H.R. 1046

ISSUE:	Amend Title XVIII of the Social Security Act to Provide Reimbursement for All Physician Services for Doctors of Chiropractic, within the Scope of their License, Under the Medicare Program. As amended in 1972, the Medicare statute defines doctors of chiropractic (D.C.s) as "physicians", but only for the purpose of "manual manipulation of the spine to correct a subluxation" (section 1861(r)(5) of the Social Security Act). The practical result of this outdated definition is to deny Medicare beneficiaries' any real choice of most services that doctors of chiropractic are licensed to perform. It offers beneficiaries an extremely limited benefit that is both insufficient for the delivery of proper care and difficult to obtain.
STATUS:	On March 10, 1999, Representative Wes Watkins (R-OK) introduced H.R. 1046, "Chiropractic Patients' Freedom of Choice Act." This legislation would grant Medicare beneficiaries access to any service presently covered under Medicare that doctors of chiropractic are licensed to perform under state law. Click here for a copy of the legislation.
ACTION NEEDED:	Members of Congress are requested to co-sponsor the Watkins bill - H.R. 1046 and work to ensure its inclusion in Medicare reform legislation, which is expected to pass through the following key committees of jurisdiction: House Ways & Means Committee, House Commerce Committee and Senate Finance Committee.
POLICY RATIONALE:	H.R. 1046 would expand beneficiaries' access to covered services while at the same time significantly improving their choice of licensed health care providers. Current Medicare law is blatantly anti-competitive. It bars doctors of chiropractic from fully competing within the Medicare system and eliminates a source of provider competition that could reduce cost. H.R. 1046 would assist in correcting this problem. In recognition of the need to control Medicare costs, this proposal would not add or require coverage of a single new service under the program. Rather, it would simply provide beneficiaries access to currently covered Medicare services when performed by D.C.s. For example, Medicare currently covers diagnostic x-ray services when performed by medical radiologists. Under this proposal, patients would receive coverage for that same service when furnished by a D.C., since the performance of x-rays falls within a D.C.'s legal scope of practice. Wherever there is overlap between the services Medicare covers and the services D.C.s are licensed to perform, beneficiaries would enjoy the ability to obtain care from a chiropractor. Expanding access to a range of reimbursed services provided by chiropractors (within their scope of practice) would expand beneficiary access to care in rural and medically underserved areas where physician and primary care services are not always readily available. Under Section 1802 of the Social Security Act, Medicare beneficiaries are guaranteed the freedom to select a physician of their choice. Unfortunately, limitations on the services of doctors of chiropractic erode the effectiveness of this guarantee. Chiropractic care is highly cost-effective, particularly for low back pain -- a malady afflicting up to 80% of Americans at some point in their lives and costing at least $20 billion a year in direct medical costs. Increasing access to cost-effective, non-surgical care for millions of seniors citizens who suffer from this condition could significantly benefit the Medicare program and decrease cost.