The U.S. House of Representatives has reintroduced ground-breaking bipartisan legislation that would expand chiropractic coverage within Medicare. Rep. Brian Higgins (D-N.Y.) introduced the Chiropractic Coverage Modernization Act (H.R. 2654) on April 19, 2021. The act's purpose and language mirror the original legislation, introduced in 2019, in that H.R. 2654 would "amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians' services furnished by doctors of chiropractic within the scope of their license."
According to the American Chiropractic Association, which has advocated for the coverage change in Congress and played a key role in introducing the original legislation as well, H.R. 2654 "would increase Medicare coverage of services provided by doctors of chiropractic within the full extent of their state licensure, enabling chiropractic patients to conveniently and safely access additional covered services that may be medically necessary. The change would also align Medicare with chiropractic coverage offered in many private health and Medicare Advantage plans."
As all chiropractors who treat Medicare patients know all too well, Medicare currently only reimburses doctors of chiropractic for a single service under Medicare Part B: "manual manipulation of the spine ... if medically necessary to correct a subluxation. Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture."
Ninety-two co-sponsors ultimately signed on to the 2019 legislation (H.R. 3654); thus far, 19 congressional members have signed on as original co-sponsors to the 2021 legislation. As of press time, H.R. 2654 has been referred to both the House Committee on Energy and Commerce, and House Committee on Ways and Means. To track the progress of H.R. 2654, visit www.congress.gov/bill/117th-congress/house-bill/2654/actions?r=4&s=1.
For chiropractors practicing today, Dr. Warren Hammer’s legacy is particularly visible in several areas that have become familiar components of modern musculoskeletal care: his early work with the Graston Technique and instrument-assisted soft-tissue mobilization; his extensive writing and teaching on functional soft-tissue examination and treatment; his role in bringing fascial manipulation to U.S. clinicians; and his decades spent educating chiropractors and other health professionals.
Financial pressure, enrollment declines and institutional challenges are emerging at several U.S. chiropractic colleges. Life Chiropractic College West's and Life University's struggles may be the most talked about but appear to be part of a larger story. And with recent USDE requirements threatening to hamstring federal student financing for DC degree programs, chiropractic education is facing questions for which it has no immediate answers.
The term standard of care is a legal term and a medical concept. There is no single, universally recognized standard of care document or authoritative reference. The medical concept defines what practitioners should do in practice. The legal term used determines whether a practitioner failed to meet that expectation. This article examines the standard of care for the doctor of chiropractic.
