1. (a) For the purposes of this section, the following words shall have the following meanings:

   1. (1) CHIROPRACTOR. A person licensed to practice chiropractic in this state.
   2. (2) CHIROPRACTIC AGREEMENT or AGREEMENT. A contract between a chiropractor and a patient or his or her legal representative in which the chiropractor or the chiropractor’s chiropractic practice agrees to provide chiropractic services to the patient for an agreed upon fee and period of time.
   3. (3) CHIROPRACTIC PRACTICE. A chiropractor or a chiropractic practice of a chiropractor that charges a periodic fee for chiropractic services and which does not bill a third party any additional fee for services for patients covered under a chiropractic agreement. The per visit charge of the practice shall be less than the monthly equivalent of the periodic fee.
2. (b) A chiropractic agreement is not insurance, may not be deemed an insurance arrangement, and is not subject to state insurance laws.
3. (c) A patient or legal representative shall not forfeit any insurance benefits or Medicare benefits by purchasing medical services or products outside the system.
4. (d) A chiropractor offering, marketing, selling, or entering into a chiropractic agreement may not be required to obtain a certificate of authority or license other than to maintain a current license to practice chiropractic in this state.
5. (e) A chiropractic agreement is not a discount medical plan.

6. (f) To be considered a chiropractic agreement for the purposes of this section, the agreement shall satisfy all of the following:

   1. (1) Be in writing.
   2. (2) Be signed by a chiropractor, or agent of the chiropractor, and the patient or his or her legal representative.
   3. (3) Allow either party to terminate the agreement upon written notice of at least 30 days to the other party.
   4. (4) Describe the scope of health care services that are covered by the periodic fee.
   5. (5) Specify the periodic fee and any additional fees outside of the periodic fee for ongoing health care.
   6. (6) Specify the duration of the agreement and any automatic renewal periods and require that no more than 12 months of the periodic fee be paid in advance.

   7. (7) Prominently state in writing that is conspicuously visible and in bold font all of the following:

      1. a. The agreement does not constitute health insurance of the laws of this state.
      2. b. An uninsured patient that enters into an agreement may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 111-148, for failing to obtain insurance.
      3. c. Patients insured by health insurance plans that are compliant with the Patient Protection and Affordable Care Act already have coverage for certain preventive care benefits at no cost to the patient.
      4. d. Payments made by a patient for services rendered under a chiropractic agreement may not count toward the patient’s health insurance deductibles and maximum out-of-pocket expenses.
      5. e. A patient is encouraged to consult with the patient’s health insurance plan before entering into the agreement and receiving care.
   8. (8) Provide that, upon termination of the agreement by the patient, all unearned fees are to be returned to the patient.

7. (g) A chiropractor providing chiropractic services under a chiropractic agreement may decline to accept a patient if, in the chiropractor’s opinion, the patient’s medical condition is such that the provider is unable to provide the appropriate level and type of health care the patient requires. The chiropractor may discontinue care for patients under the chiropractic agreement under any of the following conditions:

   1. (1) The patient fails to pay the periodic fee.
   2. (2) The patient has performed an act of fraud.
   3. (3) The patient repeatedly fails to adhere to the recommended treatment plan.
   4. (4) The patient is abusive or presents an emotional or physical danger to the staff or other patients of the chiropractic practice.
   5. (5) The chiropractor or the chiropractor’s chiropractic practice discontinues operation as a chiropractic practice.
   6. (6) Any other condition consistent with the Chiropractic Practice Act or the rules of the Alabama State Board of Chiropractic Examiners.

(Act 2018-390, §2.)