House amendment #1 makes the following changes to the 3rd edition.
Amends proposed GS 90-153.1(b), defining chiropractic peer review. Qualifies that the term means the retrospective review of the treatment records of a chiropractic patient when requested by a third-party payer (previously, did not require request by a third-party payer), performed and for the purpose as previously set out. Modifies and adds to what is not included in the term, to exclude: (1) automated screening programs, (2) reviews limited to coding and billing entries, or (3) reviews performed by a third-party payer's in-house employees or individuals hired for the purpose of providing expert testimony in or preparing for litigation of personal injury claims (previously, did not include reviews performed by a third-party payer's in-house employees for this purpose).
Summary date: Apr 5 2017 - View summary
Summary date: Mar 30 2017 - View summary
House committee substitute makes the following changes to the 2nd edition.
Amends proposed GS 90-153.1 to provide that materials submitted for chiropractic peer review must be redacted to remove any information that would identify the provider of the chiropractic services.
Summary date: Mar 14 2017 - View summary
House committee substitute makes the following changes to the 1st edition.
Amends GS 90-153.1 to provide that any chiropractor licensed under Article 8 of GS Chapter 90 by the Board of Chiropractic Examiners is subject to disciplinary action under new GS 90-154(b)(22) (was, GS 90-154-(b)(4)). Also deletes the provisions that made a licensed chiropractor who failed to comply with new GS 90-153.4 guilty of unethical conduct. Makes organizational changes.
Enacts new GS 90-154(b)(22) to make failing to comply with new GS 90-153.1 while performing a chiropractic peer review subject to disciplinary action by the Board of Chiropractic Examiners, which includes the sanctions listed in subsection a of the statute.
Summary date: Feb 21 2017 - View summary
Enacts new GS 90-153.1 to require that when a payor seeks peer review of chiropractic treatment in order to determine whether the services were clinically necessary and supported by adequate documentation, the person conducting the review must hold a current North Carolina license to practice chiropractic and satisfy certain other criteria. Defines chiropractic peer review and establishes that the term does not include automated screening programs or reviews performed by individuals hired for the purpose of providing expert testimony in or preparing litigation of personal injury claims.
Clarifies that these provisions apply only to motor vehicle liability claims for personal injury and to motor vehicle medical payments claims. States that these provisions do not apply to workers' compensation claims, general accident and health insurance claims, or claims submitted by, or on behalf of, enrollees to health benefit plans. Requires that the standard of care applied by the reviewer be state-specific. A chiropractor licensed by the state may be subject to disciplinary action for failing to comply. An unlicensed person who performs such a review may be subject to criminal and civil enforcement actions.
Effective October 1, 2017, and applies to reviews conducted on or after that date.