[Congressional Record Volume 143, Number 26 (Tuesday, March 4, 1997)]
[Extensions of Remarks]
[Page E369]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      INTRODUCTION OF LEGISLATION

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                          HON. PHILIP M. CRANE

                              of illinois

                    in the house of representatives

                         Tuesday, March 4, 1997

  Mr. CRANE. 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 rays 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.

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