S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6994

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             March 18, 2009
                               ___________

Introduced  by  M.  of  A.  LENTOL, LUPARDO, BRADLEY, CAHILL, ESPAILLAT,
  V. LOPEZ, SCHROEDER, BRODSKY, MILLMAN, ALESSI, CARROZZA,  BROOK-KRASNY
  --  Multi-Sponsored  by  -- M. of A. ABBATE, ARROYO, BENJAMIN, COLTON,
  CUSICK, DESTITO, DIAZ, GALEF, GUNTHER, KOON, LATIMER,  LIFTON,  MAYER-
  SOHN,  McENENY,  PHEFFER,  QUINN, N. RIVERA, SWEENEY, TOWNS, WRIGHT --
  read once and referred to the Committee on Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to doctors of chiropractic

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subparagraphs (A) and (C) of paragraph 21 of subsection (i)
of  section  3216  of  the insurance law, as added by chapter 426 of the
laws of 1997, are amended to read as follows:
  (A)  Every policy which is a "managed  care  product"  as  defined  in
subparagraph  (D) of this paragraph that provides coverage for physician
services in a physician's office, and every policy which is  a  "managed
care  product" that provides major medical or similar comprehensive-type
coverage, shall include coverage for chiropractic care,  as  defined  in
section  six  thousand  five  hundred  fifty-one  of  the education law,
provided by a doctor of chiropractic licensed pursuant  to  article  one
hundred  thirty-two  of  the  education  law,  in  connection  with  the
detection or correction by manual  or  mechanical  means  of  structural
imbalance,  distortion  or subluxation in the human body for the purpose
of removing nerve interference, and  the  effects  thereof,  where  such
interference  is the result of or related to distortion, misalignment or
subluxation of or in the vertebral column.   However, chiropractic  care
and  services  may  be  subject to reasonable deductible, co-payment and
co-insurance amounts, reasonable fee  [or]  LIMITS,  REASONABLE  benefit
limits,  and  reasonable  utilization  review,  provided  that  any such
amounts, limits and review: (a) shall not  function  SO  AS  to  direct,
ENCOURAGE  OR  DISCOURAGE  treatment  in a manner discriminative against

