SB1154 - 472R - House Bill Summary

House of Representatives

SB 1154

chiropractic care; medical necessity review

Sponsors: Senator Gray L, Senator Johnson, Senator Miranda et al

W/D	Committee on Finance Institutions and Insurance
X	Committee on Health
	Caucus and COW
	As Engrossed and As Passed the House

SB1154 allows health care insurers to use a licensed chiropractor to review any direct denial of prior authorization of a chiropractic service on the basis of medical necessity.

History

According to the National Center for Complementary and Alternative Medicine, a center under the National Institutes of Health, chiropractic health care focuses on the relationship between the body’s structure and its function. Chiropractors evaluate each individual patient, and then develop a treatment plan based on that patient’s specific needs. State statute stipulates that licensed chiropractors in Arizona may perform limited physical and clinical examinations, conduct certain laboratory procedures, make spinal or other skeletal adjustments and diagnosis and correct skeletal disorders. In addition, chiropractors are prohibited from prescribing or administering medicine or drugs, performing surgery or practicing obstetrics.

Current statute stipulates that any time a health care insurer makes a direct denial of an authorized service on the basis of medical necessity, a medical director must put the decision in writing and include an explanation about why the treatment was denied. The medical director must have an active unrestricted license to practice allopathic or osteopathic medicine in this state. However, statute does allow dental and optometric insurance organizations to use a professional licensed in those specialties to serve as a medical director. In addition for all insurers, statute allows a health care insurer to consult with a licensed physician whose scope of practice may provide the health care insurer with a more thorough review of the medical necessity.

Provisions

· Allows health care insurers to use a licensed chiropractor to review any direct denial of prior authorization of a chiropractic service on the basis of medical necessity.

---------- DOCUMENT FOOTER ---------

Forty-seventh Legislature