Medicare Legislation 2025 – Get the Facts

By Beth Clay

ICA Offering Legislators a Bill that Provides a Full Resolution to Medicare in a Time Certain

January 22, 2025: Given that H.R. 538/S.106 the Chiropractic Medicare Coverage Modernization Act of 2025 contains the exact same text as the last three legislative sessions, the ICA once again finds itself unable to endorse these bills. As a result, the ICA will be offering legislators a bill that provides a comprehensive solution to Medicare, including the Opt-Out Provision that is essential for eliminating disparities and discrimination against Medicare beneficiaries who seek chiropractic care.

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.

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 the subluxation reference in the definition.
  3. Remove the restrictive language used to limit reimbursement to the adjustment “only.”
  4. Ensure that radiographic (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 chiropractic patients the ability to privately contract and chiropractors the ability to opt out of the Medicare system if they so choose.

ICA legislative experts all agree that 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, even with a friendly Director at CMS who will take office in 2025. 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.

Below is a chart that shows the differences between the two approaches.

As we engage with our legislators in Washington, it is important for ICA members and those across the profession who desire a full and certain solution to the issues in Medicare to engage with your senators and representatives to express your support for the bill we are bringing to them for introduction and passage. The road to introduction and passage into law is long.

If you have any questions or would like to help, please email our Executive Director, Beth Clay, at bclay@chiropractic.org.

Compare and ContrastIntroduced
HR 538/S.106
Chiropractic Medicare Coverage Modernization Act
Proposed
Revised HR8701
Chiropractic Act of 2025
Does the bill guarantee coverage of the standards of care basics– exams and x-ray imaging?No – The bill calls for full scope coverage which will require rulemaking with no guarantees of outcome and may take years.Yes Medicare beneficiaries who have paid into the system will be able to access shortly after passage into law.
Does the bill include a date of enactment?NoYes
Does the bill protect the chiropractic -specific terminology in the definition.NoYes
Does the bill create a two-tier reimbursement model within Medicare based on mandated Continuing Education?YesNo
Does the bill federalize Continuing Education (CE) requirements to be determined and managed by HHS/CMS?YesNo
(1) CE is a state issue and (2) CMS already has authority and has provider compliance training in place – no legislation specific only to chiropractic needed.
Source
Does the bill instruct CMS to continue using the physician codes and reimbursement rates (efficient and fair) rather than creating new chiropractic specific codes at lower reimbursement rates?NoYes
Does the bill include the provision to allow Medicare beneficiaries to privately contract with their chiropractor (commonly referred to as the Opt-Out Provision)? NoYes
Does the bill keep chiropractic in the lane of chiropractic by making it clear to CMS that chiropractors are not drug prescribers?NoYes – A provision in the legislation prevents the inclusion of drug prescribing to prevent a state-by-state expansion of scope to include Rx which is outside the lane of chiropractic and in the lane of medicine.
Does the bill call for a revision of the coverage determination that currently precludes chiropractors from providing care for prevention and chronic conditions? NoYes – A provision in the legislation calls for the secretary to include covered services on health promotion, whole person care, and prevention services in chiropractic coverage for services that are covered by any other type of physician.

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