[Congressional Record Volume 145, Number 71 (Monday, May 17, 1999)]
[Senate]
[Pages S5425-S5426]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   SENATE CONCURRENT RESOLUTION 32--EXPRESSING THE SENSE OF CONGRESS 
 REGARDING THE GUARANTEED COVERAGE OF CHIROPRACTIC SERVICES UNDER THE 
                        MEDICARE+CHOICE PROGRAM

  Mr. CONRAD (for himself, Mr. Harkin, Mr. Grassley, and Mr. Hatch) 
submitted the following concurrent resolution; which was referred to 
the Committee on Finance:

                            S. Con. Res. 32

       Resolved by the Senate (the House of Representatives 
     concurring), That

     SECTION 1. SENSE OF CONGRESS REGARDING GUARANTEED COVERAGE OF 
                   CHIROPRACTIC SERVICES UNDER THE MEDICARE+CHOICE 
                   PROGRAM.

       (a) Findings.--Congress finds the following:
       (1) In 1972, Congress included chiropractors in the 
     medicare program under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.) through the definition of the term 
     ``physician'' under section 1861(r) of such Act (42 U.S.C. 
     1395x(r)), which referred to the ``treatment by means of 
     manual manipulation of the spine (to correct a 
     subluxation)''. Congress crafted this language to identify a 
     specific chiropractic service using terminology that was 
     unique to the chiropractic profession at that time. Such 
     language shows that Congress was aware that patients required 
     direct access to chiropractic care in order to provide this 
     benefit under the medicare program.
       (2) The traditional fee-for-service medicare program gave 
     beneficiaries direct access to doctors of chiropractic for 
     treatment by means of manual manipulation of the spine to 
     correct a subluxation. The sole limitation, shared by all 
     entities and health care providers under the medicare 
     program, is the limitation outlined in section 1862(a)(1) of 
     the Social Security Act (42 U.S.C. 1395y(a)(1)), which 
     requires that items and services provided to medicare 
     beneficiaries be reasonable and necessary in order for 
     payment to be made for such items and services.
       (3) Treatment by means of manual manipulation of the spine 
     to correct a subluxation is uniquely chiropractic. Doctors of 
     chiropractic are the only health care providers educated and 
     trained to perform such a treatment.
       (4) In 1982, Congress established provisions for making 
     payments to health maintenance organizations and competitive 
     medical plans under section 1876 of the Social Security Act 
     (42 U.S.C. 1395mm). Such provisions directed all eligible 
     organizations with contracts

[[Page S5426]]

     under the section to provide all benefits under part B of the 
     medicare program to medicare beneficiaries enrolled with the 
     organization. In promulgating regulations to carry out the 
     section, the Health Care Financing Administration created a 
     regulatory authority for eligible organizations with 
     contracts under such section to specify which health care 
     provider would furnish medicare benefits to an individual 
     under the plan offered by the organization.
       (5) In 1990, Congress directed the Health Care Financing 
     Administration to study the extent to which eligible 
     organizations under section 1876 of the Social Security Act 
     (42 U.S.C. 1395mm) made chiropractic services available to 
     medicare beneficiaries enrolled in a plan offered by the 
     organization. Based on the findings of this study, the 
     Secretary of Health and Human Services was required to make 
     specific legislative and regulatory recommendations necessary 
     to ensure access of medicare beneficiaries to chiropractic 
     services. This study and subsequent recommendations have not 
     been forthcoming.
       (6) Historically, medicare beneficiaries that are 
     chiropractic patients have encountered nearly total exclusion 
     from chiropractic services once they enter into a plan 
     offered by an eligible organization under section 1876 of the 
     Social Security Act (42 U.S.C. 1395mm).
       (7) The Balanced Budget Act of 1997 instituted part C of 
     the medicare program under title XVIII of the Social Security 
     Act (42 U.S.C. 1395w-21 et seq.), and section 1852(a)(1) of 
     such Act (42 U.S.C. 1395w-22(a)(1)) required each 
     Medicare+Choice plan to ``provide those items and services . 
     . .  for which benefits are available under parts A and B''.
       (8) As a covered service under part B of the medicare 
     program, chiropractic care, which includes treatment by means 
     of manual manipulation of the spine to correct a subluxation 
     as performed by a doctor of chiropractic, is a covered 
     service under part C of the medicare program.
       (b) Sense of Congress.--It is the sense of Congress that--
       (1) treatment by means of manual manipulation of the spine 
     to correct a subluxation is a uniquely chiropractic service 
     that Congress recognized in 1972 as a benefit under the 
     medicare program under part B of title XVIII of the Social 
     Security Act (42 U.S.C. 1395j et seq.);
       (2) it is the unequivocal intent of Congress to ensure that 
     every individual enrolled in a Medicare+Choice plan under 
     part C of title XVIII of the Social Security Act (42 U.S.C. 
     1395w-21 et seq.) has access to all covered services under 
     part B of the medicare program; and
       (3) as a covered service under part B of the medicare 
     program, treatment by means of manual manipulation of the 
     spine to correct a subluxation provided by a doctor of 
     chiropractic is a covered service for individuals enrolled in 
     a Medicare+Choice plan under part C of the medicare program.

