I 

108TH CONGRESS 

1ST SESSION H. R. 2560

To amend title XVIII of the Social Security Act to clarify the scope of 

chiropractic services that may be furnished under the Medicare Program 

and that chiropractors are the only health care professionals qualified 

under that program to furnish those services. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 23, 2003

Mr. MANZULLO introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to clarify 

the scope of chiropractic services that may be furnished 

under the Medicare Program and that chiropractors are 

the only health care professionals qualified under that 

program to furnish those services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Chiropractic Medicare 

5 Freedom and Benefit Protection Act’’. 
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1 SEC. 2. MEDICARE CHIROPRACTIC SERVICES. 

2 (a) SEPARATE TREATMENT OF CHIROPRACTORS.—

3 Section 1861(r) of the Social Security Act (42 U.S.C. 

4 1395x(r)) is amended—

5 (1) by striking ‘‘, or (5)’’ and all that follows 

6 and inserting a period; and 

7 (2) by inserting ‘‘or’’ before ‘‘(4)’’. 

8 (b) INCLUSION OF CHIROPRACTIC SERVICES AS MED9 ICAL AND OTHER HEALTH SERVICES.—Section 

10 1861(s)(2) of such Act (42 U.S.C. 1395x(s)(2)) is amend11 ed—

12 (1) in subparagraph (U), by striking ‘‘and’’ at 

13 the end; 

14 (2) in subparagraph (V)(iii), by inserting ‘‘and’’ 

15 at the end; and 

16 (3) by adding at the end the following new sub17 paragraph: 

18 ‘‘(W) chiropractic services (as defined in sub19 section (ww)(1));’’. 

20 (c) SERVICES DESCRIBED.—Section 1861 of such 

21 Act (42 U.S.C. 1395x) is amended by adding at the end 

22 the following new subsection: 

23 ‘‘CHIROPRACTIC SERVICES; CHIROPRACTOR

24 ‘‘(ww)(1)(A) The term ‘chiropractic services’ means 

25 only for the purpose of subsections (s)(1) and (s)(2)(A) 

26 clinically necessary care by means of adjustment of the 
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1 spine (to correct a subluxation) performed by a chiro2 practor legally authorized to perform such adjustment by 

3 the State or jurisdiction in which such care is provided. 

4 ‘‘(B) For purposes of subparagraph (A), care is clini5 cally necessary when examination by a chiropractor dem6 onstrates objective evidence of a subluxation. Such exam7 ination may include—

8 ‘‘(i) physical examination; 

9 ‘‘(ii) radiological examination; and 

10 ‘‘(iii) specialized diagnostic instruments used in 

11 the practice of chiropractic. 

12 ‘‘(C) For purposes of subparagraph (A), the term 

13 ‘subluxation’ means a complex of any or all of the fol14 lowing articular changes that compromise neural integrity 

15 and may influence organ system function and general 

16 health: 

17 ‘‘(i) Functional. 

18 ‘‘(ii) Structural. 

19 ‘‘(iii) Pathological. 

20 ‘‘(2) The term ‘chiropractor’ means an individual who 

21 is licensed as a chiropractor by the State (or in a State 

22 which does not license chiropractors as such, is legally au23 thorized to perform the services of a chiropractor in the 

24 jurisdiction in which he performs such services), and who 
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1 meets uniform minimum standards promulgated by the 

2 Secretary.’’. 

3 (d) PAYMENT AS PHYSICIANS’ SERVICES.—Section 

4 1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is 

5 amended by inserting ‘‘(2)(W),’’ after ‘‘(2)(S),’’. 

6 (e) CONFORMING AMENDMENTS.—(1) Section 

7 1834(m) of such Act (42 U.S.C. 1395m(m)) is amended 

8 by inserting ‘‘, a chiropractor (as defined in section 

9 1861(ww)(2))’’ after ‘‘a physician (as defined in section 

10 1861(r))’’. 

11 (2) Section 1852(j)(3)(D) of such Act (42 U.S.C. 

12 1395w–22(j)(3)(D)) is amended by inserting ‘‘, a chiro13 practor (as defined in section 1861(ww)(2))’’ after ‘‘a phy14 sician (as defined in section 1861(r))’’. 

15 (3) Section 1802(b)(5)(C) of such Act (42 U.S.C. 

16 1395a(b)(5)(C) is amended to read as follows: 

17 ‘‘(C) PRACTITIONER.—The term ‘practi18 tioner’ has the meaning given such term by sec19 tion 1842(b)(18)(C), and includes ‘chiropractor’ 

20 as that term is defined in continuing care re21 tirement community 1861(ww)(2).’’. 