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10436-01-9
              

A. 6994                             2

chiropractic care, [and] (b) individually and collectively shall  be  no
more restrictive UPON CHIROPRACTIC CARE AND SERVICES than those applica-
ble  under  the  same  policy,  PLAN, CONTRACT OR CERTIFICATE to care or
services provided by other health professionals in the diagnosis, treat-
ment  and  management  of  the  same  or  similar  conditions, injuries,
complaints, disorders or ailments, even  if  differing  nomenclature  is
used  to describe the condition, injury, complaint, disorder or ailment,
(C) SHALL PROVIDE THAT THE FEE AMOUNTS PAID  BY  OR  PAYABLE  UNDER  THE
POLICY,  PLAN, CERTIFICATE OR CONTRACT TO A DOCTOR OF CHIROPRACTIC SHALL
BE EQUAL TO THE AMOUNT PAID OR  PAYABLE  FOR  SIMILAR  CARE,  TREATMENT,
THERAPIES  OR  TREATMENTS  WHEN  PROVIDED  BY OTHER LICENSED HEALTH CARE
PROFESSIONALS UNDER THE SAME POLICY, PLAN, CERTIFICATE OR CONTRACT  EVEN
IF  DIFFERENT  NOMENCLATURE  IS  USED TO DESCRIBE THE CONDITION, INJURY,
COMPLIANT, DISORDER OR AILMENT, OR THE  TREATMENT,  THERAPY  OR  SERVICE
RENDERED,  REGARDLESS  WHETHER  THE  FEE  AMOUNT IS PAID BY THE INSURER,
CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR, NETWORK  OR  INDE-
PENDENT  PRACTICE  ASSOCIATION,  (D)  SHALL  NOT IMPOSE CO-INSURANCE AND
CO-PAYMENT AMOUNTS GREATER THAN THE AMOUNT DUE UNDER  THE  SAME  POLICY,
PLAN,  CONTRACT  OR  CERTIFICATE  FOR  A PRIMARY CARE PHYSICIAN AND SUCH
CO-INSURANCE AND CO-PAYMENT AMOUNTS SHALL  NOT  BE  GREATER  THAN  FIFTY
PERCENT OF THE TOTAL FEE DUE OR TO BE PAID TO THE DOCTOR OF CHIROPRACTIC
UNDER THE POLICY, PLAN, CONTRACT OR CERTIFICATE FOR THE TREATMENT, THER-
APY  OR  SERVICE  RENDERED,  AND (E) SHALL NOT IMPOSE PRE-CERTIFICATION,
CONCURRENT REVIEW OR POST-PAYMENT UTILIZATION REVIEW  PROCESSES,  PROCE-
DURES,  DOCUMENTATION OR LIMITATIONS UPON CHIROPRACTIC CARE AND SERVICES
THAT ARE GREATER THAN THOSE APPLIED TO THE  CARE  AND  SERVICES  OF  ANY
OTHER  HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY, PLAN, CONTRACT OR
CERTIFICATE, EVEN IF DIFFERENT NOMENCLATURE  IS  USED  TO  DESCRIBE  THE
CONDITION,  INJURY,  COMPLAINT,  DISORDER  OR AILMENT, OR THE TREATMENT,
THERAPY OR SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT  IS  PAID
BY  THE  INSURER,  CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR,
NETWORK OR INDEPENDENT PRACTICE ASSOCIATION.  Nothing  herein  contained
shall  be  construed  as  impeding or preventing either the provision or
coverage of chiropractic care and services by duly licensed  doctors  of
chiropractic,  within  the  lawful  scope  of  chiropractic practice, in
hospital facilities on a staff or employee basis.
  (C) Every policy which includes coverage for physician services  in  a
physician's  office,  and  every  policy which provides major medical or
similar comprehensive-type coverage, other than a "managed care product"
as defined in subparagraph (D) of this paragraph, shall provide coverage
for chiropractic care, as defined in section six thousand  five  hundred
fifty-one  of  the  education  law, provided by a doctor of chiropractic
licensed pursuant to article one hundred  thirty-two  of  the  education
law, in connection with the detection or correction by manual or mechan-
ical  means  of  structural  imbalance, distortion or subluxation in the
human body for the purpose  of  removing  nerve  interference,  and  the
effects  thereof, where such interference is the result of or related to
distortion, misalignment or subluxation of or in the  vertebral  column.
However,  chiropractic  care  and  services may be subject to reasonable
deductible, co-payment and co-insurance  amounts,  reasonable  fee  [or]
LIMITS,  REASONABLE  benefit  limits, and reasonable utilization review,
provided that any such amounts, limits and review: (a) shall  not  func-
tion  SO  AS  to  direct,  ENCOURAGE OR DISCOURAGE treatment in a manner
discriminative against chiropractic care,  [and]  (b)  individually  and
collectively  shall  be  no  more restrictive UPON CHIROPRACTIC CARE AND
SERVICES than those applicable under the same policy, PLAN, CONTRACT  OR

