Coalition Forms to Protect Unique Lexicon & Services of Chiropractic Profession in Medicare

Several organizations representing the conservative, traditional faction of chiropractic focused on the location, analysis and correction of vertebral subluxation have come together to endorse legislative language for Medicare that would allow chiropractors to be paid for exams, x-rays, the adjustment, instrumentation and other diagnostic services and add the ability for chiropractors to opt out of Medicare.

The following organizations have joined together in a coalition to support the legislative language:

• The International Federation of Chiropractors and Organizations (IFCO)
• The Foundation for Vertebral Subluxation (FVS)
• The Chiropractic Society of Texas (CST)
• The Florida Chiropractic Society (FCS)
• The Palmetto State Chiropractic Association (PSCA)
• The Chiropractic Fellowship of Pennsylvania (CFOP)
• The Sustainability Group (SG)

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 World Chiropractic Alliance and the International Chiropractors Association (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."

Recent efforts by the Chiropractic Summit Group, led by the American Chiropractic Association (ACA), seek to position chiropractors with full physician status, expand scope and even remove mention of vertebral subluxation from the legislative language of Medicare.

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The International Chiropractor’s Association (ICA) has developed their own Medicare petition in an effort to “end discrimination in Medicare”. A review of the ICA’s petition and related websites reveals that the ICA is still lending support and promoting the Chiropractic Summit Group’s efforts while at the same time promoting their own petition. The bigger concern is that according to ICA’s President, George Curry DC, even though the ICA is urging chiropractors to sign the petition to end discrimination in Medicare, they have not yet developed any legislative language to replace what is there currently. Similarly, the ACA has not yet developed any legislative language according to John Falardeau DC, ACA's senior VP of public policy and advocacy.

Both the ICA and ACA are expecting chiropractors to endorse something which does not yet exist. Will the ICA keep subluxation in but propose expanding the scope of services under Medicare to include anything allowable by state law? This is exactly what the ACA and the rest of the Chiropractic Cartel wants.   

No Opt Out

In addition to concerns about the ICA/Summit proposal regarding scope expansion, drugs, and the sidelining of subluxation is the absence of an OPT OUT option. The ICA/Summit approach has none. 

Coalition Proposal 

The legislative language being offered by the Coalition would solve these problems and provides a clear option for the subluxation faction of the profession to get behind.

As of press time the ICA had not yet made a decision to endorse the language.   

Here is the language related to subluxation in the proposed legislation:

(B) For purposes of subparagraph (A), care is clinically necessary when examination by a chiropractor demonstrates objective evidence of a subluxation. Such examination may include—

(i) physical examination;

(ii) radiological examination; and

(iii) specialized diagnostic instruments used in the practice of chiropractic.

(C) For purposes of subparagraph (A), the term ‘subluxation’ means a complex of any or all of the following articular changes that compromise neural integrity and may influence organ system function and general health:

(i) Functional.

(ii) Structural.

(iii) Pathological.

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

This is the Medicare legislation that’s needed now.

We need legislation that allows chiropractors to practice as chiropractors and be reimbursed for providing the chiropractic benefit as opposed to legislation that expands the scope to full physician status. Such efforts are clearly meant to expand the definition of chiropractic, expand the scope, allow for duplication of services, position chiropractors as primary care providers instead of portal of entry, and change the very nature of the profession.

We welcome other state and national organizations to join with us and clarify the role of chiropractic in health care.

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