Judges: Steve Clark, Attorney General
Filed Date: 5/10/1990
Status: Precedential
Modified Date: 7/5/2016
The Honorable Jack McCoy State Representative 712 McNeil Street Malvern, Arkansas 72104
Dear Representative McCoy:
This is in response to your request for my official opinion regarding whether a chiropractic physician who contracts with an out-of-state insurance company "to review claims that are subject to Arkansas statutes" is practicing "chiropractic" under the laws of this State and thus is required to be licensed by the Arkansas State Board of Chiropractic Examiners. Your request specifically asks that this opinion address the issue of "private review agents."
Due to a lack of Arkansas case law on this issue, a review of the pertinent code provisions as set out in
Under A.C.A.
Furthermore, the legislature has defined analysis in A.C.A.
Act No. 537 of 1989, codified as A.C.A.
A.C.A.
In conjunction with the application, the private review agent shall submit information that the Board requires including: (1) a utilization review plan that includes (A) a description of review standards and procedures to be used in evaluating proposed or delivered hospital and medical care; (B) the provisions by which patients, physicians, or hospitals may seek reconsideration or appeal of adverse decisions by the private review agent; (2) the type and qualifications of the personnel either employed or under contract to perform the utilization review.
In my opinion, it is unlikely that a court would conclude that an out-of-state private review agent who approves or denies payment or who recommends approval or denial of payment for hospital or medical services on a case-by-case basis is engaging for compensation in the diagnosis and analysis of any interference with normal nerve transmission and expression, and the procedure preparatory to and complimentary to the correction thereof by hand or mechanical device for the restoration and maintenance of health (in the state). See A.C.A.
A chiropractor is a type of physician. A.C.A.
While it may be helpful to a private review agent to be or to employ a chiropractor to evaluate claims and make recommendations regarding such payments, there is no authority under the definitions contained in A.C.A.
Thus, any such interpretation would unduly burden non-resident chiropractors and unfairly interfere with interstate commerce. While the legislature may define or designate what constitutes the practice of chiropractic in this State, its enactments "must be reasonable and bear some relation to the service to be rendered as well as to the end or object to be attained." See, generally, C.J.S. 7, P. 385.
Also, see exemptions for out-of-state chiropractors to provide occasional services in the state without being licensed. A.C.A.
Therefore, it is my opinion that an out-of-state private review agent reviewing claims for chiropractic services arising out of Arkansas and who conducts that review outside of Arkansas is not practicing chiropractic as it is defined in Arkansas law.
The foregoing opinion, which I hereby approve, was prepared by Assistant Attorney General Linda Pilgrim.