A. 6994                             3

CERTIFICATE  to  care or services provided by other health professionals
in the diagnosis, treatment and management of the same or similar condi-
tions, injuries, complaints, disorders or ailments,  even  if  differing
nomenclature  is  used  to  describe  the  condition, injury, complaint,
disorder or ailment, (C) SHALL PROVIDE THAT THE FEE AMOUNTS PAID  BY  OR
PAYABLE  UNDER  THE POLICY, PLAN, CERTIFICATE OR CONTRACT TO A DOCTOR OF
CHIROPRACTIC SHALL BE EQUAL TO THE AMOUNT PAID OR  PAYABLE  FOR  SIMILAR
CARE, TREATMENT, THERAPIES OR TREATMENTS WHEN PROVIDED BY OTHER LICENSED
HEALTH  CARE  PROFESSIONALS  UNDER THE SAME POLICY, PLAN, CERTIFICATE OR
CONTRACT EVEN IF DIFFERENT NOMENCLATURE IS USED TO DESCRIBE  THE  CONDI-
TION,  INJURY, COMPLIANT, DISORDER OR AILMENT, OR THE TREATMENT, THERAPY
OR SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT IS  PAID  BY  THE
INSURER,  CARRIER,  PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR, NETWORK
OR INDEPENDENT PRACTICE ASSOCIATION, (D) SHALL NOT  IMPOSE  CO-INSURANCE
AND  CO-PAYMENT AMOUNTS GREATER THAN THE AMOUNT DUE UNDER THE SAME POLI-
CY, PLAN, CONTRACT OR CERTIFICATE FOR A PRIMARY CARE PHYSICIAN AND  SUCH
CO-INSURANCE  AND  CO-PAYMENT  AMOUNTS  SHALL  NOT BE GREATER THAN FIFTY
PERCENT OF THE TOTAL FEE DUE OR TO BE PAID TO THE DOCTOR OF CHIROPRACTIC
UNDER THE POLICY, PLAN, CONTRACT OR CERTIFICATE FOR THE TREATMENT, THER-
APY OR SERVICE RENDERED, AND (E)  SHALL  NOT  IMPOSE  PRE-CERTIFICATION,
CONCURRENT  REVIEW  OR POST-PAYMENT UTILIZATION REVIEW PROCESSES, PROCE-
DURES, DOCUMENTATION OR LIMITATIONS UPON CHIROPRACTIC CARE AND  SERVICES
THAT  ARE  GREATER  THAN  THOSE  APPLIED TO THE CARE AND SERVICES OF ANY
OTHER HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY, PLAN, CONTRACT  OR
CERTIFICATE,  EVEN  IF  DIFFERENT  NOMENCLATURE  IS USED TO DESCRIBE THE
CONDITION, INJURY, COMPLAINT, DISORDER OR  AILMENT,  OR  THE  TREATMENT,
THERAPY  OR  SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT IS PAID
BY THE INSURER, CARRIER, PLAN OR THROUGH A  THIRD  PARTY  ADMINISTRATOR,
NETWORK  OR  INDEPENDENT  PRACTICE ASSOCIATION. Nothing herein contained
shall be construed as impeding or preventing  either  the  provision  or
coverage  of  chiropractic care and services by duly licensed doctors of
chiropractic, within the  lawful  scope  of  chiropractic  practice,  in
hospital facilities on a staff or employee basis.
  S  2.  Subparagraphs  (A) and (C) of paragraph 11 of subsection (k) of
section 3221 of the insurance law, as added by chapter 426 of  the  laws
of 1997, are amended to read as follows:
  (A)  Every  policy  which  is  a  "managed care product" as defined in
subparagraph (D) of this paragraph that includes coverage for  physician
services  in  a physician's office, and every policy which is a "managed
care product" that provides major medical or similar  comprehensive-type
coverage  shall  include  coverage  for chiropractic care, as defined in
section six thousand  five  hundred  fifty-one  of  the  education  law,
provided  by  a  doctor of chiropractic licensed pursuant to article one
hundred  thirty-two  of  the  education  law,  in  connection  with  the
detection  or  correction  by  manual  or mechanical means of structural
imbalance, distortion or subluxation in the human body for  the  purpose
of  removing  nerve  interference,  and  the effects thereof, where such
interference is the result of or related to distortion, misalignment  or
subluxation  of  or  in the vertebral column. However, chiropractic care
and services may be subject to  reasonable  deductible,  co-payment  and
co-insurance  amounts,  reasonable  fee  [or] LIMITS, REASONABLE benefit
limits, and  reasonable  utilization  review,  provided  that  any  such
amounts,  limits  and  review:   (a) shall not function SO AS to direct,
ENCOURAGE OR DISCOURAGE treatment in  a  manner  discriminative  against
chiropractic  care,  [and] (b) individually and collectively shall be no
more restrictive UPON CHIROPRACTIC CARE AND SERVICES than those applica-

