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

• Reimbursement for services performed by an MD shall be reimbursed if performed by a DC if the service is within the DC’s scope of practice 
• Assignment of Benefits
• Limitation periods for payment of claims; overdue claims; retroactive denials, adjustments
• Requirements of utilization review agents
• Patient right to know act

Alaska

• Direct Access to Doctors of Chiropractic
• State Scope of Practice
• Physical Examinations Provided by a Chiropractor
• Definition of manipulation and subluxation

Arizona

• Prohibiting denial of chiropractic contract benefits by hospitals and medical service corporations; direct reimbursement
• Prohibiting denial of chiropractic contract benefits by disability insurance contracts; direct reimbursement
• Prohibiting denial of chiropractic contract benefits by group disability insurance contracts; direct reimbursement
• Prompt Payment of Claims
• Unfair Claim Settlement Practices

Arkansas

• Prompt Payment of Claims
• Reimbursement Equality (23-79-114)

California

• DCs certifications of disability
• Injured workers right to chiropractic care
• Prompt Payment of Claims

Colorado

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

Connecticut

• Coverage for chiropractic services requirement
• Mandatory coverage for chiropractic services
• Required Definition of Medical Necessity/External Appeal Regulations
• Managed Care Accountability
• Silent PPO Regulations
• Prompt Payment of Claims

Delaware

• Prompt Payment of Claims
• Entitled to Compensation for Services Within Scope
• 25% Copayment/Co-insurance
• Peer Review DC Must be Licensed in State and Practice 10 hours a Week
• Chiropractic Practitioners Eligible for Compensation from Insurance

Florida

• Delegating services to chiropractic assistants
• Chiropractic reimbursement in exclusive PPO's
• Prompt Payment of Claims
• Insurance Rates and Contracts (see item #4)
• Silent PPO's, Assignment of Benefits, Overpayments

Georgia

• Requirements for private review agents
• Scope of Practice-including peer review definition
• Prompt Payment of Claims

Illinois

• Prompt Pay Regulation
• DCs Eligible to Perform Services in Assisted Living Facilities

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

• Co-payments for care provided by a DC must be equal or less than copayments for care provided by other providers
• Appropriate grounds for removal from participation in a plan or network
• Claims paid on behalf of insurer--Compensation of administrator
• Licensure requirements for adjusters
• Indemnity payable for services performed by optometrists, osteopaths, podiatrists, physicians or chiropractors
• Unfair trading practices
• Requirements for health benefit plans that include chiropractic benefits

Louisiana 

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

Maine

• Mandatory Chiropractic Coverage and Direct Access (HMO)
• Self referral for chiropractic care
• Chiropractic Assistants
• Workers' Compensation Regulations
• Chiropractic Acupuncture Certification
• Examination and Licensure
• Chiropractors in HMOs
• General Provisions

Maryland 

• Certifications of private review agents
• Criteria used by private review agents
• Time frame required for private review agent reviews

Massachusetts

• Prompt Payment of Claims (45 days)
• Reimbursement for Chiropractic Services

Minnesota

• Prompt Payment of Claims

Mississippi

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

Missouri

• Maximum Co-payment for Chiropractic Services

Montana

• Standards for utilization review

Nebraska

• Prompt Payment of Claims

Nevada

• IME Requirements
• Requirements for treatment coverage
• Reimbursement for treatment by a chiropractor (HMO)

New Hampshire

• Self referrals for chiropractic care

New Mexico

• Chiropractic Licensure, Establishing the Advanced Practice Chiropractic Certification Registry, Authorizing a Certified Advanced Practice Chiropractic Physician to Issue Prescriptions
• General Provisions Regarding Chiropractic Providers Including Pre Paid Treatmen Plan Regulations
• Chiropractic Scope of Practice

New York

• Prompt Payment of Claims

North Carolina

• Right to choose a doctor of chiropractic

Ohio

• Right to an external review
• Prompt payment regulations
• Additional prompt payment regulations
• "Overpayment" regulations
• Anti-retaliation regulations
• Insurer Transparency

Oklahoma

• Patient protections for choosing a doctor of chiropractic
• Prompt Payment of Claims

Rhode Island 

• Prompt Payment of Claims
• Recoupments
• Unfair Discrimination Prohibited

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 

• Chiropractic care coverage requirements
• Insurance enrollee's right to access chiropractor provider of their choice
• Parity Reimbursement

West Virginia

• Ethics and Fairness in Insurer Business Practices

Wisconsin

• Right to an Independent Review (632.85)
• Mandated Coverage for Chiropractic (637.87 (3) (a))
• Explanation Requirements for Restrictions or Terminations of Coverage for Chiropractic Services (632.875(2) (g))
• Grievance and Independent Review Requirements and Procedures