI. If the chiropractic provider recommends care beyond 12 visits, the participating doctor of chiropractic shall send to the insurer, or its designee, documentation containing information on the covered person's progress and necessity of care as well as a care plan for extended chiropractic care. The care recommendation shall be deemed authorized if the health benefit plan does not respond to the care recommendation within 7 business days. If the doctor of chiropractic fails to provide the required documentation, the insured or its covered person shall not be liable to the chiropractic provider for any unpaid fees.
VII. The covered person shall retain the right to choose chiropractic care on an elective, self-pay, fee-for-service basis; no entity regulated under this chapter shall prohibit a doctor of chiropractic from continuing care on an elective, self-pay, fee-for-service basis.
VIII. Nothing in this section is intended to limit the health plan's ability to credential providers or structuring with network providers.
14:2 Effective Date. This act shall take effect 60 days after its passage.
(Approved: February 18, 2000)
(Effective Date: April 18, 2000)