IV

106TH CONGRESS

1ST SESSION H. CON. RES. 62

Expressing the sense of Congress regarding the guaranteed coverage of

chiropractic services under the Medicare+Choice program.

IN THE HOUSE OF REPRESENTATIVES

MARCH 18, 1999

Mrs. CUBIN submitted the following concurrent resolution; which was referred

to the Committee on 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

CONCURRENT RESOLUTION

Expressing the sense of Congress regarding the guaranteed

coverage of chiropractic services under the

Medicare+Choice program.

1 Resolved by the House of Representatives (the Senate

2 concurring),

3 SECTION 1. SENSE OF CONGRESS REGARDING GUARAN4 TEED COVERAGE OF CHIROPRACTIC SERV5 ICES UNDER THE MEDICARE+CHOICE PRO6 GRAM.

7 (a) FINDINGS.—The Congress finds the following:
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1 (1) In 1972 Congress included chiropractors

2 under the medicare part B definition of physician to

3 provide treatment by means of manual manipulation

4 of the spine to correct a subluxation. This language

5 was crafted to identify a specific chiropractic service

6 using terminology that at the time was unique to

7 chiropractic. No other medical profession used the

8 term manual manipulation of the spine to correct a

9 subluxation. Congress was aware in 1972 that pa10 tients required direct access to chiropractic if the

11 benefit was to have any practical meaning.

12 (2) Under traditional fee-for-service medicare,

13 beneficiaries were given direct access to doctors of

14 chiropractic for this benefit. The sole limitation,

15 shared by all medicare providers, is the limitation

16 outlined in section 1862(a)(1) of the Social Security

17 Act, which requires medicare to pay only for those

18 services that are determined to be reasonable and

19 necessary.

20 (3) Treatment by manual manipulation of the

21 spine to correct a subluxation is uniquely chiro22 practic. Doctors of chiropractic are the only pro23 viders educated and trained to perform the treat24 ment of manual manipulation of the spine to correct

25 a subluxation.
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1 (4) In 1982 Congress established the Medicare

2 HMO/CMP program directing that all HMO’s pro3 vide all part B benefits to medicare beneficiaries. In

4 promulgating regulations, the Health Care Financ5 ing Administration created a regulatory authority

6 for HMO’s to specify which provider would furnish

7 medicare benefits.

8 (5) In 1990 Congress directed the Health Care

9 Financing Administration to study the extent to

10 which medicare HMO’s make chiropractic services

11 available to medicare beneficiaries. Based on the

12 findings of this study, the Secretary of Health and

13 Human Services was required to make specific legis14 lative and regulatory recommendations necessary to

15 ensure access to chiropractic services. The study and

16 subsequent recommendations have not been forth17 coming.

18 (6) Historically, chiropractic patients in medi19 care have encountered near total exclusion from

20 chiropractic services once they enter into a medicare

21 HMO.

22 (7) The Balanced Budget Act of 1997, which

23 instituted part C of medicare, establishes that each

24 Medicare+Choice plan ‘‘shall provide those items
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1 and services... for which benefits are available

2 under parts A and B’’.

3 (8) As a covered service under part B of medi4 care, chiropractic care which includes treatment by

5 means of manual manipulation of the spine to cor6 rect a subluxation as performed by a doctor of chiro7 practic, should be a covered service under part C.

8 (b) SENSE OF CONGRESS.—It is the sense of Con9 gress that—

10 (1) treatment by means of manual manipulation

11 of the spine to correct a subluxation is a uniquely

12 chiropractic service, which Congress recognized in

13 1972 as a medicare part B benefit;

14 (2) it is the unequivocal intent of Congress to

15 ensure that every Medicare+Choice beneficiary has

16 access to all services covered under the original part

17 B medicare fee-for-service program; and

18 (3) as a covered medicare part B service, treat19 ment by means of manual manipulation of the spine

20 to correct a subluxation provided by a doctor of

21 chiropractic is a guaranteed service for beneficiaries

22 under the new Medicare+Choice program.

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