Medicare: Patient Access to Chiropractic
Legislation championed by ACA to increase Medicare coverage of chiropractic services has been introduced in the U.S. House of Representatives.
The Chiropractic Medicare Coverage Modernization Act of 2019 (H.R. 3654) would allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, evaluation and management services, diagnostic imaging and utilization of other non-drug approaches that have become an important strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse.
- Appropriately defines a Doctor of Chiropractic (DC) as a “physician” in the Medicare program.
- Provides patient access to all Medicare-covered benefits allowable under a chiropractor’s state licensure.
- Requires that DCs complete a documentation webinar.
Is bipartisan legislation, introduced by Reps. Brian Higgins (D-N.Y.) and Tom Reed (R-N.Y.).
Updates Take Action Resources
H.R. 3654 FAQ
What does this legislation mean for me and my Medicare patients?
Simply put, the bill, and ACA’s entire Medicare initiative, is to ensure patient access to all Medicare-covered services that DCs are licensed to provide. Again, it is important to note that our initiative adds no new services. It only allows access to those current Medicare benefits that chiropractors are licensed to provide. The current statute that governs patient access to Medicare has been in place since 1972. It’s antiquated and does not reflect the acceptance of chiropractic into mainstream health care. In addition, it limits patient choice, which is a highlight of our educational efforts with legislators.
What happens next?
The bill needs your support! Members of Congress want to hear from YOU, the constituent, more than anyone else. We are asking that every DC contact their Members of Congress and urge them to cosponsor H.R. 3654. It is critical that Members of Congress hear a pro-chiropractic message directly from constituents, the people they represent!
Resources, toolkits and templates are available for you to use in your communication with policymakers and the general public. We are here to support you and the Government Relations team is available to help or answer any questions you may have.
Help your legislators understand the importance of increased patient access to chiropractic.
Which codes are covered by the proposed bill?
If and when bills become laws, the federal rulemaking process determines implementation. Details related to codes, reimbursement and billing will not take place until then. Be advised, that under H.R. 3654, DCs would be paid under the Medicare physician fee schedule for all services listed thereon which are authorized under their state scope of practice in the same manner MDs are paid. Also, be aware that the Medicare physician fee schedule is based on the relative value of the various services and not on the type of physician providing the service. At a minimum, if passed in its current form, the legislation would include evaluation and management (E&M) codes, therapy codes including but not limited to CMT codes, and certain diagnostic and x-ray codes.
A question I keep getting from members of congress and their staff is: “So, what does it cost?”
The bill does not add new services to Medicare, it simply allows for patient choice when selecting a provider. H.R. 3654 allows patients to choose a chiropractor for Medicare-covered services allowed by their state.
The Congressional Budget Office (CBO) may provide a ‘score’ for the bill, which is an estimate of the expected costs should the bill become law. The CBO has not yet scored H.R. 3654. Recent studies show that access to chiropractic care can save money for the healthcare system, particularly when compared to prescriptions and surgery. Click here for more information about recent studies on the cost-effectiveness of chiropractic care.
Is the option to opt out of Medicare included in the new bill?
This bill is intended to give patients greater access to chiropractic services in Medicare. The first step is to put chiropractors on par with all other physicians within the Medicare system. This lays the foundation for patients to receive covered services from their chiropractors that are allowed under their state licensure, and makes it possible to work toward other improvements. Opt-out options will require further legislation after full access is achieved.
The bill mentions completing an ‘educational documentation webinar.’ What does that mean?
This bill means that chiropractors will be able to bill Medicare for the full scope of their services allowed by their state, provided they have completed documentation training in the form of a one-time webinar or similar process, as determined by the Centers for Medicare and Medicaid Services (CMS).