Medicare

Background: Medicare was established in 1965 and is the United States’ federal health insurance program for People who are 65 years of age or older; for individuals under 65 years living with disabilities; and for people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The program was initially managed by the Social Security Administration. In 1971, the program management was moved to the Department of Health and Human Services (HHS) Center for Medicare and Medicaid Services (CMS). The laws managing Medicare are found in Title 42 U.S.C. § 1395.  

The International Chiropractors Association (ICA) is in consensus with the entire US-based chiropractic community that Medicare needs to be fixed. For too long the vestiges of restraint of trade discrimination have lingered in the Social Security Act laws through which Medicare is administered. In 2016, the International Chiropractors Association joined with over 40 chiropractic associations, institutions and vendors at the Chiropractic Summit in a unanimous resolution that the profession needed to identify and eliminate discrimination against both chiropractors and chiropractic patients in Medicare.

ICA’s Essential Elements Required of Any Medicare Legislation

1. Maintain the current mandate for coverage of the adjustment to correct a subluxation.
2. Preserve Subluxation reference in definition.
3. Remove the restrictive language used to limit reimbursements to the adjustment “only”.
4. Ensure that x-ray imaging and exams are covered services.
5. Maintain economic neutrality by removing barriers to reimbursements for existing covered services only.
6. Establish equitability in reimbursement rates to other physician level providers.
7. Eliminate discrimination that denies patients of chiropractic physicians the ability to privately contract and chiropractors to Opt-out of the Medicare system if they so choose.

ICA legislative experts all agree that the any Medicare legislation should be clear, specific, and give CMS specific instruction with deadlines for implementation. We do not believe it is in the best interest of chiropractors and their patients to leave the details up to CMS to develop. Further, if a bill were passed into law that leaves the details up to CMS, a multi-year rulemaking will be required; and there will be no guarantees at the end of the process of what will be covered.

2021- A New Congressional Session, the Same Medicare Legislation Introduced that ICA Cannot Endorse

January 2021 brought the end of the 116th Congress and the start of the 117th Congressional Session. The previous bill we had not endorsed, was re-introduced as The Chiropractic Medicare Coverage Modernization Act of 2021. Its the same legislation as last session. different number.

The Bill we have chosen not to endorse replaces the existing definition of chiropractor within the Social Security Act as “a doctor of chiropractic who is licensed as a doctor of chiropractic or a chiropractor by the State in which the function or action is performed and whose license provides legal authorization to perform such function or action in such State or in the jurisdiction in which the function or action is performed.” This removes all reference to subluxation correction by manual manipulation of the spine from the definition of a chiropractor.

The bill purports that if passed Medicare will provide coverage for all physicians’ services furnished by a doctor of chiropractic within the scope of their license. This will require CMS to conduct a lengthy rulemaking on what services are covered in scopes of practice, and after years of study, they will determine whether or not basics such as exams and x-rays will be covered services to be reimbursed and at what rate. Furthermore, this could open the door for the medicalization of chiropractic by individuals who wish to see state scopes of practice expanded to cover prescription drug prescribing and invasive services such as injecting services added so as to have them included in Medicare.

Not Revenue Neutral: The manner in which this bill is drafted, it cannot be ruled as revenue neutral. It will be seen as a bill that drives up the costs of Medicare.

Creates a Two Tier Profession – Those who Qualify for Full Reimbursement and Those Who Do Not.

This bill requires chiropractors to complete an as yet to be created educational program designed by HHS through a process as yet to be defined by the Secretary of HHS. This provision in essence federalizes all or part of the continuing education requirements for doctors of chiropractic. This should raise concerns of the state regulators over federalism issues. The lack of clarity what HHS might require as educational programing is particularly troublesome.

If you do not participate in this federally required training program, you will only be reimbursed for the adjustment. This tiering of the profession during a time when so many are asking the profession to find common ground is problematic.

They Opted out of an Opt-Out Provision– Leaving the Discrimination Against Medicare Beneficiaries in Place The Bill we have not endorsed ignores the biggest request of the profession – the Opt-Out provision. The organizations behind this bill have refused to consider inclusion of the opt-out provision. This means that beneficiaries will not have the same rights as other health care providers’ patients to privately contract with the chiropractor of their choice. Medicare is not a gift from the government, beneficiaries have paid into the system for decades through mandatory payments from paychecks. There should be no discrimination against beneficiaries who chose to use them system, and those who choose to privately contract with the health care provider of their choice.

We Cannot Settle for Just any Medicare Fix

It takes decades to get changes accomplished in Medicare. There are those that suggest that we should back this bill even though it is problematic. The ICA has chosen not to do so – instead we are working with legislators to introduce a bill that provides everything the profession requested – specific coverage of the exam, x-ray and preservation of the correction of the subluxation through manual manipulation; and the opt out provision while remaining cost neutral. We are working towards a bill that can be swiftly implemented once signed into law.