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Seniors Getting Relief for Back Pain as Medicare, VA
Expand Service
Nov. 15, 2004 Last week Medicare named Maine, New
Mexico, Illinois and Virginia as the states where chiropractic services
for neuromusculosketal conditions will be covered for senior citizens in
a demonstration project authorized in the Medicare Prescription Drug,
Improvement, and Modernization Act. This follows expansion announced
earlier this year for expanded chiropractic services for veterans by the
Department of Veteran Affairs.
The goal of the Medicare demonstration is to
evaluate the feasibility and desirability of covering additional
chiropractic services for senior citizens under Medicare beyond the
current coverage. CMS has scheduled an Open Door Forum on November 18 to
solicit input from interested groups regarding benefits of this
demonstration and implementation of its budget neutrality requirements.
The demonstration, which was mandated under section
651 of the Medicare Prescription Drug, Improvement, and Modernization
Act, will be conducted in the entire states of Maine and New Mexico, and
in the Chicago Metropolitan Statistical Area (MSA) and 17 central
counties in Virginia. The statue specified that the demonstration must
include four sites, two urban and two rural, and one site of each must
be in a health professional shortage area (HPSA).
The statute requires an evaluation of the
demonstration to assess cost effectiveness, cost benefit, beneficiary
satisfaction, and other issues as the Secretary of Health and Human
Services determines to be appropriate.
We recognize that many
Medicare beneficiaries seek the services of chiropractors for back pain
and other conditions, CMS Administrator, Dr. Mark B. McClellan said.
This demonstration provides the opportunity to evaluate whether
expanding coverage of chiropractic services reduces overall Medicare
expenditures for neuromusculoskeletal conditions.
Beginning in April 2005, chiropractors that are
located in the demonstration areas will be able to provide services to
any beneficiary enrolled under Medicare Part B. The demonstration will
expand coverage for the services that chiropractors provide for the care
of neuromusculoskeletal conditions, including diagnostic and other
services such as the provision of x-rays and therapy services.
Current Medicare coverage for chiropractic care is
limited to manual manipulation of the spine to correct a subluxation,
which is defined as a malfunction of the spine. Treatment may only be
provided for the active correction of a documented subluxation, and not
for prevention or health maintenance. Treatment for the subluxation
must be related in terms of a neuromusculoskeletal condition where there
is a reasonable expectation of recovery or functional improvement.
The current Medicare program imposes an arbitrary
limit on the covered services that can be offered by America's 60,000
doctors of chiropractic and sought by millions of older chiropractic
patients. Under current law, a chiropractor may only provide Medicare
beneficiaries with a single covered service (manual manipulation of the
spine to correct a subluxation) despite the fact that they are licensed
in all 50 states to provide additional services that are currently
covered under Medicare, including x-rays and other diagnostic tests and
physiotherapy services, says the American Chiropractic Association.
The ACA has long contended that Medicare's
arbitrary limit on chiropractic services is harmful to patients and
costly to taxpayers.
The ACA says the chiropractic demonstration project
will assess how greater freedom of choice for consumers and additional
competition among care providers, including doctors of chiropractic,
will benefit the health of Medicare beneficiaries and provide for more
efficient use of Medicare resources. The four-site, two-year
demonstration, will likely have a profound impact in rural and medically
underserved areas where beneficiaries will no longer be forced to visit
a second or third provider to receive the full range of necessary
services.
"This is chiropractic's biggest win ever on Capitol
Hill," said American Chiropractic Association Chairman George B.
McClelland, DC. "The Medicare Chiropractic Demonstration Project marks
the beginning of the end of three decades of discrimination against
doctors of chiropractic and chiropractic patients under Medicare. For
the first time, Medicare beneficiaries will have the freedom to choose a
doctor of chiropractic to provide a range of the covered services they
want and need."
"This tremendous victory is the result of many
years of hard work and commitment," said ACA President Donald
Krippendorf.
In June, the Department of Veteran's Affairs
announced steps to make chiropractic care more available and more
accessible through VA health facilities.The DVA's list includes 26
facilities located throughout the country in each of the VA service
regions, known as Veterans Integrated Service Networks or "VISNs." Each
of these facilities were to be equipped for a doctor of chiropractic to
treat patients in the fall of 2004.
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