Representative presents bill to expand chiropractic, physical therapy coverage to more body areas

A member of the House presented Senate Bill 238 with Senate Amendment 1 to the Banking, Insurance and Commerce Committee, saying the measure would expand insurance coverage for chiropractic care and physical therapy beyond the thoracic and lumbar spine to include other regions of the spine and extremities and would prohibit numerical annual or lifetime visit limits for treatment of neuromusculoskeletal structures.

The sponsor told the committee the change aims to reduce reliance on opioids by increasing early access to nonpharmacologic care, noting studies showing earlier physical and chiropractic therapy can lower later opioid use by as much as half. "This bill is about improving how we treat chronic pain in Delaware by reducing the reliance on opioids," the sponsor said.

Committee members pressed the sponsor on whether the bill addresses overprescribing; one lawmaker clarified that the measure expands coverage options and "isn't referencing that at all," meaning it does not change prescribing rules. A key point of contention centered on the bill's reference to "extremities." Several members and stakeholder witnesses said they support language limited to the spine with coverage for referred pain, while chiropractic and physical-therapy groups argued that providers routinely treat whole-patient complaints and that distinguishing spine from extremity care can be clinically difficult.

Dr. Kevin Sheehan of the Medical Society of Delaware urged the committee to adopt consensus language that would cover the full spine ("occipital, cervical, thoracic, lumbar, and sacral") and pain of spinal etiology, arguing extremity coverage as worded is unnecessary because, he said, "there's effectively minimal to no prescribing of opioids for chronic extremity pain." He added that the Medical Society's recommended wording would address referred pain without expanding scope of practice.

Representatives of provider groups disagreed. Trent Kemp, a chiropractor, told the committee, "We don't treat spines. We don't treat extremities. We treat people," and said practice and clinical reality mean extremity symptoms often cannot be cleanly separated from spinal conditions. Scott Kindner of the Delaware Physical Therapy Association also supported the bill as drafted and noted the Senate had passed it 20–yes.

Pam Price, speaking for Highmark/Blue Cross Blue Shield, cautioned that including stand-alone extremity coverage without an etiologic connection to the spine could increase premiums. Price provided actuarial estimates putting per-member premium changes in the range of roughly $0.45 to $1.45 per month depending on market segment and supported the consensus language seeking to tie coverage to spinal etiology.

The insurance commissioner addressed the committee and estimated the premium impact at "less than a dollar per member per month," describing the change as a modest cost relative to the potential public-health benefits of reduced opioid reliance.

After public and stakeholder testimony and committee discussion, a motion was made and seconded to release SB 238 with Senate Amendment 1 from committee. The chair called the roll and several members registered "yes;" the chair declared the bill had enough votes and the measure was released from committee. A committee member asked the chair to submit the bill to the comptroller general's office for fiscal analysis as needed.

The committee's action advances the bill to be scheduled by leadership; committee members and stakeholders signaled continuing negotiations over the precise wording (spine-only versus explicit extremity language) and the fiscal implications for state plans.