22 (4) Section 1832(a)(2)(C) of such Act (42 U.S.C. 

23 1395k(a)(2)(C)) is amended by inserting before the term 

24 ‘‘outpatient physical therapy services’’ the following: 

25 ‘‘chiropractic services as defined in section 1861(ww)(1)’’. 
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1 (5) Section 1835(a)(2) of such Act (42 U.S.C. 

2 1395n(a)(2)) is amended by inserting after ‘‘physician’’ 

3 the first place it appears the following: ‘‘or for purposes 

4 of chiropractic services (as defined in section 

5 1861(ww)(1)), a chiropractor,’’. 

6 (6) Section 1842(a) of such Act (42 U.S.C. 

7 1395u(a)) is amended by inserting ‘‘chiropractic services 

8 (as defined in section 1861(ww)(1)’’ after ‘‘physician’s 

9 services’’. 

10 (7) Section 1842(h) of such Act (42 U.S.C. 

11 1395u(h)) is amended by inserting ‘‘or chiropractor (as 

12 defined in section 1861(ww)(2))’’ after ‘‘physician’’ each 

13 place it appears. 

14 (8) Section 1842(r) of such Act (42 U.S.C. 1395u(r)) 

15 is amended by inserting ‘‘chiropractor (as defined in sec16 tion 1861(ww)(2))’’ after ‘‘physician’’. 

17 (9) Section 1847(d) of such Act (42 U.S.C. 1395w–

18 3(d)) is amended by inserting ‘‘chiropractic services (as 

19 defined in section 1861(ww)(1))’’ after ‘‘physicians’ serv20 ices’’. 

21 (10) Section 1852 of such Act (42 U.S.C. 1395w–

22 22) is amended by inserting ‘‘or chiropractor (as defined 

23 in section 1861(ww)(2))’’ after ‘‘physician’’ each place it 

24 appears. 
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1 (11) Section 1862(a)(20) of such Act (42 U.S.C. 

2 1395y(a)(20)) is amended by inserting ‘‘or chiropractic 

3 services (as defined in section 1861(ww)(1))’’ after ‘‘physi4 cian’s professional services’’. 

5 (12) Section 1866(a)(1)(N)(ii) of such Act (42 

6 U.S.C. 1395cc(a)(1)(N)(ii)) is amended by inserting ‘‘or 

7 chiropractor (as defined in section 1861(ww)(2))’’ after 

8 ‘‘physician’’ each place it appears. 

9 (13) Section 1868(a) of such Act (42 U.S.C. 

10 1395ee(a)) is amended by inserting ‘‘and chiropractor (as 

11 defined in section 1861(ww)(2))’’ after ‘‘physician’’. 

12 (14) Section 1869(b)(1)(F) of such Act (42 U.S.C. 

13 1395ff(b)(1)(F)) is amended by inserting ‘‘or chiropractor 

14 (as defined in section 1861(ww)(2))’’ after ‘‘physician’’. 

15 (15) Section 1876(b)(2)(i) of such Act (42 U.S.C. 

16 1395mm(b)(2)(i)) is amended by inserting ‘‘or chiro17 practic services (as defined in section 1861(ww)(1))’’ after 

18 ‘‘physicians’ services’’. 

19 (16) Section 1877 of such Act (42 U.S.C. 1395nn) 

20 is amended—

21 (1) in subsection (a)(1)(A) by inserting ‘‘or chi22 ropractor (as defined in section 1861(ww)(2))’’ after 

23 ‘‘physician’’; and 

24 (2) in subsection (b)(1)—
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1 (A) in the heading to read as follows: 

2 ‘‘PHYSICIANS’ AND CHIROPRACTIC SERVICES’’; 

3 and 

4 (B) by inserting ‘‘or chiropractic services 

5 (as defined in section 1861(ww)(1))’’ after ‘‘in 

6 section 1861(q))’’. 

7 (17) Section 1887(a)(1)(A) of such Act (42 U.S.C. 

8 1395xx(a)(1)(A)) is amended by inserting ‘‘or chiropractic 

9 services (as defined in section 1861(ww)(1))’’ after ‘‘which 

10 constitute professional medical’’. 

11 (18) Section 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

12 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘chiropractic 

13 services (as defined in section 1861(ww)(1)),’’ after ‘‘phy14 sicians’ services’’. 

15 (19) Section 1891(a)(2)(F) of such Act (42 U.S.C. 

16 1395bbb(a)(2)(F)) is amended by inserting before the pe17 riod at the end the following: ‘‘or chiropractor (as defined 

18 in section 1861(ww)(2))’’.

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