Federal Employee Program (FEP)
A decision by ACA, the Virginia Chiropractic Association (VCA) and the other chiropractic plaintiffs in 2001 to remove the national Blue Cross Blue Shield Association (BCBSA) from a federal lawsuit against Trigon Blue Cross Blue Shield paved the way for significant and substantive discussions between ACA and BCBSA on a range of insurance-related issues. As a direct result of these settlement negotiations, BCBSA agreed to include a chiropractic manipulation benefit with limited x-rays in the BCBSA FEP basic and standard options. This inclusion brought about a welcome change in status for doctors of chiropractic, as they became formally recognized as “covered providers” under both the BCBSA FEP basic and standard options. Under the BCBSA FEP, “covered providers” are eligible to be reimbursed for providing physical therapy services, if such services lie within their respective state scope of licensure.
Since 2001 the ACA has lobbied for increased coverage for chiropractic care under the Federal Employee Program. In 2015 under both the standard and basic options, chiropractic manipulations and physical therapy services are eligible for reimbursement.
FECA Chiropractic Benefits
The Federal Employees’ Compensation Act (FECA) manages the payment of workers’ compensation benefits to personnel of all branches of the United States government. Under FECA the definition of “physician” includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, osteopathic practitioners, and doctors of chiropractic within the scope of their practice as defined by state law.
Reimbursable services for doctors of chiropractic (DCs) consist of, “treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist.” Subluxation, as defined by the Office of Workers’ Compensation Programs (OWCP), is “an incomplete dislocation, offcentering, misalignment, fixation or abnormal spacing of the vertebrae.” FECA restricts DC’s reimbursable services to treatment for the correction of spinal subluxation; however, any tests necessary to diagnose the subluxation are also payable.
A DC may interpret his/her own x-rays to determine if they confirm the diagnosis of subluxation and to decide if a period of disability resulting from that condition is necessary. The OWCP will not necessarily require that the x-ray be submitted, but the report must be available upon request. A report from a doctor of chiropractic must contain a diagnosis of “spinal subluxation as demonstrated by x-ray to exist,” in order for the OWCP to consider payment of the bill. A DC may provide services in the nature of physical therapy; however, these must be under the direction of and prescribed by a qualified physician.
Should a claimant request to change from the care of a medical doctor to that of a doctor of chiropractic, the claims examiner should consult the district medical advisor to determine whether the services of the DC would qualify as medical treatment under the Act, and whether the treatment is considered reasonable and necessary.
Questions? Contact ACA.