 Mr. CONRAD. Mr. President, today I am pleased to be joined by 
Senators Harkin, Hatch, and Grassley in submitting a concurrent 
resolution that will ensure Medicare beneficiaries have access to the 
medical care they need. The Balanced Budget Act of 1997 established the 
Medicare+Choice program and required that all services covered under 
traditional Medicare would also be covered in the Medicare+Choice 
program. Unfortunately, subsequent Medicare+Choice regulations do not 
ensure that beneficiaries participating in Medicare managed care will 
be eligible for the services provided by a chiropractor.
  Medicare beneficiaries have access to chiropractic services under 
Part B of Medicare. Chiropractors are uniquely educated and trained to 
perform chiropractic services, such as a manual manipulation to the 
spine to correct a subluxation, a covered service under the traditional 
Medicare program. When the Medicare+Choice program was created, it was 
the unequivocal intent of Congress to ensure that every beneficiary 
that chooses to enroll in a Medicare+Choice program would have access 
to all services covered under Medicare Parts A and B--including 
chiropractic services.
  Under the current Medicare+Choice regulations, managed care plans 
have incorrectly assumed that they can limit access to chiropractic 
care by referring patients to other types of providers. As the number 
of beneficiaries enrolling in Medicare HMOs continues to rise we must 
make sure that beneficiaries have access to the same services that they 
are promised under traditional Medicare--and chiropractic services are 
now exception.
  This legislation will clarify the Congressional intent to ensure that 
all chiropractic services covered under traditional, fee-for-Medicare 
are also covered under the Medicare+Choice program.
  I urge my colleagues to support this resolution.
 Mr. HARKIN. Mr. President, I am pleased to join with my 
colleagues, Senators Conrad, Hatch, and Grassley, to submit this 
concurrent resolution to ensure that Medicare beneficiaries can 
continue to receive the medical care they need and deserve.
  Under the traditional Medicare program, chiropractic care is a 
covered benefit. When the Medicare+Choice program was created in the 
Balance Budget Act of 1997, it was the intent of Congress to ensure 
that every beneficiary that chooses to enroll in a Medicare+Choice 
program would have access to all services covered under Medicare Parts 
A and B--including chiropractic services.
  In addition, the Balanced Budget Act is explicit in requiring Part C 
plans to assure continuity of benefits for beneficiaries who switch 
into these plans from the fee-for-service program. The clear intent is 
to ensure that beneficiaries who chose Part C plans have uninterrupted 
access to the same physician practitioners.
  Finally, the Part C provisions of the Balanced Budget Act contain 
strong antidiscrimination language prohibiting Medicare+Choice plans 
from discriminating against any provider solely on the basis of his or 
her license or certification.
  Every Medicare beneficiary ought to have access to the range of 
services covered under the Medicare fee-for-service program. Therefore, 
as a covered service under Part B of Medicare, chiropractic care should 
be considered a covered service under Medicare Part C.
  Mr. President, we were disappointed to learn last year that the 
Health Care Financing Agency's regulations for this program ignore 
Congressional intent and do not ensure that beneficiaries participating 
in Medicare managed care plans will be eligible for the services 
provided by a chiropractor. Under their Medicare+Choice regulations, 
managed care plans can limit access to chiropractic care by referring 
patients to other types of providers. As seniors continue to enroll in 
Medicare HMOs, we must make sure that they have access to the same 
services they are promised under traditional Medicare--and chiropractic 
services are no exception.
  This legislation will send a strong message to HCFA by clarifying 
congressional intent to ensure that all chiropractic services covered 
under traditional, fee-for-service Medicare are also covered under the 
Medicare+Choice program.
  Mr. President, I urge my colleagues to cosponsor this 
resolution.
 Mr. GRASSLEY. Mr. President, I am joining my colleagues, 
Senators Conrad, Hatch, and Harkin in support of a concurrent 
resolution establishing the Sense of Congress regarding Medicare 
beneficiaries access to chiropractic services under the Medicare+Choice 
program. In 1997, Congress passed the Balanced Budget Act (BBA) which 
established the Medicare+Choice program. The BBA required that all 
benefits covered under traditional Medicare be guaranteed under 
Medicare+Choice. However, it has come to our attention that 
chiropractic coverage is not being ensured under the regulations.
  Under traditional Medicare, beneficiaries can go to a chiropractor 
for manual manipulation to the spine which is a covered benefit under 
Part B. Under the regulations for Medicare+Choice plans, this benefit 
is covered. However, access to chiropractors for this benefit is not 
guaranteed. Unfortunately, some Medicare+Choice plans have interpreted 
this omission to mean they no longer need to cover chiropractic 
services for this benefit, which is most commonly provided by 
chiropractors. The result is that beneficiaries enrolled in 
Medicare+Choice are losing access to chiropractic services, a situation 
clearly not intended by Congress.
  The concurrent resolution I am cosponsoring today would clarify 
congressional intent regarding guaranteed coverage to chiropractic 
services under the Medicare+Choice program. Medicare beneficiaries 
should have the same benefits required by law under traditional fee-
for-service as they do under Medicare+Choice. If beneficiaries can 
receive care for manual manipulation by a chiropractor under Part B, 
then they should have this same right under Medicare+Choice.
  I urge you to join me and my colleagues in support of this 
resolution.




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