State Insurance Regulations

Below you will find specific state regulations pertaining to chiropractic coverage.  As the insurance industry changes, more and more insurers do business in multiple states.  As penetration of different state markets occurs, state insurance regulations are sometimes overlooked.  Be sure that the insurers in your state are operating in accordance with the regulations cited below.  This information is also invaluable in adding strength to appeals to insurers and departments of insurance.  Please review this information and include any pertinent statutes in your appeal.  It is also helpful to review the information available from the Federation of Chiropractic Licensing Boards (FCLB) regarding state scopes of practice.  Access FCLB's information here. 

Please note: This material is provided for informational purposes only.  The ACA does not officially endorse or suggest the enactment of any of the laws or regulations provided below.  The ACA cannot provide legal advice or interpretations of state laws.  If you need legal advice, please consult a qualified attorney.

To access your state's regulations pertaining to insurer recoupments, please click here

Alabama

Alaska

Arizona

Arkansas

California

Colorado

  • Retroactive Adjustments of Claims
  • Prompt Payment of Claims
  • Network Adequacy Requirements

Connecticut

Delaware

Florida

Georgia

Illinois

Indiana

  • Employing Assistants (IC 25-10-1-13)
  • Delineation of individuals who can perform a manipulation (IC 10-1-14)
  • Right to communicate treatment options to patient outside of patient's insurance policy (IC 27-8-11-4.5)
  • Certifications for claims reviewers (IC 27-8-16-5.2)
  • Requirements for claims reviewers (IC 27-8-16-7)
  • Requirements for communications of appeals processes (IC 27-8-16-8)
  • Prompt Payment of Claims

Iowa

  • Requirement for chiropractic coverage
  • Prompt Payment of Claims

Kansas

  • Prompt Payment of Claims

Kentucky

Louisiana 

  • Requirement for Medicaid Coverage
  • Insurance Commissioner Directive Regarding Copayments, Coinsurance, Deductibles and Benefit Limitations

Maine

Maryland 

Massachusetts

Minnesota

  • Prompt Payment of Claims

Mississippi

  • Requirements, guidelines, and qualifications for chiropractor doing insurance claims reviews and/or independent examinations

Missouri

Montana

  • Standards for utilization review

Nebraska

  • Prompt Payment of Claims

Nevada

New Hampshire

New Mexico

New York

  • Prompt Payment of Claims

North Carolina

Ohio

Oklahoma

Rhode Island 

South Carolina

  • Requirement of insurers to offer chiropractic care

South Dakota 

  • Health carrier responsibility for utilization review activities
  • Copayment or coinsurance amounts for chiropractic services
  • Written utilization review program required
  • Utilization review criteria
  • Requirements for utilization review agents
  • Timeframe for utilization review determinations
  • Required information for determinations
  • Definition of a clean claim
  • Time limits for processing clean claims
  • Standards for managed care plans

Texas 

  • Selection of a chiropractor
  • Parity (pages 167-169)

Vermont 

  • Insurer Recoupments
  • Chiropractic Services

Washington 

West Virginia

Wisconsin