A. 6994                             4

ble under the same policy, PLAN, CONTRACT  OR  CERTIFICATE  to  care  or
services provided by other health professionals in the diagnosis, treat-
ment  and  management  of  the  same  or  similar  conditions, injuries,
complaints,  disorders  or  ailments,  even if differing nomenclature is
used to describe the condition, injury, complaint, disorder or  ailment,
(C)  SHALL  PROVIDE  THAT  THE  FEE AMOUNTS PAID BY OR PAYABLE UNDER THE
POLICY, PLAN, CERTIFICATE OR CONTRACT TO A DOCTOR OF CHIROPRACTIC  SHALL
BE  EQUAL  TO  THE  AMOUNT  PAID OR PAYABLE FOR SIMILAR CARE, TREATMENT,
THERAPIES OR TREATMENTS WHEN PROVIDED  BY  OTHER  LICENSED  HEALTH  CARE
PROFESSIONALS  UNDER THE SAME POLICY, PLAN, CERTIFICATE OR CONTRACT EVEN
IF DIFFERENT NOMENCLATURE IS USED TO  DESCRIBE  THE  CONDITION,  INJURY,
COMPLIANT,  DISORDER  OR  AILMENT,  OR THE TREATMENT, THERAPY OR SERVICE
RENDERED, REGARDLESS WHETHER THE FEE AMOUNT  IS  PAID  BY  THE  INSURER,
CARRIER,  PLAN  OR THROUGH A THIRD PARTY ADMINISTRATOR, NETWORK OR INDE-
PENDENT PRACTICE ASSOCIATION, (D)  SHALL  NOT  IMPOSE  CO-INSURANCE  AND
CO-PAYMENT  AMOUNTS  GREATER  THAN THE AMOUNT DUE UNDER THE SAME POLICY,
PLAN, CONTRACT OR CERTIFICATE FOR A  PRIMARY  CARE  PHYSICIAN  AND  SUCH
CO-INSURANCE  AND  CO-PAYMENT  AMOUNTS  SHALL  NOT BE GREATER THAN FIFTY
PERCENT OF THE TOTAL FEE DUE OR TO BE PAID TO THE DOCTOR OF CHIROPRACTIC
UNDER THE POLICY, PLAN, CONTRACT OR CERTIFICATE FOR THE TREATMENT, THER-
APY OR SERVICE RENDERED, AND (E)  SHALL  NOT  IMPOSE  PRE-CERTIFICATION,
CONCURRENT  REVIEW  OR POST-PAYMENT UTILIZATION REVIEW PROCESSES, PROCE-
DURES, DOCUMENTATION OR LIMITATIONS UPON CHIROPRACTIC CARE AND  SERVICES
THAT  ARE  GREATER  THAN  THOSE  APPLIED TO THE CARE AND SERVICES OF ANY
OTHER HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY, PLAN, CONTRACT  OR
CERTIFICATE,  EVEN  IF  DIFFERENT  NOMENCLATURE  IS USED TO DESCRIBE THE
CONDITION, INJURY, COMPLAINT, DISORDER OR  AILMENT,  OR  THE  TREATMENT,
THERAPY  OR  SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT IS PAID
BY THE INSURER, CARRIER, PLAN OR THROUGH A  THIRD  PARTY  ADMINISTRATOR,
NETWORK  OR  INDEPENDENT  PRACTICE ASSOCIATION. Nothing herein contained
shall be construed as impeding or preventing  either  the  provision  or
coverage  of  chiropractic care and services by duly licensed doctors of
chiropractic, within the  lawful  scope  of  chiropractic  practice,  in
hospital facilities on a staff or employee basis.
  (C)  Every  policy which includes coverage for physician services in a
physician's office, and every policy which  provides  major  medical  or
similar comprehensive-type coverage, other than a "managed care product"
as defined in subparagraph (D) of this paragraph, shall provide coverage
for  chiropractic  care, as defined in section six thousand five hundred
fifty-one of the education law, provided by  a  doctor  of  chiropractic
licensed  pursuant  to  article  one hundred thirty-two of the education
law, in connection with the detection or correction by manual or mechan-
ical means of structural imbalance, distortion  or  subluxation  in  the
human  body  for  the  purpose  of  removing nerve interference, and the
effects thereof, where such interference is the result of or related  to
distortion,  misalignment  or subluxation of or in the vertebral column.
However, chiropractic care and services may  be  subject  to  reasonable
deductible,  co-payment  and  co-insurance  amounts, reasonable fee [or]
LIMITS, REASONABLE benefit limits, and  reasonable  utilization  review,
provided  that  any such amounts, limits and review: (a) shall not func-
tion SO AS to direct, ENCOURAGE OR  DISCOURAGE  treatment  in  a  manner
discriminative  against  chiropractic  care,  [and] (b) individually and
collectively shall be no more restrictive [that] UPON CHIROPRACTIC  CARE
AND SERVICES THAN those applicable under the same policy, PLAN, CONTRACT
OR  CERTIFICATE  to  care  or  services provided by other health profes-
sionals in the diagnosis, treatment and management of the same or  simi-

