2017 -- S 0789

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LC002439

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Lombardo, DiPalma, Nesselbush, Lynch Prata, and McCaffrey

     Date Introduced: April 25, 2017

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-48.2. Patient access to alternative medicine.

     (a) Legislative purpose - Medications prescribed for the management of pain constitute a

factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section

is to ensure patient access to alternative means of pain management, specifically, access to and

reimbursement of medical services rendered by chiropractic physicians in the diagnosis and

treatment of conditions associated with the usage of pain medications.

     (b) Construction of health policies, plans and contracts. - Notwithstanding any other

provision of law, when any health insurance policy, health care services plan, or other contract

provides for the payment for medical expense benefits or procedures related to the treatment of

pain, such policy, plan, or contract shall be construed to include equivalent payment to a

chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits

or procedures which are within the scope of a chiropractic physician's license. Any limitation or

condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing

non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed

physicians without unfair discrimination based upon the usual and customary treatment

procedures of any class of physicians. Nothing in this section shall be construed as preventing a

group health plan or a health insurance issuer from establishing varying reimbursement rates

based on quality or performance measures; provided, however, that:

     (1) Reimbursement may not be arbitrarily capped and must be based on medical

necessity;

     (2) Reimbursement rates must be set utilizing industry standard relative value scale

metrics, including equivalent co-payments for equivalent levels of service delivered by any

licensed provider group; and

     (3) No discriminatory contractual terms may be imposed based upon whether the treating

provider is an allopathic, osteopathic, or chiropractic physician.

     (c) Enforcement. The office of the health insurance commissioner shall enforce the

provisions of this section.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-40.2. Patient access to alternative medicine.

     (a) Legislative purpose - Medications prescribed for the management of pain constitute a

factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section

is to ensure patient access to alternative means of pain management, specifically, access to and

reimbursement of medical services rendered by chiropractic physicians in the diagnosis and

treatment of conditions associated with the usage of pain medications.

     (b) Construction of health policies, plans and contracts. - Notwithstanding any other

provision of law, when any health insurance policy, health care services plan, or other contract

provides for the payment for medical expense benefits or procedures related to the treatment of

pain, such policy, plan, or contract shall be construed to include equivalent payment to a

chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits

or procedures which are within the scope of a chiropractic physician's license. Any limitation or

condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing

non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed

physicians without unfair discrimination based upon the usual and customary treatment

procedures of any class of physicians. Nothing in this section shall be construed as preventing a

group health plan or a health insurance issuer from establishing varying reimbursement rates

based on quality or performance measures; provided, however, that:

     (1) Reimbursement may not be arbitrarily capped and must be based on medical

necessity;

     (2) Reimbursement rates must be set utilizing industry standard relative value scale

metrics, including equivalent co-payments for equivalent levels of service delivered by any

LC002439 - Page 2 of 5

licensed provider group; and

     (3) No discriminatory contractual terms may be imposed based upon whether the treating

provider is an allopathic, osteopathic, or chiropractic physician.

     (c) Enforcement. The office of the health insurance commissioner shall enforce the

provisions of this section.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-35.2 Patient access to alternative medicine.

     (a) Legislative purpose - Medications prescribed for the management of pain constitute a

factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section

is to ensure patient access to alternative means of pain management, specifically, access to and

reimbursement of medical services rendered by chiropractic physicians in the diagnosis and

treatment of conditions associated with the usage of pain medications.

     (b) Construction of health policies, plans and contracts. - Notwithstanding any other

provision of law, when any health insurance policy, health care services plan, or other contract

provides for the payment for medical expense benefits or procedures related to the treatment of

pain, such policy, plan, or contract shall be construed to include equivalent payment to a

chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits

or procedures which are within the scope of a chiropractic physician's license. Any limitation or

condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing

non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed

physicians without unfair discrimination based upon the usual and customary treatment

procedures of any class of physicians. Nothing in this section shall be construed as preventing a

group health plan or a health insurance issuer from establishing varying reimbursement rates

based on quality or performance measures; provided, however, that:

     (1) Reimbursement may not be arbitrarily capped and must be based on medical

necessity;

     (2) Reimbursement rates must be set utilizing industry standard relative value scale

metrics, including equivalent co-payments for equivalent levels of service delivered by any

licensed provider group; and

     (3) No discriminatory contractual terms may be imposed based upon whether the treating

provider is an allopathic, osteopathic, or chiropractic physician.

     (c) Enforcement. The office of the health insurance commissioner shall enforce the

provisions of this section.

LC002439 - Page 3 of 5

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-49.2. Patient access to alternative medicine.

     (a) Legislative purpose - Medications prescribed for the management of pain constitute a

factor involved in the incidence of drug-related overdoses and deaths. The purpose of this section

is to ensure patient access to alternative means of pain management, specifically, access to and

reimbursement of medical services rendered by chiropractic physicians in the diagnosis and

treatment of conditions associated with the usage of pain medications.

     (b) Construction of health policies, plans and contracts. - Notwithstanding any other

provision of law, when any health insurance policy, health care services plan, or other contract

provides for the payment for medical expense benefits or procedures related to the treatment of

pain, such policy, plan, or contract shall be construed to include equivalent payment to a

chiropractic physician who provides the equivalent non-pharmaceutical medical service benefits

or procedures which are within the scope of a chiropractic physician's license. Any limitation or

condition placed upon services, diagnosis, treatment, or payments for pain conditions utilizing

non-pharmaceutical interventions, by any licensed physician shall apply equally to all licensed

physicians without unfair discrimination based upon the usual and customary treatment

procedures of any class of physicians. Nothing in this section shall be construed as preventing a

group health plan or a health insurance issuer from establishing varying reimbursement rates

based on quality or performance measures; provided, however, that:

     (1) Reimbursement may not be arbitrarily capped and must be based on medical

necessity;

     (2) Reimbursement rates must be set utilizing industry standard relative value scale

metrics, including equivalent co-payments for equivalent levels of service delivered by any

licensed provider group; and

     (3) No discriminatory contractual terms may be imposed based upon whether the treating

provider is an allopathic, osteopathic, or chiropractic physician.

     (c) Enforcement. The office of the health insurance commissioner shall enforce the

provisions of this section.

     SECTION 5. This act shall take effect upon passage.

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LC002439

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require insurance reimbursement for chiropractic diagnosis and treatment

of conditions associated with the use of pain medications.

     This act would take effect upon passage.

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LC002439

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