SCON 32 IS

Expressing the sense of Congress regarding the guaranteed coverage of chiropractic services under the Medicare+Choice program.

May 17 (legislative day, MAY 14), 1999

Mr. CONRAD (for himself, Mr. HARKIN, Mr. GRASSLEY, and Mr. HATCH) submitted the following concurrent resolution; which was referred to the Committee on Finance

Expressing the sense of Congress regarding the guaranteed coverage of chiropractic services under the Medicare+Choice program.

Resolved by the Senate (the House of Representatives concurring), That

SECTION 1. SENSE OF CONGRESS REGARDING GUARANTEED COVERAGE OF CHIROPRACTIC SERVICES UNDER THE MEDICARE+CHOICE PROGRAM.

(a) FINDINGS- Congress finds the following:

(1) In 1972, Congress included chiropractors in the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) through the definition of the term `physician' under section 1861(r) of such Act (42 U.S.C. 1395x(r)), which referred to the `treatment by means of manual manipulation of the spine (to correct a subluxation)'. Congress crafted this language to identify a specific chiropractic service using terminology that was unique to the chiropractic profession at that time. Such language shows that Congress was aware that patients required direct access to chiropractic care in order to provide this benefit under the medicare program.

(2) The traditional fee-for-service medicare program gave beneficiaries direct access to doctors of chiropractic for treatment by means of manual manipulation of the spine to correct a subluxation. The sole limitation, shared by all entities and health care providers under the medicare program, is the limitation outlined in section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)), which requires that items and services provided to medicare beneficiaries be reasonable and necessary in order for payment to be made for such items and services.

(3) Treatment by means of manual manipulation of the spine to correct a subluxation is uniquely chiropractic. Doctors of chiropractic are the only health care providers educated and trained to perform such a treatment.

(4) In 1982, Congress established provisions for making payments to health maintenance organizations and competitive medical plans under section 1876 of the Social Security Act (42 U.S.C. 1395mm). Such provisions directed all eligible organizations with contracts under the section to provide all benefits under part B of the medicare program to medicare beneficiaries enrolled with the organization. In promulgating regulations to carry out the section, the Health Care Financing Administration created a regulatory authority for eligible organizations with contracts under such section to specify which health care provider would furnish medicare benefits to an individual under the plan offered by the organization.

(5) In 1990, Congress directed the Health Care Financing Administration to study the extent to which eligible organizations under section 1876 of the Social Security Act (42 U.S.C. 1395mm) made chiropractic services available to medicare beneficiaries enrolled in a plan offered by the organization. Based on the findings of this study, the Secretary of Health and Human Services was required to make specific legislative and regulatory recommendations necessary to ensure access of medicare beneficiaries to chiropractic services. This study and subsequent recommendations have not been forthcoming.

(6) Historically, medicare beneficiaries that are chiropractic patients have encountered nearly total exclusion from chiropractic services once they enter into a plan offered by an eligible organization under section 1876 of the Social Security Act (42 U.S.C. 1395mm).

(7) The Balanced Budget Act of 1997 instituted part C of the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.), and section 1852(a)(1) of such Act (42 U.S.C. 1395w-22(a)(1)) required each Medicare+Choice plan to `provide those items and services . . . for which benefits are available under parts A and B'.

(8) As a covered service under part B of the medicare program, chiropractic care, which includes treatment by means of manual manipulation of the spine to correct a subluxation as performed by a doctor of chiropractic, is a covered service under part C of the medicare program.

(b) SENSE OF CONGRESS- It is the sense of Congress that--

(1) treatment by means of manual manipulation of the spine to correct a subluxation is a uniquely chiropractic service that Congress recognized in 1972 as a benefit under the medicare program under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.);

(2) it is the unequivocal intent of Congress to ensure that every individual enrolled in a Medicare+Choice plan under part C of title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et seq.) has access to all covered services under part B of the medicare program; and

(3) as a covered service under part B of the medicare program, treatment by means of manual manipulation of the spine to correct a subluxation provided by a doctor of chiropractic is a covered service for individuals enrolled in a Medicare+Choice plan under part C of the medicare program.

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