Q: Does the proposed Coalition language provide for opt out?

A: Yes. Chiropractors currently do not have the ability to opt out of Medicare. The Coalition proposal would correct this shortcoming. 

Q: If a chiropractor is not classified as a “physician,” does this mean chiropractors would be downgraded to “mid-level” practitioners at a lower level of reimbursement?

A. No. Chiropractors would have their own, separate classification. The language would state “or chiropractor” after physician in each place where it appears. Furthermore, “or chiropractic services” would be added after “physician’s professional services.”

Q: Would it be necessary to have a secondary musculoskeletal diagnosis, as is currently required, to obtain reimbursement?

A: No. The proposed language states, in part, “care is clinically necessary when examination by a chiropractor demonstrates objective evidence of a subluxation.”

Q: How can a subluxation be demonstrated under this proposal?

A: The following language is proposed: “Such examination may include—

(i) physical examination;

(ii) radiological examination; and

(iii) specialized diagnostic instruments used in the practice of chiropractic.”

Q: How is subluxation defined in the proposal?

A: It parallels the widely accepted definition adopted by the Association of Chiropractic Colleges:

“For purposes of subparagraph (A), the term ‘subluxation’ means a complex of any or all of the following articular changes that compromise neural integrity and may influence organ system function and general health:

(i) Functional.

(ii) Structural.

(iii) Pathological.

Q: Will the Coalition proposal increase Medicare costs?

A: No. See the attached document.

Medicare Folly by Dr. Christopher Kent

Dr. Christopher Kent has addressed the concerns regarding opt out language in Medicare.

“The way to handle the opt out language is to simply add chiropractors to the existing list of practitioners who can opt out under 42 CFR 405.400 https://www.law.cornell.edu/cfr/text/42/405.400 . 42 CFR 405.415 addresses the requirements of private contracts under opt-out.”https://www.law.cornell.edu/cfr/text/42/405.415

This is the Medicare legislation that’s needed now.

We need legislation that allows chiropractors to practice as chiropractors and be reimbursed for providing the chiropractic benefit as opposed to legislation that expands the scope to full physician status. Such efforts are clearly meant to expand the definition of chiropractic, expand the scope, allow for duplication of services, position chiropractors as primary care providers instead of portal of entry, and change the very nature of the profession.

We welcome other state and national organizations to join with us and clarify the role of chiropractic in health car

The parity issue is addressed by creating a separate category for the chiropractor. Where the term “physician” is used, “or chiropractor” is added.

Over a decade ago the International Federation of Chiropractors and Organizations (IFCO) participated in the development and promotion of the Chiropractic Medicare Freedom and Benefit Protection Act, along with a coalition of other organizations including the World Chiropractic Alliance and the International Chiropractors Association (ICA). The centerpiece of this Act was a revolutionary bill (HR 2560) that provided a definition of chiropractic that actually reflects what chiropractic has always been and what it should always be.

The Bill was written by legislative staff from Representative Don Manzullo’s office, in collaboration with Christopher Kent DC, JD, President of the Foundation for Vertebral Subluxation and Board Member of the IFCO.

The bill’s purpose was to prevent duplication of services between chiropractors and medical doctors.  Contrary to what some in the profession want, not all chiropractors aspire to be medical doctors. Chiropractors have a unique role to play in the health care system – correcting subluxations — and we are the only ones trained to do that.

According to Christopher Kent, DC, JD, “This initiative does not seek to expand chiropractic practice to include a duplication of services already offered by other providers.”  Rather than establish a new chiropractic program, such as is currently being recommended by other groups, our initiative establishes a separate chiropractic category.  “The language seeks to rectify the errors made in the original Medicare statute including chiropractic care,” Kent explained.  “A significant error in this legislation was classifying D.C.s as limited scope physicians.  Thus, the chiropractic benefit was characterized as a physician service, permitting medical doctors and osteopaths to provide what is purportedly a chiropractic benefit.”

Recent efforts by the other groups, seek to position chiropractors with full physician status, expand scope and even remove mention of vertebral subluxation from the legislative language of Medicare.

If you want to see the Coalition language be adopted by our organizations then it is of great importance that you contact your state and national organizations.

If you are not currently member of the International Federation of Chiropractors and Organizations (IFCO), your membership will support these and future efforts to maintain chiropractic as a separate and distinct profession dedicated to the correction of vertebral subluxation.