Texas § IN.1451.109 - SELECTION OF CHIROPRACTOR

§ IN.1451.109. SELECTION OF CHIROPRACTOR

SELECTION OF CHIROPRACTOR. (a) An insured may select a chiropractor to provide the medical or surgical services or procedures scheduled in the health insurance policy that are within the scope of the chiropractor's license. (b) If physical modalities and procedures are covered services under a health insurance policy and within the scope of the license of a chiropractor and one or more other type of practitioner, a health insurance policy issuer may not: (1) deny payment or reimbursement for physical modalities and procedures provided by a chiropractor if: (A) the chiropractor provides the modalities and procedures in strict compliance with state law; and (B) the health insurance policy issuer allows payment or reimbursement for the same physical modalities and procedures performed by another type of practitioner that an insured may select under this subchapter; (2) make payment or reimbursement for particular covered physical modalities and procedures within the scope of a chiropractor's license contingent on treatment or examination by a practitioner that is not a chiropractor; or (3) establish other limitations on the provision of covered physical modalities and procedures that would prohibit an insured from seeking the covered physical modalities and procedures from a chiropractor to the same extent that the insured may obtain covered physical modalities and procedures from another type of practitioner. (c) Nothing in this section requires a health insurance policy issuer to cover particular services or affects the ability of a health insurance policy issuer to determine whether specific procedures for which payment or reimbursement is requested are medically necessary. (d) This section does not apply to: (1) workers' compensation insurance coverage as defined by Section 401.011 , Labor Code; (2) a self-insured employee welfare benefit plan subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.); (3) the child health plan program under Chapter 62 , Health and Safety Code, or the health benefits plan for children under Chapter 63 , Health and Safety Code; or (4) a Medicaid managed care program operated under Chapter 540 or 540A , Government Code, as applicable, or a Medicaid program operated under Chapter 32 , Human Resources Code. (e) A health insurance policy issuer that violates this section is subject to an administrative penalty as provided by Chapter 84 of not more than $1,000 for each claim that remains unpaid in violation of this section. Each day the violation continues constitutes a separate violation. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7 ), Sec. 11.01, eff. September 28, 2011. Acts 2019, 86th Leg., R.S., Ch. 116 (S.B. 1739 ), Sec. 3, eff. September 1, 2019. Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 2.130, eff. April 1, 2025.