[Congressional Record Volume 143, Number 40 (Tuesday, April 8, 1997)]
[Senate]
[Page S2846]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE (for himself and Mr. Dorgan):
  S. 524. A bill to amend title XVIII of the Social Security Act to 
remove the requirement of an x ray as a condition of coverage of 
chiropractic services under the Medicare Program; to the Committee on 
Finance.


                          MEDICARE LEGISLATION

  Mr. DASCHLE. Mr. President, today I am introducing legislation that 
makes a commonsense change to Medicare's outdated policy regarding 
chiropractic care. Specifically, my bill would eliminate the 
requirement that beneficiaries get an x ray before they are authorized 
to be reimbursed for chiropractic services under Medicare. This 
legislation accomplishes two important goals. First, it removes 
outdated vestiges of still pronounced discrimination against 
chiropractic practitioners in the Medicare Program. Second, this bill 
makes chiropractic services more accessible and affordable for 
beneficiaries. I encourage my colleagues to join me in supporting this 
measure, which is the Senate companion to legislation introduced in the 
House of Representatives on March 4, 1997 by Representative Phil Crane.
  Existing Medicare law strictly limits reimbursement for chiropractic 
services to manual manipulation of the spine and only to correct a 
subluxation. However, before beneficiaries can be reimbursed for 
chiropractic care, Medicare requires that the patient get an x ray to 
confirm the need for these services. Beneficiaries must either pay for 
the x ray out of their own pockets, a cost that many cannot afford, or 
pass through the ``gateway'' controlled by other medical providers, 
whose x rays, typically far more expensive, are reimbursable under the 
program.
  While x rays are often a useful diagnostic tool to verify a medical 
condition, most medical professionals and health analysts agree that 
there is no clinical justification for a blanket requirement that 
Medicare beneficiaries verify the need for chiropactic care through an 
x ray. Medicare's statutory x ray requirement results in unnecessary 
patient exposure to x rays and simply cannot be justified as an across-
the-board requirement.
  Representatives of the Health Care Financing Administration [HCFA] 
who have closely studied this issue reached the same conclusion that I 
did and recommended to the President that this provision be included in 
his Medicare reform plan. I am pleased that the President did include 
in his fiscal year 1998 balanced budget proposal a provision calling 
for the elimination of the x ray requirement for chiropractic care. I 
am cautiously optimistic that bipartisan support from within the 
Congress and the administration will help facilitate passage of this 
modest, but important, measure.
  I grew up in a community where chiropractors perform a valuable 
service by providing an alternative to allopathic medicine. The nearly 
200 chiropractors in South Dakota serve the State well. In rural States 
like mine, chiropractors are often an essential source of health care 
delivery. Sometimes they are the only health providers in the 
community. In rural States across the country, the chiropractic 
profession plays an integral role in the health care system.
  But the issue is even larger than one of correcting inequities in the 
law and recognizing the contributions of chiropractors alone. We are 
constantly searching for ways to give more Americans greater access to 
quality health care, and to facilitate that availability of care in the 
most cost-effective manner. One proven way to make progress toward 
those goals is to exploit the talent and dedication represented in the 
diversity of practitioners increasingly involved in the delivery of 
health care services in the United States. Competition among different 
kinds of providers and access to less expensive forms of care have to 
be emphasized if we are to control escalating health care costs. Yet 
this competition is virtually impossible when programs like Medicare 
put up barriers to beneficiaries receiving care from a group of 
licensed professionals like chiropractors.
  As health care cost increases continue to threaten both the quality 
and economic stability of our national health care delivery system, the 
cost savings potential of chiropractic care should be fully explored. 
The bill I am introducing today will help provide access to quality 
care at a reasonable cost. I urge my colleagues in the Senate to 
support this measure to ensure Medicare patients have appropriate 
access to the benefits of chiropractic care.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 524

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

     SECTION 1. REMOVAL OF REQUIREMENT FOR X-RAY AS A CONDITION OF 
                   COVERAGE OF CHIROPRACTIC SERVICES UNDER THE 
                   MEDICARE PROGRAM.

       (a) In General.--Section 1861(r)(5) of the Social Security 
     Act (42 U.S.C. 1395x(r)(5)) is amended by striking 
     ``demonstrated by X-ray to exist''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to services furnished on or after January 1, 
     1998.
                                 ______