A. 6994                             5

lar  conditions,  injuries,  complaints,  disorders or ailments, even if
differing nomenclature  is  used  to  describe  the  condition,  injury,
complaint,  disorder  or ailment, (C) SHALL PROVIDE THAT THE FEE AMOUNTS
PAID  BY OR PAYABLE UNDER THE POLICY, PLAN, CERTIFICATE OR CONTRACT TO A
DOCTOR OF CHIROPRACTIC SHALL BE EQUAL TO THE AMOUNT PAID OR PAYABLE  FOR
SIMILAR  CARE, TREATMENT, THERAPIES OR TREATMENTS WHEN PROVIDED BY OTHER
LICENSED HEALTH CARE PROFESSIONALS UNDER THE SAME POLICY, PLAN,  CERTIF-
ICATE OR CONTRACT EVEN IF DIFFERENT NOMENCLATURE IS USED TO DESCRIBE THE
CONDITION,  INJURY,  COMPLIANT,  DISORDER  OR AILMENT, OR THE TREATMENT,
THERAPY OR SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT  IS  PAID
BY  THE  INSURER,  CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR,
NETWORK OR INDEPENDENT PRACTICE ASSOCIATION, (D) SHALL NOT IMPOSE CO-IN-
SURANCE AND CO-PAYMENT AMOUNTS GREATER THAN THE  AMOUNT  DUE  UNDER  THE
SAME  POLICY, PLAN, CONTRACT OR CERTIFICATE FOR A PRIMARY CARE PHYSICIAN
AND SUCH CO-INSURANCE AND CO-PAYMENT AMOUNTS SHALL NOT BE  GREATER  THAN
FIFTY  PERCENT  OF  THE  TOTAL  FEE  DUE  OR TO BE PAID TO THE DOCTOR OF
CHIROPRACTIC UNDER THE POLICY, PLAN, CONTRACT  OR  CERTIFICATE  FOR  THE
TREATMENT,  THERAPY  OR  SERVICE  RENDERED,  AND  (E)  SHALL  NOT IMPOSE
PRE-CERTIFICATION, CONCURRENT REVIEW OR POST-PAYMENT UTILIZATION  REVIEW
PROCESSES,  PROCEDURES,  DOCUMENTATION  OR LIMITATIONS UPON CHIROPRACTIC
CARE AND SERVICES THAT ARE GREATER THAN THOSE APPLIED TO  THE  CARE  AND
SERVICES  OF  ANY  OTHER HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY,
PLAN, CONTRACT OR CERTIFICATE, EVEN IF DIFFERENT NOMENCLATURE IS USED TO
DESCRIBE THE CONDITION, INJURY, COMPLAINT, DISORDER OR AILMENT,  OR  THE
TREATMENT,  THERAPY  OR  SERVICE  RENDERED,  REGARDLESS  WHETHER THE FEE
AMOUNT IS PAID BY THE INSURER, CARRIER, PLAN OR THROUGH  A  THIRD  PARTY
ADMINISTRATOR,  NETWORK  OR  INDEPENDENT  PRACTICE  ASSOCIATION. Nothing
herein contained shall be construed as impeding or preventing either the
provision or coverage of chiropractic care and services by duly licensed
doctors of chiropractic, within the lawful scope of  chiropractic  prac-
tice, in hospital facilities on a staff or employee basis.
  S  3.  Paragraphs  1  and  3  of subsection (y) of section 4303 of the
insurance law, as added by chapter 426 of the laws of 1997, are  amended
to read as follows:
  (1) Every contract issued by a health service corporation or a medical
expense  indemnity  corporation  which  is  a  "managed care product" as
defined in paragraph four of this subsection that includes coverage  for
physician  services  in  a  physician's  office, and every "managed care
product" that  provides  major  medical  or  similar  comprehensive-type
coverage,  shall  include  coverage for chiropractic care, as defined in
section six thousand  five  hundred  fifty-one  of  the  education  law,
provided  by  a  doctor of chiropractic licensed pursuant to article one
hundred  thirty-two  of  the  education  law,  in  connection  with  the
detection  or  correction  by  manual  or mechanical means of structural
imbalance, distortion or subluxation in the human body for  the  purpose
of  removing  nerve  interference,  and  the effects thereof, where such
interference is the result of or related to distortion, misalignment  or
subluxation  of  or  in the vertebral column. However, chiropractic care
and services may be subject to  reasonable  deductible,  co-payment  and
co-insurance  amounts,  reasonable  fee  [or] LIMITS, REASONABLE benefit
limits, and  reasonable  utilization  review,  provided  that  any  such
amounts,  limits  and  review:   (a) shall not function SO AS to direct,
ENCOURAGE OR DISCOURAGE treatment in  a  manner  discriminative  against
chiropractic  care,  [and] (b) individually and collectively shall be no
more restrictive UPON CHIROPRACTIC CARE AND SERVICES than those applica-
ble under the same policy, PLAN, CONTRACT  OR  CERTIFICATE  to  care  or

