The regulations that cover the Medicare Program are contained in Chapter IV of Title 42 of the Code of Federal Regulations. Any proposed changes to these regulations must be first posted in the Federal Register by the Department of Health and Human Services (HHS) for public comment. A Notice of Proposed Rule Making (or “NPRM”) typically requests public comment on a proposed rule, and provides notice of any public meetings where a proposed rule will be discussed. The public comments would then be considered by HHS, and the text of a final rule along with a discussion of the comments is published in the Federal Register.
It should be noted that changing the definition of a chiropractor in Section 1861(r)5 and removing the current restriction would enable HHS to develop new regulations but it would not require it to do so.