Coverage for Chiropractic Care; Notice 2003-11 [33 Pa.B. 5888] It has come to the attention of the Insurance Department (Department) that there is some confusion among automobile insurers concerning whether 75 Pa.C.S. §§ 1701--1725 (relating to the Motor Vehicle Financial Responsibility Law) (MVFRL) requires automobile insurers to pay first party benefit claims that involve adjunctive procedures delegated, in whole or in part, by a chiropractor to an unlicensed assistant. The purpose of this notice is to provide guidance to all automobile insurers doing business in this Commonwealth concerning the requirements of the MVFRL.
The MVFRL requires automobile insurance policies to provide coverage for chiropractic care as part of mandatory first party benefits coverage. See section 1712(1) of the MVFRL (relating to availability of benefits). Section 601 of the Chiropractic Practice Act (act) (63 P. S. § 625.601) explicitly permits licensed chiropractors to delegate activities or duties to their unlicensed assistants as long as those activities or duties are performed under the direct on-the-premises supervision of the chiropractor and do not require formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor. The Legal Office of the Department of State, Bureau of Professional and Occupational Affairs (BPOA), has further interpreted this statutory provision to allow delegation of any aspects of adjunctive procedures that, in accordance with section 601 of the act, do not require formal education or training in the practice of chiropractic or the knowledge and skill of a licensed chiropractor. However, the licensed chiropractor must make the diagnosis and evaluation, specify the treatment regimen, and perform any aspects of the adjunctive procedures that may not be delegated under section 601 of the act. Therefore, the Department has concluded that the MVFRL requires that automobile insurers pay first party benefits claims that involve those aspects of adjunctive procedures that may be properly delegated by a chiropractor to an unlicensed assistant under section 601 of the act.
The recent decision of the Supreme Court affirming the Commonwealth Court's opinion in Kleinberg v. Southeastern Penn. Transp. Auth., 765 A.2d 405 (Pa. Cmwlth. 2000), aff'd, 810 A.2d 635 (Pa. 2002) has not changed the Department's interpretation of the MVFRL. In Kleinberg, the Commonwealth Court held that SEPTA was not required by the act of February 21, 2002 (P. L. 234, No. 6) to reimburse an osteopathic physician for physical therapy modalities delegated to unlicensed assistants. Kleinberg has nothing to do with either chiropractors or adjunctive procedures. The Supreme Court has explicitly recognized that adjunctive procedures performed by chiropractors and physical therapy are not legally the same. See Bureau of Professional and Occupational Affairs v. State Bd. of Physical Therapy, 556 Pa. 268, 728 A.2d 340 (1999). Therefore, the Kleinberg decision does not change the Department's longstanding position that the MVFRL requires automobile insurers to pay first party claims involving those aspects of adjunctive procedures that may properly be delegated by chiropractors to unlicensed assistants. The Department has discussed its interpretation with the BPOA. The BPOA has confirmed that its interpretation has not changed post Kleinberg. However, the Department is not the proper forum to determine which aspects of adjunctive procedures may be properly delegated to unlicensed support personnel under the act.
Questions regarding this notice should be addressed to Ronald A. Gallagher, Jr., P. E., Deputy Insurance Commissioner for the Office of Producer and Consumer Services, Insurance Department, 13th Floor, Strawberry Square, Harrisburg, PA 17120, at ra-in-chiropractors@state.pa.us.
M. DIANE KOKEN,
Insurance Commissioner[Pa.B. Doc. No. 03-2288. Filed for public inspection November 26, 2003, 9:00 a.m.]
