"We recognize that many Medicare beneficiaries seek the services of chiropractors for back pain and other conditions," said CMS Administrator Dr. Mark McClellan, at a press conference announcing the project. "This demonstration provides the opportunity to evaluate whether expanding coverage of chiropractic services reduces overall Medicare expenditures for neuromusculoskeletal conditions."
Medicare Part B, also known as supplementary Medicare insurance, provides coverage for a variety of outpatient and physician services, including durable medical equipment, prosthetic devices, supplies related to physician services, and ambulance transportation. Coverage for chiropractic care was originally added to Medicare Part B by an act of Congress in 1972. Under existing Medicare regulations, however, coverage is limited to only one type of chiropractic service: manipulation of the spine to correct a subluxation or malfunction of the spine. Treatment may be provided only for active correction of a documented subluxation - not to prevent future subluxations from occurring, or to maintain overall health. In addition, treatment for the subluxation must be related in terms of a neuromusculoskeletal condition in which there is a reasonable expectation of recovery or functional improvement.
Beginning in April 2005, chiropractors located in the entire states of Maine and New Mexico, 17 central counties in Virginia, and the metropolitan area of Chicago, Ill., will be able to provide services to any beneficiary enrolled under Medicare Part B. The project allows for expanded coverage for services chiropractors provide to treat neuromusculoskeletal conditions, including diagnosis, X-rays and other therapies. Chiropractors will also be able to treat other parts of the body in addition to the spine. To ensure optimal participation, Medicare beneficiaries will not be required to receive approval from a physician or other health care provider to receive chiropractic services from a chiropractor participating in the demonstration project.
In an interview in the Lynchburg [Va.] News and Advance, Richard Lawlor, DC, a member of the CMS administrative staff in Washington, D.C., said that the project is "incredibly important" to the chiropractic profession. With expanded coverage, Dr. Lawlor explained, chiropractors could include items such as "physical therapy modalities, like ultrasound and electrical muscle stimulation" in the course of care. He added that the expanded coverage would allow chiropractors to treat conditions that affect a person's arms, legs and knees.
"It has the opportunity to allow the chiropractors to treat patients much closer to the scope of practice they're trained to provide," Dr. Lawlor added.
The demonstration project was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act, signed into law by President Bush in December 2003. Language in the act specifies that the project must include four sites - two in urban areas and two in rural areas - with one site from each category in a designated "health professional shortage area," or HPSA. The statute also requires that the Secretary of Health and Human Services conduct an evaluation of the project to assess cost-effectiveness, cost-benefit, beneficiary satisfaction, and "such other matters" as the secretary deems appropriate, and that the evaluation be submitted to Congress no later than one year after the conclusion of the project.
- CMS identifies sites for Medicare demonstration to expand coverage of chiropractic services. Centers for Medicare & Medicaid Services, Nov. 10, 2004.
- Chiropractic' biggest win ever on Capitol Hill; opponents told to "back off" as Congress approves plan to test expanded Medicare access to DCs. Dynamic Chiropractic, Jan. 1, 2004: www.chiroweb.com/archives/22/01/02.html.
- Pegram CT. Two counties are pilot sites for Medicare. Lynchburg News & Advance, Nov. 10, 2004.
- HR 1 - The Medicare Prescription Drug, Improvement and Modernization Act. Section 651 - demonstration of coverage of chiropractic services under Medicare. Signed by President George W. Bush on Dec. 8, 2003.