HF3687

Purpose

• To change how chiropractic services are covered under Minnesota’s Medical Assistance (Medicaid) and MinnesotaCare programs, by setting age limits, visit caps, and specific coverage rules.

Main changes to coverage

• Age limit: Chiropractic services would be covered only for individuals under age 21.
• Visit cap for those under 21: Coverage would be limited to one annual evaluation and up to 24 visits per year, unless more visits are approved through prior authorization.
• Authorization requirement: Any number of visits beyond the annual limit or beyond the 24-visit cap would require prior authorization.
• Scope of covered services: Chiropractic care and related services must be recommended by a licensed health care professional and follow generally accepted chiropractic standards of care.
• Conditions covered: Services would be covered for treating acute spinal pain, chronic spinal pain, and neuromusculoskeletal conditions related to the spine.
• Included services: Covered services include medical evaluation and management, manual therapy, spinal manipulation (often called chiropractic adjustments), and therapeutic exercises.
• Non-xray services cap: Other than X-rays, covered services are limited to 24 visits per year unless prior authorization is obtained.
• X-ray coverage: X-ray coverage would be limited to specific radiologic areas of the spine and pelvis (full spine, cervical, thoracic, lumbar, lumbosacral regions, and pelvis or sacroiliac joints) and only if necessary to support a diagnosis of subluxation.

Specific statutory changes

• Amendment to Minnesota Statutes 256B.0625, subdivision 8e: Establishes the age limit, visit caps, prior authorization rule, and covered services as described.
• Repeal of Minnesota Statutes 256L.03, subdivision 3b: The bill would remove this existing provision (scope not detailed in the text provided).

What this would accomplish

• Creates a narrower, more restricted chiropractic benefit under state health programs.
• Emphasizes a youth-focused policy (under 21) with defined limits to visits and need for authorization for extended care.
• Establishes explicit types of chiropractic services and imaging that are reimbursable under Medicaid/M MinnesotaCare.

Potential impacts and considerations

• Access impact for young people needing chiropractic care could be reduced if prior authorizations are not approved or if the visit cap is reached.
• Administrative processes would increase due to the prior authorization requirement.
• Providers would need to ensure coverage aligns with the defined scope (evaluation, manual therapy, spinal manipulation, therapeutic exercises) and the stated imaging limitations.

Relevant Terms Medicaid, MinnesotaCare, chiropractic services, chiropractic care, spinal manipulation, manual therapy, therapeutic exercises, medical evaluation and management, acute spinal pain, chronic spinal pain, neuromusculoskeletal conditions, full spine, cervical, thoracic, lumbar, lumbosacral, pelvis, sacroiliac joints, subluxation, prior authorization, visits per year, under age 21, radiologic examinations, generally accepted standards of care, licensed health care professional.