Opt-Out in Medicare – A Top Priority for Chiropractic Profession

In the 1997 Balanced Budget Act Congress confirmed in to law the freedom of Medicare beneficiaries to privately contract with their health care professionals. This is often referred to as the ‘opt-out provision’ because it requires the provider to make an ‘opting-out’ determination with the Center for Medicare and Medicaid Services (CMS). While there are ongoing discussions on Capitol Hill about including more flexibility, at present the law requires that providers either opt-out of Medicare for all their patients or none of them for a period of at least 2 years.

At the 2016 Chiropractic Summit and in collaboration with partner organizations, the ICA agreed on the necessity for chiropractic patients to choose who they privately contract as medical doctors, dentists, podiatrists, optometrists, social workers, psychologists, nurse practitioners, nurse anesthetists, and nurse midwives.

The only way to end the disparity in Medicare is through legislation. The CMS cannot change this provision without Congress and the ICA has been working diligently to see that legislation is introduced to eliminate any chiropractic Medicare discrimination.

ICA is seeking a technical correction in Medicare and is comparable to the recent action taken by Congress to correct a disparity between the FAST Act regulations and the existing Federal Motor Safety Carrier Administration (FMSCA) regulations.  Congress corrected the disparity through the Jobs for Heroes Act. This disparity would clarify that chiropractors employed by the Department of Veterans Affairs as well as physician assistants and advance practice nurses are added to the list of health professionals eligible to become certified to conduct physical examinations if they are licensed to conduct such exams in their licensing state.  An announcement will be made when the Bill is introduced.

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