```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. Con. Res. 32 Introduced in Senate (IS)]

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.

    Resolved by the Senate (the House of Representatives concurring), 
That

SECTION 1. SENSE OF CONGRESS REGARDING GUARANTEED COVERAGE OF 
              CHIROPRACTIC SERVICES UNDER THE MEDICARE+CHOICE PROGRAM.

    (a) Findings.--Congress finds the following:
            (1) In 1972, Congress included chiropractors in the 
        medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.) through the definition of the term 
        ``physician'' under section 1861(r) of such Act (42 U.S.C. 
        1395x(r)), which referred to the ``treatment by means of manual 
        manipulation of the spine (to correct a subluxation)''. 
        Congress crafted this language to identify a specific 
        chiropractic service using terminology that was unique to the 
        chiropractic profession at that time. Such language shows that 
        Congress was aware that patients required direct access to 
        chiropractic care in order to provide this benefit under the 
        medicare program.
            (2) The traditional fee-for-service medicare program gave 
        beneficiaries direct access to doctors of chiropractic for 
        treatment by means of manual manipulation of the spine to 
        correct a subluxation. The sole limitation, shared by all 
        entities and health care providers under the medicare program, 
        is the limitation outlined in section 1862(a)(1) of the Social 
        Security Act (42 U.S.C. 1395y(a)(1)), which requires that items 
        and services provided to medicare beneficiaries be reasonable 
        and necessary in order for payment to be made for such items 
        and services.
            (3) Treatment by means of manual manipulation of the spine 
        to correct a subluxation is uniquely chiropractic. Doctors of 
        chiropractic are the only health care providers educated and 
        trained to perform such a treatment.
            (4) In 1982, Congress established provisions for making 
        payments to health maintenance organizations and competitive 
        medical plans under section 1876 of the Social Security Act (42 
        U.S.C. 1395mm). Such provisions directed all eligible 
        organizations with contracts under the section to provide all 
        benefits under part B of the medicare program to medicare 
        beneficiaries enrolled with the organization. In promulgating 
        regulations to carry out the section, the Health Care Financing 
        Administration created a regulatory authority for eligible 
        organizations with contracts under such section to specify 
        which health care provider would furnish medicare benefits to 
        an individual under the plan offered by the organization.
            (5) In 1990, Congress directed the Health Care Financing 
        Administration to study the extent to which eligible 
        organizations under section 1876 of the Social Security Act (42 
        U.S.C. 1395mm) made chiropractic services available to medicare 
        beneficiaries enrolled in a plan offered by the organization. 
        Based on the findings of this study, the Secretary of Health 
        and Human Services was required to make specific legislative 
        and regulatory recommendations necessary to ensure access of 
        medicare beneficiaries to chiropractic services. This study and 
        subsequent recommendations have not been forthcoming.
            (6) Historically, medicare beneficiaries that are 
        chiropractic patients have encountered nearly total exclusion 
        from chiropractic services once they enter into a plan offered 
        by an eligible organization under section 1876 of the Social 
        Security Act (42 U.S.C. 1395mm).
            (7) The Balanced Budget Act of 1997 instituted part C of 
        the medicare program under title XVIII of the Social Security 
        Act (42 U.S.C. 1395w-21 et seq.), and section 1852(a)(1) of 
        such Act (42 U.S.C. 1395w-22(a)(1)) required each 
        Medicare+Choice plan to ``provide those items and services . . 
        .  for which benefits are available under parts A and B''.
            (8) As a covered service under part B of the medicare 
        program, chiropractic care, which includes treatment by means 
        of manual manipulation of the spine to correct a subluxation as 
        performed by a doctor of chiropractic, is a covered service 
        under part C of the medicare program.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) treatment by means of manual manipulation of the spine 
        to correct a subluxation is a uniquely chiropractic service 
        that Congress recognized in 1972 as a benefit under the 
        medicare program under part B of title XVIII of the Social 
        Security Act (42 U.S.C. 1395j et seq.);
            (2) it is the unequivocal intent of Congress to ensure that 
        every individual enrolled in a Medicare+Choice plan under part 
        C of title XVIII of the Social Security Act (42 U.S.C. 1395w-21 
        et seq.) has access to all covered services under part B of the 
        medicare program; and
            (3) as a covered service under part B of the medicare 
        program, treatment by means of manual manipulation of the spine 
        to correct a subluxation provided by a doctor of chiropractic 
        is a covered service for individuals enrolled in a 
        Medicare+Choice plan under part C of the medicare program.
                                 <all>
```