REPORT TITLE:
Chiropractic; Req'd Coverage


DESCRIPTION:
Mandates coverage after 12/31/99 for chiropractic services for
all health insurers, hospital medical associations, and HMOs and
allows coinsurance and choice of practitioner.  Requires each
policy to be construed to include payment to chiropractors
without discrimination for payment customary services. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            782         
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT
RELATING TO MANDATORY HEALTH INSURANCE FOR CHIROPRACTIC SERVICES.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to article 10A to be appropriately
 
 3 designated and to read as follows:
 
 4      "431:10A-     Chiropractic services; options.  (a)
 
 5 Notwithstanding any provision of law to the contrary, each
 
 6 employer group health policy, contract, plan, or agreement issued
 
 7 or renewed in this State after December 31, 1999, that provides
 
 8 for payment of or reimbursement for chiropractic-related
 
 9 services, shall provide chiropractic services performed by an
 
10 individual licensed to practice chiropractic pursuant to
 
11 chapter 442, to the subscriber or any dependent of the subscriber
 
12 who is covered by the policy.
 
13      (b)  The services provided in this section shall be subject
 
14 to any coinsurance provisions which may be in force in these
 
15 policies, contracts, plans, or agreements.  An insurer may
 
16 provide the services required by this section through contracts
 
17 with providers; provided that the contract is determined to be a
 
18 cost-effective means of delivering the services without sacrifice
 
19 of quality and meets the approval of the director of health."
 
20      SECTION 2.  Chapter 432, Hawaii Revised Statutes, is amended
 

 
Page 3                                         782         
                                     H.B. NO.           
                                                        
                                                        

 
 1 by adding a new section to be appropriately designated and to
 
 2 read as follows:
 
 3      "432-     Chiropractic services; options; health
 
 4 maintenance organizations.  (a)  Notwithstanding any provision of
 
 5 law to the contrary, each individual and group hospital or
 
 6 medical service plan, policy, contract, or agreement issued or
 
 7 renewed in this State after December 31, 1999, that provides for
 
 8 payment of or reimbursement for chiropractic-related services,
 
 9 shall provide chiropractic services performed by an individual
 
10 licensed to practice chiropractic pursuant to chapter 442, for
 
11 the member or any dependent of the member who is covered by the
 
12 policy.
 
13      (b)  The services provided in this section shall be subject
 
14 to any coinsurance provisions which may be in force in these
 
15 policies, contracts, plans, or agreements.  The plan, policy,
 
16 contract, or agreement may provide the services required by this
 
17 section through contracts with providers; provided that the
 
18 contract is determined to be a cost-effective means of delivering
 
19 the services without sacrifice of quality and meets the approval
 
20 of the director of health."
 
21      SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is
 
22 amended by adding a new section to be appropriately designated
 
23 and to read as follows:
 

 
Page 4                                         782         
                                     H.B. NO.           
                                                        
                                                        

 
 1      "432D-     Chiropractic services; options; health
 
 2 maintenance organizations.  (a)  Notwithstanding any provision of
 
 3 law to the contrary, each health maintenance organization that
 
 4 provides for payment of or reimbursement for chiropractic-related
 
 5 services, shall provide chiropractic services performed by an
 
 6 individual licensed to practice chiropractic pursuant to chapter
 
 7 442, for the enrollee or any dependent of the enrollee who is
 
 8 covered by the policy.
 
 9      (b)  The services provided in this section shall be subject
 
10 to any coinsurance provisions which may be in force in these
 
11 policies, contracts, plans, or agreements.  A health maintenance
 
12 organization may provide the services required by this section
 
13 through contracts with providers; provided that the contract is
 
14 determined to be a cost-effective means of delivering the
 
15 services without sacrifice of quality and meets the approval of
 
16 the director of health."
 
17      SECTION 4.  Section 431:10-237, Hawaii Revised Statutes, is
 
18 amended to read as follows:
 
19      "431:10-237  Construction of policies.  (a)  Every
 
20 insurance contract shall be construed according to the entirety
 
21 of its terms and conditions as set forth in the policy, and as
 
22 amplified, extended, restricted, or modified by any rider,
 
23 endorsement or application attached to and made a part of the
 

 
Page 5                                         782         
                                     H.B. NO.           
                                                        
                                                        

 
 1 policy.
 
 2      (b)  Any other law to the contrary notwithstanding, no
 
 3 health insurance policy, employer group health policy, contract,
 
 4 plan, or agreement, health care services plan or other health
 
 5 care delivery arrangement issued after December 31, 1999, that
 
 6 provides for the payment or reimbursement of health care
 
 7 expenses, or provides health care services, shall discriminate
 
 8 with regard to the choice of health care service provider and
 
 9 shall allow the choice of a person licensed to practice
 
10 chiropractic pursuant to chapter 442.  Each policy shall be
 
11 construed to include payment to persons who are licensed to
 
12 practice chiropractic and who provide health care service
 
13 benefits within the scope of the chiropractic practitioner's
 
14 license.  Chiropractors shall be treated in the same manner as
 
15 any other licensed physician, surgeon, or other health care
 
16 provider, without discrimination, with regard to payment for
 
17 usual and customary service, diagnosis, and treatment procedures.
 
18      (c)  Nothing in this section shall be construed to extend
 
19 the practice or privileges of any health care provider beyond
 
20 that provided in the laws governing the provider's practice and
 
21 privileges."
 
22      SECTION 5.  Chapter 432, Hawaii Revised Statutes, is amended
 
23 by adding a new section to be appropriately designated and to
 

 
Page 6                                         782         
                                     H.B. NO.           
                                                        
                                                        

 
 1 read as follows:
 
 2      "432-     Construction of policies.  (a)  Any other law to
 
 3 the contrary notwithstanding, no health insurance policy,
 
 4 employer group health policy, contract, plan, or agreement,
 
 5 health care services plan or other health care delivery
 
 6 arrangement issued after December 31, 1999, that provides for the
 
 7 payment or reimbursement of health care expenses, or provides
 
 8 health care services, shall discriminate with regard to the
 
 9 choice of health care service provider and shall allow the choice
 
10 of a person licensed to practice chiropractic pursuant to chapter
 
11 442.  Each policy shall be construed to include payment to
 
12 persons who are licensed to practice chiropractic and who provide
 
13 health care service benefits within the scope of the chiropractic
 
14 practitioner's license.  Chiropractors shall be treated in the
 
15 same manner as any other licensed physician, surgeon, or other
 
16 health care provider, without discrimination, with regard to
 
17 payment for usual and customary service, diagnosis, and treatment
 
18 procedures.
 
19      (b)  Nothing in this section shall be construed to extend
 
20 the practice or privileges of any health care provider beyond
 
21 that provided in the laws governing the provider's practice and
 
22 privileges."
 
23      SECTION 6.  Statutory material to be repealed is bracketed.
 

 
Page 7                                         782         
                                     H.B. NO.           
                                                        
                                                        

 
 1 New statutory material is underscored.
 
 2      SECTION 7.  This Act shall take effect upon its approval.
 
 3 
 
 4                           INTRODUCED BY:  _______________________