50 years of legislative battles creating and protecting patient access to chiropractic

Dr. Dave Butters

Fighting to ensure that our patients can access chiropractic care is a core value of the Washington State Chiropractic Trust, and it’s an ongoing effort to educate legislators about the good work that we do to keep people healthy. Despite our nation’s political divide, it’s important to keep in mind that the Trust – with your ongoing, invaluable support – raises money for legislators who support chiropractic, regardless of their party affiliation.

As we continue our work, it’s also important to remember how much we have accomplished over the past 50 years. In the 1950s, ‘60s and ‘70s, Washington’s chiropractic successes were credited to the work done by chiropractic pioneers Senator William. S. Day, DC and Representative Al Adams, DC. Notable legislation passed in 1971 (RCW 48.21.14,) states that benefits shall not be denied for a chiropractor’s service if it is within the scope of practice and would pay if performed by a physician. And RCW 48.44.310 — passed in 1983 — requires that each health insurance group contract shall offer coverage for chiropractic care on the same basis as any other care.

Other key chiropractic legislation followed, including:

1995 – Every Category of Provider Law (RCW 48.43.045): Patients must have access to every category of licensed health care provider who treats covered conditions within the state’s Basic Health Plan, and the services are within the providers’ designated scope of practice, and who is contracted by the insurer, for benefits listed in the patient’s policy when it is regulated by the State of Washington.

1996 – A health carrier may not prohibit its enrollees from contracting for services outside the health care plan (RCW 48.43.085): This gives providers the right to sell their services to consumers outside of a health care plan, whereas in the past insurers tried to control the services that chiropractors, and other providers, provided to patients even if the plan was not going to cover it.

2000 – Self-referral to chiropractors (RCW  48.43.515): Patients who have insurance plans that are regulated by the State of Washington, that have spinal adjusting benefits, are allowed to self-refer for those services and no longer have to obtain a referral from a physician or other provider.

2002 –  HB 2501 modifying provisions concerning chiropractors.This allows chiropractors to recommend nutritional products of all types and removed the limitation of certain types of nutritional supplements. The bill also allows for the performance of extremity adjustments independent of a spinal complaint, and the chiropractor is allowed to bill for the extremity services provided.

2005 –  E2SHB 1418 regulating insurance overpayment recovery practices. This bill protects providers from insurance companies who retroactively seek to deny, adjust or recoup a claim that has been paid, after the expiration of two years from the date that the initial claim was paid. The bill does not stop an insurer from collecting on claims that are fraudulent (a scheme or practice specifically intended to steal from the insurer.)

2007 – 2SSB 5597 concerning contracts with chiropractors: This bill strongly benefits both the patient and the chiropractor in that a patient should never have to be turned away from their regular chiropractic clinic if their usual doctor is not available, but a fully licensed and capable associate is.

2008 – SSB 5596 Chiropractic Fair Payment: This bill prevents insurers from creating different reimbursement rates for providers based on their profession, and not taking into account what is the actual service performed and the cost to deliver the actual service. SB 6487, passed in 2010, made this payment permanent.

2014 – Concerning physical therapists’ ability to perform spinal manipulation. This law establishes specific educational requirements that physical therapists must prove prior to receiving an endorsement to perform spinal manipulation.

2015 – E2SHB 1471, mitigating barriers to patient access to care resulting from health insurance contracting practices. This law removes prior authorization for evaluation and management for initial visits or in a new episode of care. Episodes of care are defined as treatment given for the same condition within the previous 90 days. The bill also removes the long-standing requirement that a provider give a discount from their usual and customary rate on non-covered­ services.

2018 –  ESB 5518, chiropractic payment parity for spinal manipulation. This bill requires insurers to pay chiropractors fairly for spinal manipulation services using the insurers’ own formula, known as the Resource Based Relative Value Scale (RBRVS). History shows that insurers pay chiropractors LESS than this calculation, and pay other professions 100% more than what is paid to chiropractors, for the same service.

2020 – E2SB 5601 was passed to require registration for health care benefit managers (HCBMs) at the Office of the Insurance Commissioner by 1/1/2022. Any company that manages a network of providers, benefits for patients and processes claims (and other services) must disclose who they work for, what services they provide to the carrier and where they are domiciled, along with other details about their business model.

2021 – SB 5169 was passed to require health care insurance companies pay for personal protective equipment (PPE) to providers for up to $6.57 per patient encounter during the coronavirus pandemic while under a state of emergency, for state regulated health plans.

The success of the Washington State Chiropractic Association, the Trust and ultimately the Washington state chiropractic profession hinges upon a strong working relationship within the profession and its external allies.  That includes your contributions to elect our chiropractic friends and “un-elect” our foes.

Your financial support of the WSCT and membership in the WSCA is EVERYTHING! You have and will continue to benefit from everything that we do. If you have donated recently and/or are a regular contributor to the WSCT, it is appreciated, and it makes a difference. CLICK HERE to make either a one-time or recurring donation.

— By Dr. Dave Butters, President
Washington State Chiropractic Trust