September 2003

ACA attacks Coalition bill HR 2560 in Capitol

>>> Misleading interpretation of bill's potential effects disputed by legislative staffers, political experts

The American Chiropractic Association (ACA) openly declared war on a Medicare bill sponsored by longtime chiropractic advocate Rep. Donald Manzullo (R‑Ill.) and supported by the Chiropractic Coalition ‑‑ comprised of the International Chiropractors Association (ICA), the Federation of Straight Chiropractors and Organizations, the World Chiropractic Alliance and more than a dozen affiliated organizations worldwide.

The ACA, which has repeatedly condemned other chiropractic organizations for failing to act cooperatively in legislative efforts, launched a campaign to attack and malign Rep. Manzullo's bill, H.R. 2560, and has used inaccurate and misleading information to convince doctors that the bill will reduce Medicare reimbursements.

"Medicare is a limited reimbursement program only and HR 2560 would have no impact at all on chiropractic scope of practice, ability to bill for evaluation and management codes, or the status of the D.C. as a doctor level professional," countered ICA Legislative Committee Chairman Dr. Michael S. McLean.

"Medicare law only deals with what D.C.s are paid for under this one program. Presently, the only reimbursable Medicare service is subluxation correction. HR 2560 would significantly expand the list of chiropractic services recognized by the Medicare program, he explained."

The ACA also attempted to persuade Manzullo to withdraw his sponsorship of the bill. Manzullo ‑‑ who, as chair of the House Small Business Committee held a series of hearings on Medicare abuse that uncovered blatant anti‑chiropractic discrimination ‑‑ has said the bill will "not only reshape the definition of chiropractic in federal policy...it will blow the lid off the definition of chiropractic in federal policy... We will make it clear once and for all that chiropractic is equal but unique." He remains committed to the bill.

HR 2560 would create a separate category for doctors of chiropractic under the Medicare system, and specify that only D.C.s could provide and be reimbursed for the unique chiropractic service of correcting subluxations.

"HR 2560 won't restrict any D.C. from practicing the way he or she chooses ‑‑ from neuromusculoskeletal to subluxation‑based. It doesn't prohibit any chiropractic service allowed by state scope laws," the ICA explained.

The ACA has been pushing its own Medicare provision, added as a last minute addendum to the Medicare drug bill, S1. The ACA bill would establish a limited demonstration project, where ‑‑ at a handful of selected sites ‑‑ doctors of chiropractic would be permitted to bill Medicare for anything within their state scope of practice.

Although members of the Coalition jointly made the decision not to attack the ACA bill or do anything that might jeopardize the possibility of its success, leaders noted that, since state statues vary widely, reimbursing chiropractors for any procedure allowed in any state might not be cost‑effective or administratively viable.

The ACA provision was criticized by the White House and in the media as one of many "tacked on" riders that were unrelated to the bill's original intent, providing a drug benefit under Medicare.

When political insiders and experts working with the Coalition advised it was likely that the ACA provision would be dropped, the Coalition suggested to legislators the wording of HR 2560 be used instead, ensuring at least some benefit to chiropractors in the S1 bill.

If enacted ‑‑ either as part of S1 or as a separate law ‑‑ HR 2560 will establish the profession as separate and distinct from other health care providers. It will insure that the majority of the 50,000 chiropractors providing vital care to millions of Americans will be recognized for the first time in the Medicare law.

The bill would also rectify errors made in the original Medicare statute including chiropractic care. Due to a lack of understanding about chiropractic, the Medicare legislation classified D.C.s as limited scope physicians.

"HR 2560 would establish a separate classification for chiropractors, recognizing them for providing the unique services that only they can provide. By clearly defining chiropractic services, the bill would prevent duplication of services offered by medical and osteopathic physicians and covered by Medicare. The result is that chiropractors are recognized and reimbursed for uniquely chiropractic services, medical providers are reimbursed for medical services ‑‑ and Medicare enjoys significant savings," the Coalition explained.

The ACA's faulty interpretation of the bill was criticized by several Washington insiders, including Barry Pineles, Regulatory Counsel for the House Committee on Small Business.

"The fact that the new codes would be subject to scrutiny by others again is of little concern," he noted, responding to an ACA criticism. "Would you rather have codes solely developed for chiropractors or ones that are developed for chiropractors and physicians?"

He added that, "by reducing the costs to Medicare, chiropractors can make an argument that more of their services should be used relative to others that might perform 'spinal manipulation.'"

The bill has received overwhelming support by all members of the Coalition.

"This powerful legislative initiative has been so thoughtfully crafted and is so innovative, opening new doors for chiropractor and chiropractic patient alike in Medicare, that it deserves the strong and immediate support of everyone in the chiropractic profession," said ICA President CJ Mertz, D.C.

A letter‑writing campaign was initiated to win legislative support for the bill, which is gaining increased visibility on Capitol Hill. Doctors are urged to visit the Coalition website at www.chiropracticcoalition.org to learn more about how they can help pass the bill. A sample letter of support is posted on the site, which doctors can print on their letterhead and fax to their Representative.