A. 6994                             6

services provided by other health professionals in the diagnosis, treat-
ment  and  management  of  the  same  or  similar  conditions, injuries,
complaints, disorders or ailments, even  if  differing  nomenclature  is
used  to describe the condition, injury, complaint, disorder or ailment,
(C) SHALL PROVIDE THAT THE FEE AMOUNTS PAID  BY  OR  PAYABLE  UNDER  THE
POLICY,  PLAN, CERTIFICATE OR CONTRACT TO A DOCTOR OF CHIROPRACTIC SHALL
BE EQUAL TO THE AMOUNT PAID OR  PAYABLE  FOR  SIMILAR  CARE,  TREATMENT,
THERAPIES  OR  TREATMENTS  WHEN  PROVIDED  BY OTHER LICENSED HEALTH CARE
PROFESSIONALS UNDER THE SAME POLICY, PLAN, CERTIFICATE OR CONTRACT  EVEN
IF  DIFFERENT  NOMENCLATURE  IS  USED TO DESCRIBE THE CONDITION, INJURY,
COMPLIANT, DISORDER OR AILMENT, OR THE  TREATMENT,  THERAPY  OR  SERVICE
RENDERED,  REGARDLESS  WHETHER  THE  FEE  AMOUNT IS PAID BY THE INSURER,
CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR, NETWORK  OR  INDE-
PENDENT  PRACTICE  ASSOCIATION,  (D)  SHALL  NOT IMPOSE CO-INSURANCE AND
CO-PAYMENT AMOUNTS GREATER THAN THE AMOUNT DUE UNDER  THE  SAME  POLICY,
PLAN,  CONTRACT  OR  CERTIFICATE  FOR  A PRIMARY CARE PHYSICIAN AND SUCH
CO-INSURANCE AND CO-PAYMENT AMOUNTS SHALL  NOT  BE  GREATER  THAN  FIFTY
PERCENT OF THE TOTAL FEE DUE OR TO BE PAID TO THE DOCTOR OF CHIROPRACTIC
UNDER THE POLICY, PLAN, CONTRACT OR CERTIFICATE FOR THE TREATMENT, THER-
APY  OR  SERVICE  RENDERED,  AND (E) SHALL NOT IMPOSE PRE-CERTIFICATION,
CONCURRENT REVIEW OR POST-PAYMENT UTILIZATION REVIEW  PROCESSES,  PROCE-
DURES,  DOCUMENTATION OR LIMITATIONS UPON CHIROPRACTIC CARE AND SERVICES
THAT ARE GREATER THAN THOSE APPLIED TO THE  CARE  AND  SERVICES  OF  ANY
OTHER  HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY, PLAN, CONTRACT OR
CERTIFICATE, EVEN IF DIFFERENT NOMENCLATURE  IS  USED  TO  DESCRIBE  THE
CONDITION,  INJURY,  COMPLAINT,  DISORDER  OR AILMENT, OR THE TREATMENT,
THERAPY OR SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT  IS  PAID
BY  THE  INSURER,  CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR,
NETWORK OR INDEPENDENT PRACTICE ASSOCIATION.  Nothing  herein  contained
shall  be  construed  as  impeding or preventing either the provision or
coverage of chiropractic care and services by duly licensed  doctors  of
chiropractic,  within  the  lawful  scope  of  chiropractic practice, in
hospital facilities on a staff or employee basis.
  (3) Every contract issued by a health service corporation or a medical
expense indemnity corporation  which  includes  coverage  for  physician
services  in  a  physician's  office,  and every contract which provides
major medical or  similar  comprehensive-type  coverage,  other  than  a
"managed  care product" as defined in paragraph four of this subsection,
shall provide coverage for chiropractic care, as defined in section  six
thousand  five  hundred  fifty-one  of  the education law, provided by a
doctor of chiropractic licensed pursuant to article one hundred  thirty-
two of the education law, in connection with the detection or correction
by  manual  or  mechanical  means of structural imbalance, distortion or
subluxation in the human body for the purpose of removing  nerve  inter-
ference,  and the effects thereof, where such interference is the result
of or related to distortion, misalignment or subluxation of  or  in  the
vertebral column. However, chiropractic care and services may be subject
to  reasonable  deductible, co-payment and co-insurance amounts, reason-
able fee [or] LIMITS, REASONABLE benefit limits, and reasonable utiliza-
tion review, provided that any such  amounts,  limits  and  review:  (a)
shall not function SO AS to direct, ENCOURAGE OR DISCOURAGE treatment in
a manner discriminative against chiropractic care, [and] (b) individual-
ly  and collectively shall be no more restrictive UPON CHIROPRACTIC CARE
AND SERVICES than those applicable under the same POLICY, PLAN, contract
OR CERTIFICATE to care or services  provided  by  other  health  profes-
sionals  in the diagnosis, treatment and management of the same or simi-

