Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

by  Wyn Staheli, Director of Content - innoviHealth
Aug 13th, 2019

Two separate pieces of legislation have been introduced in the House of Representatives which have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Other payers allow chiropractors to do more than spinal manipulation and even state licensing boards have a great deal more listed as being included within their scope of practice. The two bills approach the problem from different angles, they are :

• H.R. 2883 - Chiropractors Equity Act of 2019, introduced May 2019, seeks to revise the Social Security Act definition of a physician.
• H.R. 3654 - Chiropractic Medicare Coverage Modernization Act of 2019, introduced July 2019, proposes to allow doctors of chiropractic to do more than just spinal manipulation. 

H.R. 2883 is supported by the International Chiropractor Association and proposes to revise the Social Security Act definition of a physician in section 1802(b)(6)(B) as follows:

(B) Physician.—The term “physician” has the meaning given such term by paragraphs (1), (2), (3), and (4) of section 1861(r).

Paragraph (5) of Section 1861(r) says doctors of chiropractic are defined as a physician but only for manual manipulation. It states the following (emphasis added):

(5) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided. . 

While this small change will allow doctors of chiropractic to have the ability to ‘opt out’ of Medicare like other physicians, it still doesn’t change the scope of allowed services.

H.R. 3654 goes a little further than H.R. 2883. The Act states:

It is the purpose of this Act to expand recognition and coverage of a doctor of chiropractic as a “physician” under the Medicare program in connection with the performance of any function or action, including current service of “manual manipulation of the spine to correct a subluxation”, as is legally authorized by the State in which such doctor performs such function or action.

We believe that more closely aligning the Medicare program with state scope of practice is a good idea. Clinical Congress, formerly COCSA, issued a letter on July 29, 2019 in support of this legislation (see References below). They stated “While ChiroCongress supports legislative efforts which we believe positively impact the profession, we encourage each association to independently assess support of legislative efforts with your association’s leadership team.”

Summary

At the time of this article, it doesn’t appear that either bill is moving forward very quickly. H.R. 3654 has been referred to the Committee on Energy and Commerce, where many bills get held up. The only way that things will move forward is with continued support. Contact the association(s) you are affiliated with as well as your state congressional members. CLICK HERE to obtain your state representative information.