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Doctors of chiropractic continue to be treated unfairly in reimbursement for the services they provide their patients. One prime example is the Medicare program. Currently, HCFA only recognizes doctors of chiropractic for manual manipulation of the spine to correct a subluxation. Medicare does not even reimburse a doctor of chiropractic for diagnostic services. As mentioned above, doctors of chiropractic are trained and educated to perform a multitude of other services. However, regulations, written at the height of an anti-chiropractic movement within the medical community severely restrict reimbursable services under Medicare. The ACA continues to work on all levels to ensure that doctors of chiropractic be reimbursed for all Medicare-covered services they provide. Reimbursement disparities are also occurring in alarming rates with private insurers. Some of the problems that the ACA has heard include; systematic attempts to exclude chiropractic care from insurance industry products, reimbursement comparisons to non-physician providers, withholding of chiropractic network information from insured patients, reimbursement "standards per visit" levels which are unfair and do not adequately reflect the business expense of the provider, and failure to conduct proper claim investigation as is required by the Fair Claim Practices Act. Access to Chiropractic Services In addition to the problems faced by doctors of chiropractic in being reimbursed for the services they provide, consumers seeking chiropractic services - especially through federally funded programs - are finding it increasingly difficult to access chiropractic services. I would like to provide the commission with a few examples. Medicare In 1972, Congress recognized doctors of chiropractic as physicians in the Medicare program for treatment by means of manual manipulation of the spine to correct a subluxation. It is the view of the ACA that implicit in the word "treatment" is the full clinical approach that constitutes chiropractic treatment of a Medicare beneficiary. The statute does not simply state chiropractors are physicians only for the purposes of "manual manipulation of the spine" and nothing else, but rather clearly identifies treatment of the patient by means of "manual manipulation of the spine" and all the related physician services and ancillary physician services that are integral in such treatment. Unfortunately, as the regulations are written, doctors of chiropractic are currently only recognized for the one procedure, "manual manipulation of the spine". No other services are covered including the initial evaluation of the patient. HCFA refuses to change its position on this issue, and currently the ACA is pursuing a legislative remedy to ensure that the full scope (as determined by state law) of a chiropractor's services are reimbursed under the Medicare program. The Health Care Financing Administration (HCFA) has gone one step farther in limiting Medicare beneficiary access to doctors of chiropractic. In 1997, Congress created the Medicare+Choice program as an additional avenue for Medicare beneficiaries to receive care. The statute stipulates that all Medicare Part A and B benefits be provided to those patients seeking care through Medicare+Choice programs. Manual manipulation of the spine to correct a subluxation, which is a uniquely chiropractic service, is a guaranteed part B benefit. Patients in the Part B program can freely access doctors of chiropractic. Unfortunately, in its final regulations for the Medicare+Choice program, HCFA has issued a rule that allows these plans to exclude doctors of chiropractic from participating in the Medicare+Choice program. The ACA has filed suit against the Department of Health and Human Services to assure that Medicare beneficiaries are provided the opportunity to seek the care of a doctor of chiropractic in the Medicare+Choice program. Veterans Administration Last November, President Clinton signed into law the Veterans' Millennium Health Care Act (PL 106-237). This Act, among other things, included a provision requiring the Department of Veterans Affairs to develop a policy with regard to chiropractic care in the DVA health care system. More specifically, the law required that within days after the enactment of the Act, the Under Secretary of Health, after consultation with chiropractors, shall establish a policy for VHA regarding the role of chiropractic treatment in the care of veterans. The VA was not forthcoming in the development of this policy. In fact, the ACA had to request congressional intervention to get the VA to agree to meet with the chiropractic groups, as required by statute. At this meeting, the ACA, along with the Association of Chiropractic Colleges (ACC), provided to the VA a detailed report to assist in the development of a comprehensive chiropractic policy. In short, the VA ignored the recommendations provided by the chiropractic professions and developed a policy that severely limits a veterans access to chiropractic. The ACA is committed to returning to Congress next session in order to again mandate that the VA provide our nation's veterans with quality access to chiropractic care. Conclusion These are just two examples of the problems faced by doctors of chiropractic in providing care to their patients. Although various statutes call for the inclusion of chiropractic care in federal programs, federal agencies such as the VA and HCFA continue to drag their feet in providing chiropractic care to their constituencies. In advocating for the profession and the chiropractic consumers, the ACA has been forced to file suit in federal court, as well as work with members of Congress in passing stronger mandates to ensure that chiropractic services - already mandated by law - are actually provided to consumers. In developing recommendations to Congress, this Commission needs to consider what the real problems are. In the case of chiropractic, there are laws that have been passed. It's the continued stonewalling of federal agencies that continues to provide access problems for consumers. The Commission needs to ensure that once laws are in place, those laws are accurately implemented in regulations and policy. The Commission must recommend that federal agencies consult with the complementary and alternative therapy community in the development of policy by contracting or hiring CAM providers as part of their health care policy teams. Unless federal agencies like HCFA and the VA begin to look outside the medical model, and accept complementary and alternative practices, federal laws will continue to be watered down. The result, continued barriers to CAM practices, and fewer choices for providers. Thank you for the opportunity to present the views of the American Chiropractic Association. I would be happy to answer your questions. © 2002, American Chiropractic Association. All Rights Reserved. 1701 Clarendon Blvd, Arlington, VA 22209 • Phone 800/986-4636 • Fax 703/243-2593 |