[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2560 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2560

To amend title XVIII of the Social Security Act to clarify the scope of 
chiropractic services that may be furnished under the Medicare Program 
and that chiropractors are the only health care professionals qualified 
             under that program to furnish those services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2003

 Mr. Manzullo introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to clarify the scope of 
chiropractic services that may be furnished under the Medicare Program 
and that chiropractors are the only health care professionals qualified 
             under that program to furnish those services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Chiropractic Medicare Freedom and 
Benefit Protection Act''.

SEC. 2. MEDICARE CHIROPRACTIC SERVICES.

    (a) Separate Treatment of Chiropractors.--Section 1861(r) of the 
Social Security Act (42 U.S.C. 1395x(r)) is amended--
            (1) by striking ``, or (5)'' and all that follows and 
        inserting a period; and
            (2) by inserting ``or'' before ``(4)''.
    (b) Inclusion of Chiropractic Services as Medical and Other Health 
Services.--Section 1861(s)(2) of such Act (42 U.S.C. 1395x(s)(2)) is 
amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V)(iii), by inserting ``and'' at the 
        end; and
            (3) by adding at the end the following new subparagraph:
            ``(W) chiropractic services (as defined in subsection 
        (ww)(1));''.
    (c) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

                 ``chiropractic services; chiropractor

    ``(ww)(1)(A) The term `chiropractic services' means only for the 
purpose of subsections (s)(1) and (s)(2)(A) clinically necessary care 
by means of adjustment of the spine (to correct a subluxation) 
performed by a chiropractor legally authorized to perform such 
adjustment by the State or jurisdiction in which such care is provided.
    ``(B) For purposes of subparagraph (A), care is clinically 
necessary when examination by a chiropractor demonstrates objective 
evidence of a subluxation. Such examination may include--
            ``(i) physical examination;
            ``(ii) radiological examination; and
            ``(iii) specialized diagnostic instruments used in the 
        practice of chiropractic.
    ``(C) 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.
    ``(2) The term `chiropractor' means an individual who is licensed 
as a chiropractor by the State (or in a State which does not license 
chiropractors as such, is legally authorized to perform the services of 
a chiropractor in the jurisdiction in which he performs such services), 
and who meets uniform minimum standards promulgated by the 
Secretary.''.
    (d) Payment as Physicians' Services.--Section 1848(j)(3) of such 
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ``(2)(W),'' after 
``(2)(S),''.
    (e) Conforming Amendments.--(1) Section 1834(m) of such Act (42 
U.S.C. 1395m(m)) is amended by inserting ``, a chiropractor (as defined 
in section 1861(ww)(2))'' after ``a physician (as defined in section 
1861(r))''.
    (2) Section 1852(j)(3)(D) of such Act (42 U.S.C. 1395w-22(j)(3)(D)) 
is amended by inserting ``, a chiropractor (as defined in section 
1861(ww)(2))'' after ``a physician (as defined in section 1861(r))''.
    (3) Section 1802(b)(5)(C) of such Act (42 U.S.C. 1395a(b)(5)(C) is 
amended to read as follows:
                    ``(C) Practitioner.--The term `practitioner' has 
                the meaning given such term by section 1842(b)(18)(C), 
                and includes `chiropractor' as that term is defined in 
                continuing care retirement community 1861(ww)(2).''.
    (4) Section 1832(a)(2)(C) of such Act (42 U.S.C. 1395k(a)(2)(C)) is 
amended by inserting before the term ``outpatient physical therapy 
services'' the following: ``chiropractic services as defined in section 
1861(ww)(1)''.
    (5) Section 1835(a)(2) of such Act (42 U.S.C. 1395n(a)(2)) is 
amended by inserting after ``physician'' the first place it appears the 
following: ``or for purposes of chiropractic services (as defined in 
section 1861(ww)(1)), a chiropractor,''.
    (6) Section 1842(a) of such Act (42 U.S.C. 1395u(a)) is amended by 
inserting ``chiropractic services (as defined in section 1861(ww)(1)'' 
after ``physician's services''.
    (7) Section 1842(h) of such Act (42 U.S.C. 1395u(h)) is amended by 
inserting ``or chiropractor (as defined in section 1861(ww)(2))'' after 
``physician'' each place it appears.
    (8) Section 1842(r) of such Act (42 U.S.C. 1395u(r)) is amended by 
inserting ``chiropractor (as defined in section 1861(ww)(2))'' after 
``physician''.
    (9) Section 1847(d) of such Act (42 U.S.C. 1395w-3(d)) is amended 
by inserting ``chiropractic services (as defined in section 
1861(ww)(1))'' after ``physicians' services''.
    (10) Section 1852 of such Act (42 U.S.C. 1395w-22) is amended by 
inserting ``or chiropractor (as defined in section 1861(ww)(2))'' after 
``physician'' each place it appears.
    (11) Section 1862(a)(20) of such Act (42 U.S.C. 1395y(a)(20)) is 
amended by inserting ``or chiropractic services (as defined in section 
1861(ww)(1))'' after ``physician's professional services''.
    (12) Section 1866(a)(1)(N)(ii) of such Act (42 U.S.C. 
1395cc(a)(1)(N)(ii)) is amended by inserting ``or chiropractor (as 
defined in section 1861(ww)(2))'' after ``physician'' each place it 
appears.
    (13) Section 1868(a) of such Act (42 U.S.C. 1395ee(a)) is amended 
by inserting ``and chiropractor (as defined in section 1861(ww)(2))'' 
after ``physician''.
    (14) Section 1869(b)(1)(F) of such Act (42 U.S.C. 1395ff(b)(1)(F)) 
is amended by inserting ``or chiropractor (as defined in section 
1861(ww)(2))'' after ``physician''.
    (15) Section 1876(b)(2)(i) of such Act (42 U.S.C. 1395mm(b)(2)(i)) 
is amended by inserting ``or chiropractic services (as defined in 
section 1861(ww)(1))'' after ``physicians' services''.
    (16) Section 1877 of such Act (42 U.S.C. 1395nn) is amended--
            (1) in subsection (a)(1)(A) by inserting ``or chiropractor 
        (as defined in section 1861(ww)(2))'' after ``physician''; and
            (2) in subsection (b)(1)--
                    (A) in the heading to read as follows: 
                ``Physicians' and chiropractic services''; and
                    (B) by inserting ``or chiropractic services (as 
                defined in section 1861(ww)(1))'' after ``in section 
                1861(q))''.
    (17) Section 1887(a)(1)(A) of such Act (42 U.S.C. 1395xx(a)(1)(A)) 
is amended by inserting ``or chiropractic services (as defined in 
section 1861(ww)(1))'' after ``which constitute professional medical''.
    (18) Section 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ``chiropractic services 
(as defined in section 1861(ww)(1)),'' after ``physicians' services''.
    (19) Section 1891(a)(2)(F) of such Act (42 U.S.C. 1395bbb(a)(2)(F)) 
is amended by inserting before the period at the end the following: 
``or chiropractor (as defined in section 1861(ww)(2))''.
                                 <all>