Editor's Note: Article submitted by Michele Maiers, DC, MPH, PhD, president of the American Chiropractic Association (ACA); Keith Overland, DC, chair of the ACA's Legislative Committee; and John Falardeau, the ACA's senior vice president of public policy and advocacy.
The introduction of S. 4042, a Senate companion bill for the Chiropractic Medicare Coverage Modernization Act (H.R. 2654), in April was a key step forward in the campaign to pass legislation that will finally level the playing field for doctors of chiropractic and their Medicare patients. Now comes the final hurdle: getting Congress to pass the bill before time runs out at the end of the congressional session in December.
It's critical that doctors of chiropractic understand the significance of how this historic bill will impact the profession and its patients; and make their voices heard loud and clear in support of it.
If passed, S. 4042/H.R. 2654 will enable chiropractors treating Medicare Part B beneficiaries to provide and be reimbursed not only for manual manipulation of the spine, but all services that are both covered by Medicare and allowed under their state license. This will vary from state to state; in some places, it may include services such as evaluation and management, therapeutic exercises, and other diagnostic services such as X-rays.
S. 4042/H.R. 2654 does not take away or add any new services or costs to Medicare; it simply allows patients to access current Medicare benefits their chiropractors are licensed to provide. It's a win-win.
How Will the Bill Affect My Practice?
Doctors of chiropractic currently must ask Medicare beneficiaries to sign an advance beneficiary notice (ABN) to acknowledge that any services rendered other than manual manipulation of the spine will not be covered by Medicare. Patients must then decide whether to pay out of pocket for these services or seek them elsewhere. It's a situation that inevitably leaves many Medicare patients, who are often on fixed incomes, lacking care or incurring more expenses and hassle to obtain services they need.
Since the statute was put in place in 1972, chiropractors have had their hands tied as far as providing patients with quality care. It's striking that no other physician-level providers in Medicare are restricted in this manner. There is simply no valid scientific or policy basis to justify it.
S. 4042/H.R. 2654 would finally update the 50-year-old Medicare statute that is the source of the arbitrary restriction, enabling chiropractors to provide and bill approved services – and better meet the needs of their Medicare patients.
While this legislation will certainly improve access for Medicare beneficiaries, it's also important to note that it could have an even further-reaching effect. Medicare policy is often emulated by private insurers; passage of the act should positively affect those plans, too. Moreover, other federal programs that follow Medicare guidelines, such as federal worker's comp, could be favorably impacted as well.
Bipartisan Support Indicates Time for Medicare Equity Has Come
Those who have worked with the American Chiropractic Association (ACA) in support of S. 4042/H.R. 2654 in recent years are encouraged by the strong bipartisan support for the legislation. The bill has had an equal number of Republican and Democratic co-sponsors in the House for many months – which appears to indicate that broad support for this change is available if we as a profession can harness it. As of press time in early July, the House bill had 136 co-sponsors (69 Republican and 67 Democratic).
Political insiders such as Brian Sutter of the Capitol Hill Consulting Group and former Missouri Congressman Lacy Clay have provided invaluable insight and support to the ACA's advocacy. Each has deep experience navigating legislation to passage. Their consensus is that the chiropractic profession has a real shot of achieving its goal if the pressure on Congress remains strong and the number of co-sponsors continues to rise through the end of the year.
How Can I Help?
Join our effort to increase access to safe, effective chiropractic services for seniors:
Please do your part to bring equality and justice to the chiropractic profession and our patients in the Medicare program and beyond. Let's get this done!
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