Legal Opinions

There is complete agreement …  It is time for patients to demand fairness in the Medicare systems and the elimination of discrimination against those patients who choose a Doctor of Chiropractic for their neuro-musculoskeletal healthcare.

The question is …  what specific changes are required and/or should be recommended for change to the Medicare statute?

The devil is in the details.  To understand the differences in the proposals currently being circulated and debated, it is necessary to understand the difference between the statutes (U.S. Code), the regulations (Code of Federal Regulations),  Medicare Policies (Chapter 15) and the Coverage Determinations (NCDs and LCDs) used by the Medicare Administrative Contractors (MACs) in making coverage determinations that are either enabling or prohibiting based upon how the statutes have been written.

Historically, the chiropractic profession has not fared well when their expectations were left in the hands of the regulators.

Changing the definition of a chiropractor as a physician in Section 1861(r)5 is necessary because of two words ” …and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) …”

It is the “only” that has enabled the regulators to develop regulations (see CFR Sec. 410.21) and CMS to develop policies (see Chapter 15 Section 240.1.1 of the Medicare Benefit Policy Manual), which defines– “Covered Medical and Other Health Services”.  It is these policies that are used by the MACs in developing the LCDs that are used to make the coverage determinations.

In reviewing the recent proposal for legislative language the ICA sought the opinion of its legal counsel and two other highly respected former members of congress.  To review their take on the proposed language click Legal Opinion 1 , or Legal Opinion 2 , or Legal Opinion 3 .

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