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 Com-
mittee 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Chiropractic Medicare 
Freedom and Benefit Protection Act’’.
SEC. 2. MEDICARE CHIROPRACTIC SERVICES. 
(a) SEPARATE TREATMENT OF CHIROPRACTORS.—
Section 1861(r) of the Social Security Act (42 U.S.C. 
1395x(r)) is amended—
(1) by striking ‘‘, or (5)’’ and all that follows 
and inserting a period; and 
(2) by inserting ‘‘or’’ before ‘‘(4)’’. 
(b) INCLUSION OF CHIROPRACTIC SERVICES AS MED-
ICAL
AND
OTHER
HEALTH
SERVICES.—Section 
1861(s)(2) of such Act (42 U.S.C. 1395x(s)(2)) is amend-
ed—
(1) in subparagraph (U), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (V)(iii), by inserting ‘‘and’’ 
at the end; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(W) chiropractic services (as defined in sub-
section (ww)(1));’’. 
(c) SERVICES DESCRIBED.—Section 1861 of such 
Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘CHIROPRACTIC SERVICES; CHIROPRACTOR 
‘‘(ww)(1)(A) The term ‘chiropractic services’ means 
only for the purpose of subsections (s)(1) and (s)(2)(A) 
clinically necessary care by means of adjustment of the
spine (to correct a subluxation) performed by a chiro-
practor legally authorized to perform such adjustment by 
the State or jurisdiction in which such care is provided. 
‘‘(B) For purposes of subparagraph (A), care is clini-
cally necessary when examination by a chiropractor dem-
onstrates objective evidence of a subluxation. Such exam-
ination may include—
‘‘(i) physical examination; 
‘‘(ii) radiological examination; and 
‘‘(iii) specialized diagnostic instruments used in 
the practice of chiropractic. 
‘‘(C) For purposes of subparagraph (A), the term 
‘subluxation’ means a complex of any or all of the fol-
lowing articular changes that compromise neural integrity 
and may influence organ system function and general 
health: 
‘‘(i) Functional. 
‘‘(ii) Structural. 
‘‘(iii) Pathological. 
‘‘(2) The term ‘chiropractor’ means an individual who 
is licensed as a chiropractor by the State (or in a State 
which does not license chiropractors as such, is legally au-
thorized to perform the services of a chiropractor in the 
jurisdiction in which he performs such services), and who
meets uniform minimum standards promulgated by the 
Secretary.’’. 
(d) PAYMENT AS PHYSICIANS’ SERVICES.—Section 
1848(j)(3) of such Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(W),’’ after ‘‘(2)(S),’’. 
(e) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1834(m) of such Act (42 U.S.C. 1395m(m)) is amended 
by inserting ‘‘, a chiropractor (as defined in section 
1861(ww)(2))’’ after ‘‘a physician (as defined in section 
1861(r))’’. 
(2) Section 1852(j)(3)(D) of such Act (42 U.S.C. 
1395w–22(j)(3)(D)) is amended by inserting ‘‘, a chiro-
practor (as defined in section 1861(ww)(2))’’ after ‘‘a phy-
sician (as defined in section 1861(r))’’. 
(3) Section 1802(b)(5)(C) of such Act (42 U.S.C. 
1395a(b)(5)(C) is amended to read as follows: 
‘‘(C) PRACTITIONER.—The term ‘practi-
tioner’ has the meaning given such term by sec-
tion 1842(b)(18)(C), and includes ‘chiropractor’ 
as that term is defined in continuing care re-
tirement community 1861(ww)(2).’’. 
(4) Section 1832(a)(2)(C) of such Act (42 U.S.C. 
1395k(a)(2)(C)) is amended by inserting before the term 
‘‘outpatient physical therapy services’’ the following: 
‘‘chiropractic services as defined in section 1861(ww)(1)’’.
(5) Section 1835(a)(2) of such Act (42 U.S.C. 
