As you are aware, Congress passed the One Big Beautiful Bill Act (OBBBA) today and it is now on its way to the president’s desk. The bill touches almost every part of federal spending. Beyond the tax and immigration sections, there are provisions that affect chiropractors as well. Let’s take a look at those.
Reimbursement
The bill provides a 2.5 percent adjustment to the Medicare Physician Fee Schedule for Calendar Year 2026 ONLY; this adjustment would result in about a 0.9 percent increase for chiropractors. There is nothing in the bill that addresses years 2027 and beyond.
Artificial Intelligence (AI)
There is nothing in the bill on implementing AI to review Medicare claims; however, late last month the Center for Medicare and Medicaid Innovation released a new model (the Wasteful and Inappropriate Services Reduction – or WISeR — Model) wherein they would partner “with companies that have experience implementing technology-enhanced prior authorization with other payers, including MA plans, as model participants. Under the model, participants will implement and streamline prior authorizations to ensure that select services that are provided and paid for are clinically appropriate, evidence-based, and consistent with Medicare Fee for Service requirements.” While this new program will initially only apply to processes for services including skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis, AI for Medicare claim reviews will only grow in time.
Pass-throughs
The OBBBA establishes an individual-level limitation of partnership or S corporations’ owner’s separately stated share of pass-through entity taxes (PTETs). The PTET limitation allows an individual pass-through entity owner to deduct any unused portion of their state and local tax cap plus the greater of $40,000 of their allocation of the PTET or 50 percent of their allocation of the PTET. This provision applies to taxable years beginning Jan. 1, 2026. This is great progress compared with the zero deduction offered by the House version of the OBBBA, but obviously not the full deduction ACA and our coalition partners worked for. We are still viewing this as a win because the Senate would have left the PTET deduction at zero if not for our outreach.
Telehealth and High-deductible Plans
The version the Senate passed today would revive and make permanent a rule allowing high-deductible health plans to cover telehealth visits before individuals on the plans have hit their deductibles. As you recall, Congress began allowing the virtual doctor visits with the 2020 pandemic relief law known as the CARES Act and extended the coverage through the end of last year, when the extension expired.
Proponents claim around 90 percent of high-deductible health plans used the telehealth provision last year, up from more than 80 percent in 2021 and more than 60 percent in April 2020. More than 30 million Americans are enrolled in high-deductible health plans. Their preventive care is fully covered, but they must meet a deductible of at least $1,650 for individual coverage and $3,300 for family coverage before their insurance kicks in.
What’s Next?
There are discussions happening within Congress already that bipartisan health measures will start to be considered later in the fall. With the Chiropractic Medicare Coverage Modernization Act (H.R. 539/S. 106) filling that description, be assured ACA will be pushing for that bill to rise to the top of the agenda for consideration. You can play an important role in getting this legislation passed by contacting your representative and senators via the ACA Legislative Action Center.
John Falardeau is senior vice president of public policy and advocacy at the American Chiropractic Association.
