Billing / Fees / Insurance

For the Record

Editorial Staff

Congressman Philip Crane: "It only makes sense to encourage access to chiropractic care and remove those barriers which exist in current law."

On March 4, 1997, Congressman Philip M. Crane (R-Illinois) introduced his bill to eliminate mandatory x-rays for chiropractic Medicare patients, which was printed in the Congressional Record of the 105th Congress (vol. 143, No. 26).

"Mr. Speaker, today I am introducing legislation repealing a defect in current Medicare law which often causes beneficiaries seeking chiropractic treatment under the Medicare program to be subjected to unnecessary x-ray exposure. The heart of the problem, which my legislation seeks to correct, arises from current law which requires a diagnostic x-ray to be taken before a beneficiary can be provided with chiropractic manual manipulation benefits under Medicare. Frequently, x-rays are a useful and valid diagnostic tool properly utilized by doctors of chiropractic. However, the existing statutory requirement that, in every instance, a diagnostic x-ray be taken before chiropractic services can be provided as a benefit under Medicare is clearly arbitrary and unnecessary.

"According to the American Chiropractic Association (ACA) and ACA College of Radiology, there is no medical justification for a blanket requirement that all beneficiaries seeking chiropractic care under Medicare must first undergo a diagnostic x-ray. While in many instances x-rays are clinically justified, all responsible health authorities agree that diagnostic x-rays are warranted only when, in the assessment of the treating health provider, they provide a direct clinical benefit to the patient.

"I, for one, find it totally unacceptable that we, as responsible members of Congress, would allow the continuance of an artificial statutory requirement that results in the continued unnecessary x-ray exposure of Medicare patients. I am confident that any of my colleagues that examine this issue will conclude, as have I, that requiring an x-ray as a prerequisite to reimbursement is bad public policy for which there is no real justification.

"This is not just my opinion, but it is also the opinion of senior officials in the Health Care Financing Administration (HCFA) and the Department of Health and Human Services (HHS) who have studied this issue in detail. As many of my colleagues know, the ACA and various members of Congress have, over the past 2 years in particular, talked with the administration regarding a variety of chiropractic-related issues. As a result of those discussions and inquiries, the mandatory x-ray requirement issue has been closely examined by HCFA and HHS. I am pleased to say that as part of this fiscal year 1998 budget proposal, President Clinton has included a specific legislative provision which would abolish this requirement. "Specifically, the proposal I am introducing today would strike for the physician definition portion of the existing statute describing the chiropractic Medicare benefit (Section 1861 (r)(5), Social Security Act), the words "demonstrated by x-ray to exist."

"Also, I would note, the existing x-ray requirement is a barrier to beneficiary access to chiropractic care which places an undue financial burden on beneficiaries who must often pay for the required x-ray out-of-pocket. Chiropractic care is a proven and effective treatment for spinal related maladies including low back pain. It is a nonsurgical and nondrug form of health care which often substitutes for more expensive forms of care, including surgery. It only makes sense to encourage access to chiropractic care and remove those barriers which exist in current law.

"In conclusion, I am confident this proposal, which is first and foremost a matter of public health and safety, will enjoy bipartisan support in this Congress. I urge my colleagues to act quickly to ensure the incorporation of this long overdue proposal into Medicare reform legislation which may be approved in this Congress."

April 1997
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