A. 6994                             7

lar conditions, injuries, complaints,  disorders  or  ailments  even  if
differing  nomenclature  is  used  to  describe  the  condition, injury,
complaint, disorder or ailment, (C) SHALL PROVIDE THAT THE  FEE  AMOUNTS
PAID  BY OR PAYABLE UNDER THE POLICY, PLAN, CERTIFICATE OR CONTRACT TO A
DOCTOR OF CHIROPRACTIC SHALL BE EQUAL TO THE AMOUNT PAID OR PAYABLE  FOR
SIMILAR  CARE, TREATMENT, THERAPIES OR TREATMENTS WHEN PROVIDED BY OTHER
LICENSED HEALTH CARE PROFESSIONALS UNDER THE SAME POLICY, PLAN,  CERTIF-
ICATE OR CONTRACT EVEN IF DIFFERENT NOMENCLATURE IS USED TO DESCRIBE THE
CONDITION,  INJURY,  COMPLIANT,  DISORDER  OR AILMENT, OR THE TREATMENT,
THERAPY OR SERVICE RENDERED, REGARDLESS WHETHER THE FEE AMOUNT  IS  PAID
BY  THE  INSURER,  CARRIER, PLAN OR THROUGH A THIRD PARTY ADMINISTRATOR,
NETWORK OR INDEPENDENT PRACTICE ASSOCIATION, (D) SHALL NOT IMPOSE CO-IN-
SURANCE AND CO-PAYMENT AMOUNTS GREATER THAN THE  AMOUNT  DUE  UNDER  THE
SAME  POLICY, PLAN, CONTRACT OR CERTIFICATE FOR A PRIMARY CARE PHYSICIAN
AND SUCH CO-INSURANCE AND CO-PAYMENT AMOUNTS SHALL NOT BE  GREATER  THAN
FIFTY  PERCENT  OF  THE  TOTAL  FEE  DUE  OR TO BE PAID TO THE DOCTOR OF
CHIROPRACTIC UNDER THE POLICY, PLAN, CONTRACT  OR  CERTIFICATE  FOR  THE
TREATMENT,  THERAPY  OR  SERVICE  RENDERED,  AND  (E)  SHALL  NOT IMPOSE
PRE-CERTIFICATION, CONCURRENT REVIEW OR POST-PAYMENT UTILIZATION  REVIEW
PROCESSES,  PROCEDURES,  DOCUMENTATION  OR LIMITATIONS UPON CHIROPRACTIC
CARE AND SERVICES THAT ARE GREATER THAN THOSE APPLIED TO  THE  CARE  AND
SERVICES  OF  ANY  OTHER HEALTH CARE PROFESSIONAL UNDER THE SAME POLICY,
PLAN, CONTRACT OR CERTIFICATE, EVEN IF DIFFERENT NOMENCLATURE IS USED TO
DESCRIBE THE CONDITION, INJURY, COMPLAINT, DISORDER OR AILMENT,  OR  THE
TREATMENT,  THERAPY  OR  SERVICE  RENDERED,  REGARDLESS  WHETHER THE FEE
AMOUNT IS PAID BY THE INSURER, CARRIER, PLAN OR THROUGH  A  THIRD  PARTY
ADMINISTRATOR,  NETWORK  OR  INDEPENDENT  PRACTICE  ASSOCIATION. Nothing
herein contained shall be construed as impeding or preventing either the
provision or coverage of chiropractic care and services by duly licensed
doctors of chiropractic, within the lawful scope of  chiropractic  prac-
tice, in hospital facilities on a staff or employee basis.
  S  4. Section 4406 of the public health law is amended by adding a new
subdivision 5 to read as follows:
  5. EVERY CONTRACT  WHICH  INCLUDES  COVERAGE  FOR  PHYSICIAN  SERVICES
PERFORMED  IN A PHYSICIAN'S OFFICE SHALL PROVIDE COVERAGE FOR CHIROPRAC-
TIC CARE, AS DEFINED IN SECTION  SIXTY-FIVE  HUNDRED  FIFTY-ONE  OF  THE
EDUCATION LAW, PROVIDED BY A DOCTOR OF CHIROPRACTIC LICENSED PURSUANT TO
ARTICLE  ONE HUNDRED THIRTY-TWO OF THE EDUCATION LAW, IN CONNECTION WITH
THE DETECTION OR CORRECTION BY MANUAL OR MECHANICAL MEANS OF  STRUCTURAL
IMBALANCE,  DISTORTION  OR SUBLUXATION IN THE HUMAN BODY FOR THE PURPOSE
OF REMOVING NERVE INTERFERENCE, AND  THE  EFFECTS  THEREOF,  WHERE  SUCH
INTERFERENCE  IS THE RESULT OF OR RELATED TO DISTORTION, MISALIGNMENT OR
SUBLUXATION OF OR IN THE VERTEBRAL COLUMN.   HOWEVER, CHIROPRACTIC  CARE
AND  SERVICES  MAY  BE  SUBJECT TO REASONABLE DEDUCTIBLE, CO-PAYMENT AND
CO-INSURANCE AMOUNTS, REASONABLE FEE LIMITS, REASONABLE  BENEFIT  LIMITS
AND  REASONABLE  UTILIZATION  REVIEW,  PROVIDED  THAT  ANY SUCH AMOUNTS,
LIMITS AND REVIEW: (A) SHALL NOT FUNCTION SO AS TO DIRECT, ENCOURAGE  OR
DISCOURAGE  TREATMENT  IN  A  MANNER DISCRIMINATIVE AGAINST CHIROPRACTIC
CARE, (B) INDIVIDUALLY AND COLLECTIVELY SHALL  BE  NO  MORE  RESTRICTIVE
UPON CHIROPRACTIC CARE AND SERVICES THAN THOSE APPLICABLE UNDER THE SAME
POLICY,  PLAN,  CONTRACT, OR CERTIFICATE TO CARE OR SERVICES PROVIDED BY
OTHER HEALTH PROFESSIONALS IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF
THE SAME OR  SIMILAR  CONDITIONS,  INJURIES,  COMPLAINTS,  DISORDERS  OR
AILMENTS  EVEN  IF DIFFERING NOMENCLATURE IS USED TO DESCRIBE THE CONDI-
TION, INJURY, COMPLAINT, DISORDER OR AILMENT, (C) SHALL PROVIDE THAT THE
FEE AMOUNTS PAID BY OR PAYABLE UNDER THE POLICY,  PLAN,  CERTIFICATE  OR

