(a) (1) For purposes of disability insurance, standard health and accident, sickness, and all other such insurance plans, whether or not they are considered insurance policies, and contracts issued by health service corporations and health maintenance organizations, if the chiropractor is authorized by law to perform a particular service, all of the following apply:
a. The chiropractor is entitled to compensation for that chiropractor’s services under the plan or contract.
b. The plan or contract is prohibited from placing annual or lifetime numerical limits on chiropractic visits for the treatment of the spine and other neuromusculoskeletal structures, including extremities.
c. 1. The plan or contract may not deny coverage for chiropractic supportive care on the basis that the chiropractic supportive care constitutes maintenance therapy.
2. Paragraph (a)(1)c.1. of this section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2023.
(2) This subsection applies to a plan of health insurance or health benefits delivered or issued under any of the following:
a. Title 18.
b. [Repealed.]
c. Section 505(3) of Title 31.
(3) Paragraphs (a)(1)a. and (a)(1)c. of this section apply to a plan of health insurance or health benefits delivered or issued under Chapter 52 of Title 29.
(4) This subsection may not be waived by contract. A contractual arrangement in conflict with this subsection or that purports to waive any requirements of this subsection is void.
(b) Nothing in this section prevents the operation of reasonable and nondiscriminatory cost containment or managed care provisions, including deductibles, coinsurance, allowable charge limitations, coordination of benefits and utilization review. Any copayment or coinsurance amount must be equal to or less than 25% of the fee due or to be paid to the chiropractor under the policy, contract, or certificate for the treatment, therapy, or service provided.
(c) The Insurance Commissioner shall adopt regulations necessary for the administration, effectuation, investigation, and enforcement of this section, including the establishment of appropriate utilization review standards.
(d) (1) For purposes of this subsection:
a. 1. “Carrier” means any entity that provides health insurance in this State.
2. “Carrier” includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation under Title 18.
3. “Carrier” also includes any third-party administrator, as defined under § 102 of Title 18, or other entity that adjusts, administers, or settles claims in connection with health benefit plans.
4. “Carrier” does not mean a plan of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act (42 U.S.C. §§ 1395 et seq., 1396 et seq. and 1397aa et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans.
b. “Medicare” means the federal Medicare Program (U.S. Public Law 89-97, as amended) (42 U.S.C. § 1395 et seq.).
(2) A carrier shall reimburse services provided by a chiropractor at a reimbursement rate that is not less than the Medicare reimbursement rate for comparable services.
(3) If a comparable Medicare reimbursement rate is not available, a carrier shall reimburse for services provided by a chiropractor at the rates generally available under Medicare for services such as office visits or prolonged preventive services.
(4) The Medicare reimbursement rate provisions under paragraphs (d)(2) and (d)(3) of this section do not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies.
(5) This subsection may not be waived by contract. A contractual arrangement in conflict with this subsection or that purports to waive any requirements of this subsection is void.
(6) This subsection applies to an individual or group health insurance policy, plan, or contract that is delivered, issued for delivery, or renewed by a carrier on or after January 1, 2022.