1395n(a)(2)) is amended by inserting after ‘‘physician’’ 
the first place it appears the following: ‘‘or for purposes 
of 
chiropractic 
services 
(as 
defined 
in 
section 
1861(ww)(1)), a chiropractor,’’. 
(6) Section 1842(a) of such Act (42 U.S.C. 
1395u(a)) is amended by inserting ‘‘chiropractic services 
(as defined in section 1861(ww)(1)’’ after ‘‘physician’s 
services’’. 
(7) Section 1842(h) of such Act (42 U.S.C. 
1395u(h)) is amended by inserting ‘‘or chiropractor (as 
defined in section 1861(ww)(2))’’ after ‘‘physician’’ each 
place it appears. 
(8) Section 1842(r) of such Act (42 U.S.C. 1395u(r)) 
is amended by inserting ‘‘chiropractor (as defined in sec-
tion 1861(ww)(2))’’ after ‘‘physician’’. 
(9) Section 1847(d) of such Act (42 U.S.C. 1395w–
3(d)) is amended by inserting ‘‘chiropractic services (as 
defined in section 1861(ww)(1))’’ after ‘‘physicians’ serv-
ices’’. 
(10) Section 1852 of such Act (42 U.S.C. 1395w–
22) is amended by inserting ‘‘or chiropractor (as defined 
in section 1861(ww)(2))’’ after ‘‘physician’’ each place it 
appears.
(11) Section 1862(a)(20) of such Act (42 U.S.C. 
1395y(a)(20)) is amended by inserting ‘‘or chiropractic 
services (as defined in section 1861(ww)(1))’’ after ‘‘physi-
cian’s professional services’’. 
(12) Section 1866(a)(1)(N)(ii) of such Act (42 
U.S.C. 1395cc(a)(1)(N)(ii)) is amended by inserting ‘‘or 
chiropractor (as defined in section 1861(ww)(2))’’ after 
‘‘physician’’ each place it appears. 
(13) Section 1868(a) of such Act (42 U.S.C. 
1395ee(a)) is amended by inserting ‘‘and chiropractor (as 
defined in section 1861(ww)(2))’’ after ‘‘physician’’. 
(14) Section 1869(b)(1)(F) of such Act (42 U.S.C. 
1395ff(b)(1)(F)) is amended by inserting ‘‘or chiropractor 
(as defined in section 1861(ww)(2))’’ after ‘‘physician’’. 
(15) Section 1876(b)(2)(i) of such Act (42 U.S.C. 
1395mm(b)(2)(i)) is amended by inserting ‘‘or chiro-
practic services (as defined in section 1861(ww)(1))’’ after 
‘‘physicians’ services’’. 
(16) Section 1877 of such Act (42 U.S.C. 1395nn) 
is amended—
(1) in subsection (a)(1)(A) by inserting ‘‘or chi-
ropractor (as defined in section 1861(ww)(2))’’ after 
‘‘physician’’; and 
(2) in subsection (b)(1)—
(A) in the heading to read as follows: 
‘‘PHYSICIANS’ AND CHIROPRACTIC SERVICES’’; 
and 
(B) by inserting ‘‘or chiropractic services 
(as defined in section 1861(ww)(1))’’ after ‘‘in 
section 1861(q))’’. 
(17) Section 1887(a)(1)(A) of such Act (42 U.S.C. 
1395xx(a)(1)(A)) is amended by inserting ‘‘or chiropractic 
services (as defined in section 1861(ww)(1))’’ after ‘‘which 
constitute professional medical’’. 
(18) Section 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘chiropractic 
services (as defined in section 1861(ww)(1)),’’ after ‘‘phy-
sicians’ services’’. 
(19) Section 1891(a)(2)(F) of such Act (42 U.S.C. 
1395bbb(a)(2)(F)) is amended by inserting before the pe-
riod at the end the following: ‘‘or chiropractor (as defined 
in section 1861(ww)(2))’’.
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