20-1057.03. Chiropractic care; definitions

A. Every health care services organization shall provide coverage for chiropractic services provided by network chiropractic providers pursuant to this section.

B. A health care services organization is not required to provide coverage for chiropractic services obtained from a provider who is not a member of the health care services organization's provider network.

C. An enrollee may obtain medically necessary chiropractic services from a network chiropractic provider through self-referral for a minimum of twelve visits in an annual contract period, unless the enrollee's evidence of coverage with the health care services organization allows for additional visits or benefits.

D. This section does not:

1. Require a health care services organization to provide services that are not covered by the enrollee's evidence of coverage and does not diminish or impair any preexisting condition limitation in the evidence of coverage.

2. Prohibit an enrollee from seeking chiropractic services in addition to the limits prescribed in this section from any chiropractic provider if the enrollee accepts financial responsibility for those services.

E. Nothing in this section prohibits the use of deductibles, coinsurance, copayments or other cost sharing in relation to the chiropractic benefits offered.

F. For the purposes of this section:

1. " Chiropractic services" means only nonsurgical and noninvasive treatment of neck and back pain through physiotherapy, musculoskeletal manipulation and other physical corrections of musculoskeletal conditions within the scope of the chiropractic practice.

2. " Musculoskeletal" means any function of the musculoskeletal system that is integrated with neurological function and is expressed by biological regulatory mechanisms.

3. " Network chiropractic provider" means a chiropractic physician who is licensed pursuant to title 32, chapter 8 and who is under written contract with the health care services organization to provide services pursuant to this section.

4. " Self-referral" means obtaining treatment by a provider without referral from a primary care physician.