A. 6994                             8

CONTRACT  TO  A DOCTOR OF CHIROPRACTIC SHALL BE EQUAL TO THE AMOUNT PAID
OR PAYABLE FOR SIMILAR CARE, TREATMENT,  THERAPIES  OR  TREATMENTS  WHEN
PROVIDED  BY  OTHER  LICENSED  HEALTH  CARE PROFESSIONALS UNDER THE SAME
POLICY,  PLAN, CERTIFICATE OR CONTRACT EVEN IF DIFFERENT NOMENCLATURE IS
USED TO DESCRIBE THE CONDITION, INJURY, COMPLIANT, DISORDER OR  AILMENT,
OR  THE  TREATMENT,  THERAPY OR SERVICE RENDERED, REGARDLESS WHETHER THE
FEE AMOUNT IS PAID BY THE INSURER, CARRIER,  PLAN  OR  THROUGH  A  THIRD
PARTY  ADMINISTRATOR,  NETWORK  OR INDEPENDENT PRACTICE ASSOCIATION, (D)
SHALL NOT IMPOSE CO-INSURANCE AND CO-PAYMENT AMOUNTS  GREATER  THAN  THE
AMOUNT  DUE  UNDER  THE SAME POLICY, PLAN, CONTRACT OR CERTIFICATE FOR A
PRIMARY CARE PHYSICIAN AND  SUCH  CO-INSURANCE  AND  CO-PAYMENT  AMOUNTS
SHALL  NOT  BE  GREATER THAN FIFTY PERCENT OF THE TOTAL FEE DUE OR TO BE
PAID TO THE DOCTOR OF CHIROPRACTIC UNDER THE POLICY, PLAN,  CONTRACT  OR
CERTIFICATE  FOR  THE  TREATMENT,  THERAPY  OR SERVICE RENDERED, AND (E)
SHALL NOT IMPOSE PRE-CERTIFICATION, CONCURRENT  REVIEW  OR  POST-PAYMENT
UTILIZATION  REVIEW  PROCESSES, PROCEDURES, DOCUMENTATION OR LIMITATIONS
UPON CHIROPRACTIC CARE AND SERVICES THAT ARE GREATER THAN THOSE  APPLIED
TO THE CARE AND SERVICES OF ANY OTHER HEALTH CARE PROFESSIONAL UNDER THE
SAME  POLICY, PLAN, CONTRACT OR CERTIFICATE, EVEN IF DIFFERENT NOMENCLA-
TURE IS USED TO DESCRIBE THE CONDITION, INJURY, COMPLAINT,  DISORDER  OR
AILMENT,  OR  THE  TREATMENT,  THERAPY  OR  SERVICE RENDERED, REGARDLESS
WHETHER THE FEE AMOUNT IS PAID BY THE INSURER, CARRIER, PLAN OR  THROUGH
A  THIRD  PARTY  ADMINISTRATOR,  NETWORK OR INDEPENDENT PRACTICE ASSOCI-
ATION. NOTHING IN THIS SUBDIVISION SHALL BE  CONSTRUED  AS  IMPEDING  OR
PREVENTING  EITHER  THE  PROVISION  OR COVERAGE OF CHIROPRACTIC CARE AND
SERVICES BY DULY LICENSED DOCTORS OF  CHIROPRACTIC,  WITHIN  THE  LAWFUL
SCOPE  OF  CHIROPRACTIC  PRACTICE,  IN HOSPITAL FACILITIES ON A STAFF OR
EMPLOYEE BASIS.
  S 5. This act shall take effect on the ninetieth day  after  it  shall
have  become  a  law  and  shall apply to policies, plans, contracts and
certificates issued, renewed, modified, altered or amended on  or  after
such effective date.