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.
Resolved by the House of Representatives (the Senate
concurring),
SECTION 1. SENSE OF CONGRESS REGARDING GUARAN-
TEED COVERAGE OF CHIROPRACTIC SERV-
ICES UNDER THE MEDICARE+CHOICE PRO-
GRAM.
(a) FINDINGS.—The Congress finds the following:
•HCON 62 IH
(1) In 1972 Congress included chiropractors
under the medicare part B definition of physician to
provide treatment by means of manual manipulation
of the spine to correct a subluxation. This language
was crafted to identify a specific chiropractic service
using terminology that at the time was unique to
chiropractic. No other medical profession used the
term manual manipulation of the spine to correct a
subluxation. Congress was aware in 1972 that pa-
tients required direct access to chiropractic if the
benefit was to have any practical meaning.
(2) Under traditional fee-for-service medicare,
beneficiaries were given direct access to doctors of
chiropractic for this benefit. The sole limitation,
shared by all medicare providers, is the limitation
outlined in section 1862(a)(1) of the Social Security
Act, which requires medicare to pay only for those
services that are determined to be reasonable and
necessary.
(3) Treatment by manual manipulation of the
spine to correct a subluxation is uniquely chiro-
practic. Doctors of chiropractic are the only pro-
viders educated and trained to perform the treat-
ment of manual manipulation of the spine to correct
a subluxation.
•HCON 62 IH
(4) In 1982 Congress established the Medicare
HMO/CMP program directing that all HMO’s pro-
vide all part B benefits to medicare beneficiaries. In
promulgating regulations, the Health Care Financ-
ing Administration created a regulatory authority
for HMO’s to specify which provider would furnish
medicare benefits.
(5) In 1990 Congress directed the Health Care
Financing Administration to study the extent to
which medicare HMO’s make chiropractic services
available to medicare beneficiaries. Based on the
findings of this study, the Secretary of Health and
Human Services was required to make specific legis-
lative and regulatory recommendations necessary to
ensure access to chiropractic services. The study and
subsequent recommendations have not been forth-
coming.
(6) Historically, chiropractic patients in medi-
care have encountered near total exclusion from
chiropractic services once they enter into a medicare
HMO.
(7) The Balanced Budget Act of 1997, which
instituted part C of medicare, establishes that each
Medicare+Choice plan ‘‘shall provide those items
•HCON 62 IH
and services . . .
for which benefits are available
under parts A and B’’.
(8) As a covered service under part B of medi-
care, chiropractic care which includes treatment by
means of manual manipulation of the spine to cor-
rect a subluxation as performed by a doctor of chiro-
practic, should be a covered service under part C.
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that—
(1) treatment by means of manual manipulation
of the spine to correct a subluxation is a uniquely
chiropractic service, which Congress recognized in
1972 as a medicare part B benefit;
(2) it is the unequivocal intent of Congress to
ensure that every Medicare+Choice beneficiary has
access to all services covered under the original part
B medicare fee-for-service program; and
(3) as a covered medicare part B service, treat-
ment by means of manual manipulation of the spine
to correct a subluxation provided by a doctor of
chiropractic is a guaranteed service for beneficiaries
under the new Medicare+Choice program.
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