b'ComplianceLEGAL NUTRITIONCouncilANJC Leadership ANJC LeadershipOnly NJ Licensed LEGAL EASE NUTRITION Chiropractors Can CutOff Chiropractic Care By Jeffrey RandolphANJC Legal Counsel On Jan. 21, 2010, then New JerseyDue to this loophole in the law whichprovision of the scope bill, alleging Governor Jon Corzine signed intonegatively affected chiropracticthat insurance carriers would have toREHAB Council law an amended chiropractic scopepatients in New Jersey, the amendedexpend significant additional resources of practice statute which updatedscope of statute included a provisionto hire New Jersey licensed chiroprac-the antiquated New Jersey scopethat states, It shall be unlawful fortors to perform utilization management statute which had not been revisedany person, not duly licensed in thisreviews if the statute was enacted as since the 1950s. Though only a fewState to practice chiropractic, . todrafted. However, the insurers failed sentences in length, there was includedLEGAL Q&A CHIROASSISTrender a utilization managementto address the fact that the language a provision in the scope statutedecision that limits, restricts orof the statute merely required that Executive Directors UPDATE curtails a course of chiropracticthe reviewing chiropractor have a amendments which closed a loophole of monumental size in New Jersey lawNew Jersey chiropractic license. It did concerning utilization managementnot dictate where the person had to reviews of chiropractic care by insurers.be located, where they perform the As a result, since the statutes enact- review, or what regions prevailing rates ment in 2010, only New Jersey licensedare paid for the review. During testi-chiropractors are legally permittedmony before the Senate Commerce to render a utilization managementLegislative UpdateCommittee in December of 2009, the INSURANCE Update INSURANCE Update ANJC made it clear to the senators on decision that limits, restricts or curtails a course of chiropractic care.the committee that an insurer could However, insurance carriers andvery well hire a chiropractor domiciledTECHNIQUE Counciltheir administrators routinely violatein Iowa to perform New Jersey this statutory provision and cut offchiropractic reviews at the lower rates chiropractic care with non-New Jerseyof professional reimbursement in that licensed chiropractors. state provided only that the reviewer Prior to Jan. 21, 2010, there was nohas an active New Jersey chiropractic statute in New Jersey which mandatedlicense and could be called before MedicareQ&Athe New Jersey Board of Chiropractic that commercial insurers use NewExaminers if he or she performedOUR HEALTHJersey licensed chiropractors tocare. This section of the scopedeficient reviews. The senators perform utilization management reviewstatue codified existing New Jerseyunderstood the logic of this point and of chiropractic care. Rather, it waslaw which established a minimumdismissed the carriers allegations to the industry standard to hire nurses,standard that persons performingthe contrary. doctors, out-of-state chiropractors,chiropractic utilization management or even laypersons to perform thesedeterminations must meet with theIn addition, the ANJC presented reviews. Not only was this cheaperoverall goal of protecting citizens oftestimony which supported the fact for insurers due to the high wagethe State of New Jersey. The inclusionthat there would be no substantial rates in New Jersey, it also took theseof the requirement that a personadditional burden to New Jersey PIP reviewers beyond the jurisdiction andperforming a chiropractic utilization(No-Fault) carriers by the mandate as control of the New Jersey professionalmanagement determination be a NewPIP carriers, under New Jersey law licensing boards, such as the NewJersey licensed chiropractor ensuresin effect since 1998, already had a Jersey Board of Chiropractic Exam- that any person performing reviewsstatutory mandate to contract with iners, which had promulgated detailedupon New Jersey patients is subjectchiropractors who practice in New regulations to ensure reviews ofto the minimum standards set forth byJersey to perform same specialty chiropractic care were done correctlythe New Jersey Board of ChiropracticIndependent Chiropractic Examina-and in the patients best interest. AsExaminers in their detailed regulationstions. The ANJC delegation further a result, these out-of-state reviewersand may be subject to discipline if theypointed out that there would also be were not subject to these regulationsdo not.no substantial additional burden to nor could they be disciplined bymajor medical insurance carriers in New Jersey licensing boards if theyWhile the amended scope statute wasNew Jersey as the medical necessity performed a deficient review andproceeding through the legislativeappeal process, mandated by the improperly terminated or reduced aprocess to become law, the insuranceHCAPPA law since 2007, required all course of chiropractic care.industry vehemently opposed thiscarriers to have internal utilization 6 I Spring2019 www.anjc.info'