SECOND REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 1509
92ND GENERAL ASSEMBLY
Reported from the Committee on Financial Services April 15, 2004, with recommendation that the House Committee Substitute
for House Bill No. 1509 Do Pass.
Taken up for Perfection April 20, 2004. House Committee Substitute for House Bill No. 1509 ordered Perfected and printed.
STEPHEN S. DAVIS, Chief Clerk
To repeal section 376.1230, RSMo, and to enact in lieu thereof one new section relating to
health benefits for chiropractic care.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 376.1230, RSMo, is repealed and one new section enacted in lieu
thereof, to be known as section 376.1230, to read as follows:
376.1230. 1. Every [policy] health benefit plan issued by a health carrier, as those
terms are defined in section 376.1350, shall provide coverage for chiropractic care delivered by
a licensed chiropractor within the health carrier's network acting within the scope of his or
her practice as defined in chapter 331, RSMo. The coverage shall include initial diagnosis and
clinically appropriate and medically necessary services and supplies required to treat the
diagnosed disorder[, subject to the terms and conditions of the policy. The coverage may be
limited to chiropractors within the health carrier's network, and nothing in this section shall be
construed to require a health carrier to contract with a chiropractor not in the carrier's network
nor shall a carrier be required to reimburse for services rendered by a nonnetwork chiropractor
unless prior approval has been obtained from the carrier by the enrollee]. An enrollee [may]
shall have direct access to chiropractic care within the network for [a total of] at least
twenty-six chiropractic physician office visits per policy period, but may be required to provide
the health carrier with notice prior to any additional [visit] visits as a condition of coverage. A
health carrier may require prior authorization or notification before any follow-up diagnostic
tests are ordered by a chiropractor or for any office visits for treatment in excess of twenty-six
in any policy period, except that a health carrier shall not deny medically necessary and
clinically appropriate chiropractic care for additional diagnostic tests or treatment
provided the attending chiropractic physician submits documentations supporting
necessity for additional tests or continued treatment. The certificate of coverage for any
health benefit plan issued by a health carrier shall clearly state the availability of chiropractic
coverage under the policy and any limitations, conditions, and exclusions.
2. A health benefit plan shall provide coverage for [treatment of a] chiropractic care
[condition] and shall not establish any rate, term, or condition that places a greater financial
burden on an insured for access to [treatment for a] chiropractic care [condition] than for access
to treatment for [another] any other physical health condition.
3. The provisions of this section shall not apply to [any] a health benefit plan or contract
that is individually underwritten unless such individually written coverage is issued by a
health maintenance organization.
4. The provisions of this section shall not apply to benefits provided under the Medicaid
5. The provisions of this section shall not apply to a supplemental insurance policy,
including a life care contract, accident-only policy, specified disease policy, hospital policy
providing a fixed daily benefit only, Medicare supplement policy, long-term care policy,
short-term major medical policy of six months' or less duration, or any other similar