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Author: Adrienne Hersh, JD, ICS Legal Counsel

Applying for a License in Illinois

Under the Medical Practice Act of 1987, the Department of Financial and Professional Regulation (IDFPR) is responsible for regulating the practice of medicine, including the issuance of licenses and enforcement of laws that apply to licensees. The ICS has previously published an article entitled, “Administrative Investigations at the IDFPR: Know the Process and Handle With Care,” which details the enforcement process and is available to ICS members on the ICS website at www.ilchiro.org/.

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Chiropractic and Medicaid

Senate Bill 2840, spun by its drafters as the “Save Medicaid Access and Resources Together (SMART) Act,” has been passed by both houses of the Illinois legislature and is on its way to the Governor’s desk for signature. Despite vigorous lobbying efforts by the Illinois ChiropracticSociety and other health care provider groups, this bill limits and eliminates Medicaid coverage for a number of health care services. Unfortunately, Medicaid coverage for adult chiropractic services will be terminated effective July 1, 2012.

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Personal Injury Payment Red Flags

Once the case has been concluded, the amount of your payment depends on whether the settlement or judgment amount was enough to cover all of the bills in the case. Often it is not, which means you may file a petition to adjudicate your lien before the court, or you may negotiate with the attorney for the amount you are to receive, and you could receive a check for less than the full amount of your bill.

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ICS Files Department of Insurance Complaint Against UHC/Optum “Per Diem” Reimbursement Model

Many of you recently were notified by United Health Care/Optum that it intends to change its reimbursement model for chiropractic physician providers. In Optum’s own words, “Effective December 1, 2015, OptumHealthCare Solutions, Inc. (Optum) will implement a new chiropractic ‘per visit’ fee schedule for UnitedHealthcare commercial products managed by the Optum™ network.”

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