III

106TH CONGRESS

1ST SESSION S. CON. RES. 32

Expressing the sense of Congress regarding the guaranteed coverage of

chiropractic services under the Medicare+Choice program.

IN THE SENATE OF THE UNITED STATES

MAY 17 (legislative day, MAY 14), 1999

Mr. CONRAD (for himself, Mr. HARKIN, Mr. GRASSLEY, and Mr. HATCH) submitted the following concurrent resolution; which was referred to the

Committee on Finance

CONCURRENT RESOLUTION

Expressing the sense of Congress regarding the guaranteed

coverage of chiropractic services under the

Medicare+Choice program.

1 Resolved by the Senate (the House of Representatives

2 concurring), That

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

7 (a) FINDINGS.—Congress finds the following:

8 (1) In 1972, Congress included chiropractors in

9 the medicare program under title XVIII of the So-
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•SCON 32 IS

1 cial Security Act (42 U.S.C. 1395 et seq.) through

2 the definition of the term ‘‘physician’’ under section

3 1861(r) of such Act (42 U.S.C. 1395x(r)), which re4 ferred to the ‘‘treatment by means of manual manip5 ulation of the spine (to correct a subluxation)’’. Con6 gress crafted this language to identify a specific

7 chiropractic service using terminology that was

8 unique to the chiropractic profession at that time.

9 Such language shows that Congress was aware that

10 patients required direct access to chiropractic care in

11 order to provide this benefit under the medicare pro12 gram.

13 (2) The traditional fee-for-service medicare pro14 gram gave beneficiaries direct access to doctors of

15 chiropractic for treatment by means of manual ma16 nipulation of the spine to correct a subluxation. The

17 sole limitation, shared by all entities and health care

18 providers under the medicare program, is the limita19 tion outlined in section 1862(a)(1) of the Social Se20 curity Act (42 U.S.C. 1395y(a)(1)), which requires

21 that items and services provided to medicare bene22 ficiaries be reasonable and necessary in order for

23 payment to be made for such items and services.

24 (3) Treatment by means of manual manipula25 tion of the spine to correct a subluxation is uniquely
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1 chiropractic. Doctors of chiropractic are the only

2 health care providers educated and trained to per3 form such a treatment.

4 (4) In 1982, Congress established provisions for

5 making payments to health maintenance organiza6 tions and competitive medical plans under section

7 1876 of the Social Security Act (42 U.S.C.

8 1395mm). Such provisions directed all eligible orga9 nizations with contracts under the section to provide

10 all benefits under part B of the medicare program

11 to medicare beneficiaries enrolled with the organiza12 tion. In promulgating regulations to carry out the

13 section, the Health Care Financing Administration

14 created a regulatory authority for eligible organiza15 tions with contracts under such section to specify

16 which health care provider would furnish medicare

17 benefits to an individual under the plan offered by

18 the organization.

19 (5) In 1990, Congress directed the Health Care

20 Financing Administration to study the extent to

21 which eligible organizations under section 1876 of

22 the Social Security Act (42 U.S.C. 1395mm) made

23 chiropractic services available to medicare bene24 ficiaries enrolled in a plan offered by the organiza25 tion. Based on the findings of this study, the Sec-
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1 retary of Health and Human Services was required

2 to make specific legislative and regulatory rec3 ommendations necessary to ensure access of medi4 care beneficiaries to chiropractic services. This study

5 and subsequent recommendations have not been

6 forthcoming.

7 (6) Historically, medicare beneficiaries that are

8 chiropractic patients have encountered nearly total

9 exclusion from chiropractic services once they enter

10 into a plan offered by an eligible organization under

11 section 1876 of the Social Security Act (42 U.S.C.

12 1395mm).

13 (7) The Balanced Budget Act of 1997 insti14 tuted part C of the medicare program under title

15 XVIII of the Social Security Act (42 U.S.C. 1395w–

16 21 et seq.), and section 1852(a)(1) of such Act (42

17 U.S.C. 1395w–22(a)(1)) required each

18 Medicare+Choice plan to ‘‘provide those items and

19 services... for which benefits are available under

20 parts A and B’’.

21 (8) As a covered service under part B of the

22 medicare program, chiropractic care, which includes

23 treatment by means of manual manipulation of the

24 spine to correct a subluxation as performed by a
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1 doctor of chiropractic, is a covered service under

2 part C of the medicare program.

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that—

5 (1) treatment by means of manual manipulation

6 of the spine to correct a subluxation is a uniquely

7 chiropractic service that Congress recognized in

8 1972 as a benefit under the medicare program

9 under part B of title XVIII of the Social Security

10 Act (42 U.S.C. 1395j et seq.);

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

12 ensure that every individual enrolled in a

13 Medicare+Choice plan under part C of title XVIII

14 of the Social Security Act (42 U.S.C. 1395w–21 et

15 seq.) has access to all covered services under part B

16 of the medicare program; and

17 (3) as a covered service under part B of the

18 medicare program, treatment by means of manual

19 manipulation of the spine to correct a subluxation

20 provided by a doctor of chiropractic is a covered

21 service for individuals enrolled in a

22 Medicare+Choice plan under part C of the medicare

23 program.

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