ACA, ICA & COCSA Respond to IFCO Regarding Medicare Proposals

The International Federation of Chiropractors and Organizations (IFCO) reached out to the American Chiropractic Association (ACA), International Chiropractors Association (ICA) and the Congress of Chiropractic State Associations (COCSA) to request information regarding their current proposals and efforts related to Medicare reform.

Specifically the IFCO asked to see any drafts or final copies of actual legislative language being proposed.

All three organizations - ACA, ICA and COCSA stated they do not have any actual legislative language drafted.

Despite this the ACA and the ICA have set up elaborate websites asking their members and non-members to sign petitions to reform Medicare.

The ACA is calling for removal of subluxation language from the law, for inclusion of all services under states’ scope of practice and for “full physician status”. In an e-mail responding to the IFCO’s request for copies of any legislative language being considered, the ACA’s Vice President for Public Policy and Advocacy John Falardeau DC stated:

Please allow me to answer your question and I apologize for the delay.  There is no bill or legislative language yet, but we are working with congress to allow doctors of chiropractic to provide services allowed under their state scopes of practice that are already being provided by other providers -- such as MDs, DOs and others – under Medicare.  We seek only a modification of existing statute to ensure that doctors of chiropractic are allowed to furnish and order “existing covered services” which they are currently lawfully permitted to do under state law.  To this end, ACA is dedicated, as called for by the ACA House of Delegates in 2015, to work with Congress to correct this disparity and, through grassroots and similar efforts, create a cacophony so loud that Washington must act in the best interests of Medicare beneficiaries and allow DCs to perform at the highest level of their licensure.

The ICA’s President George Curry DC responded by confirming that the ICA also has no legislative language at this time:

Specific language has not been crafted as of this time but is being worked on. The ICA rejects and will oppose all initiatives with language that attempts to remove “subluxation” from the Medicare law.

John LaMonica DC, President of COCSA also responded after several requests stating:

In your email you requested draft legislation from COCSA. The Congress of Chiropractic State Associations does not draft or introduce any legislation. With that said, we do not have a draft bill to forward to you. COCSA continues to work for State Associations by disseminating information about the profession to our member states. The current discussions in regards to Medicare, are based on current Social Security Act language, which is readily available to the public. If the IFCO has any thoughts, comments or suggestions on issues concerning the profession, please feel free to forward them to us so that we can review and disseminate any pertinent information to our member states.

LaMonica is also President of the New York Chiropractic Council and has been lobbying for merger between the Council and the New York State Chiropractic Association (NYSCA). NYSCA is for broad expansion of scope of practice in New York State.

The response from COCSA seems to contradict an earlier letter sent out by LaMonica to member state organizations wherein COCSA was voicing support for expansion of scope and even stated that they started a Task Force: 

See: COCSA Supports Scope Expansion in Medicare

Despite these organizations (ACA/ICA) setting up websites urging their members to sign petitions demanding fairness and scope expansion in Medicare, none of these organizations have developed specific legislative language to replace what is currently in Medicare and COCSA now seems to deny it is doing anything. 

The only organization that is proposing actual legislative language to address the Medicare issue is the IFCO.

Over a decade ago the International Federation of Chiropractors and Organizations (IFCO) participated in the development and promotion of the Chiropractic Medicare Freedom and Benefit Protection Act, along with a coalition of other organizations including the WCA and the ICA. The centerpiece of this Act was a revolutionary bill (HR 2560) that provided a definition of chiropractic that actually reflects what chiropractic has always been and what it should always be. 

The Bill was written by legislative staff from Representative Don Manzullo’s office, in collaboration with Christopher Kent DC, JD, President of the Foundation for Vertebral Subluxation and Board Member of the IFCO. 

The bill's purpose was to prevent duplication of services between chiropractors and medical doctors.  Contrary to what many in the profession such as the American Chiropractic Association (ACA) and the Chiropractic Summit Group want, not all chiropractors aspire to be medical doctors. Chiropractors have a unique role to play in the health care system – correcting subluxations -- and we are the only ones trained to do that. 

According to Christopher Kent, DC, JD, “This initiative does not seek to expand chiropractic practice to include a duplication of services already offered by other providers."  Rather than establish a new chiropractic program, such as is currently being recommended by the ACA, ICA and the Summit Group, our initiative establishes a separate chiropractic category.  "The language seeks to rectify the errors made in the original Medicare statute including chiropractic care," Kent explained.  "A significant error in this legislation was classifying D.C.s as limited scope physicians.  Thus, the chiropractic benefit was characterized as a physician service, permitting medical doctors and osteopaths to provide what is purportedly a chiropractic benefit." 

Dr. Kent also addressed the concerns regarding opt out language in Medicare. 

“The way to handle the opt out language is to simply add chiropractors to the existing list of practitioners who can opt out under 42 CFR 405.400 https://www.law.cornell.edu/cfr/text/42/405.400 . 42 CFR 405.415 addresses the requirements of private contracts under opt-out.” https://www.law.cornell.edu/cfr/text/42/405.415

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Thus far several organizations have endorsed the IFCO’s proposal including: 

• International Federation of Chiropractors & Organizations (IFCO)
• Florida Chiropractic Society
• Palmetto State Chiropractic Association
• Foundation for Vertebral Subluxation
• Chiropractic Society of Texas

All chiropractors focused on the location, analysis and correction of vertebral subluxation are urged to contact their state and national chiropractic associations and tell them to support the IFCO proposal and not to simply sign their name to a petition without knowing what legislative language is going to be submitted. 

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