To amend title XVIII of the Social Security Act to clarify the scope of chiropractic services that may be furnished under the Medicare Program and that chiropractors are the only health care professionals qualified under that program to furnish those services.

June 23, 2003

Mr. MANZULLO introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To amend title XVIII of the Social Security Act to clarify the scope of chiropractic services that may be furnished under the Medicare Program and that chiropractors are the only health care professionals qualified under that program to furnish those services.

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Chiropractic Medicare Freedom and Benefit Protection Act'.

SEC. 2. MEDICARE CHIROPRACTIC SERVICES.

(a) SEPARATE TREATMENT OF CHIROPRACTORS- Section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)) is amended--

(1) by striking `, or (5)' and all that follows and inserting a period; and

(2) by inserting `or' before `(4)'.

(b) INCLUSION OF CHIROPRACTIC SERVICES AS MEDICAL AND OTHER HEALTH SERVICES- Section 1861(s)(2) of such Act (42 U.S.C. 1395x(s)(2)) is amended--

(1) in subparagraph (U), by striking `and' at the end;

(2) in subparagraph (V)(iii), by inserting `and' at the end; and

(3) by adding at the end the following new subparagraph:

`(W) chiropractic services (as defined in subsection (ww)(1));'.

(c) SERVICES DESCRIBED- Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

`CHIROPRACTIC SERVICES; CHIROPRACTOR

`(ww)(1)(A) The term `chiropractic services' means only for the purpose of subsections (s)(1) and (s)(2)(A) clinically necessary care by means of adjustment of the spine (to correct a subluxation) performed by a chiropractor legally authorized to perform such adjustment by the State or jurisdiction in which such care is provided.

`(B) For purposes of subparagraph (A), care is clinically necessary when examination by a chiropractor demonstrates objective evidence of a subluxation. Such examination may include--

`(i) physical examination;

`(ii) radiological examination; and

`(iii) specialized diagnostic instruments used in the practice of chiropractic.

`(C) For purposes of subparagraph (A), the term `subluxation' means a complex of any or all of the following articular changes that compromise neural integrity and may influence organ system function and general health:

`(i) Functional.

`(ii) Structural.

`(iii) Pathological.

`(2) The term `chiropractor' means an individual who is licensed as a chiropractor by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary.'.

(d) PAYMENT AS PHYSICIANS' SERVICES- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(W),' after `(2)(S),'.

(e) CONFORMING AMENDMENTS- (1) Section 1834(m) of such Act (42 U.S.C. 1395m(m)) is amended by inserting `, a chiropractor (as defined in section 1861(ww)(2))' after `a physician (as defined in section 1861(r))'.

(2) Section 1852(j)(3)(D) of such Act (42 U.S.C. 1395w-22(j)(3)(D)) is amended by inserting `, a chiropractor (as defined in section 1861(ww)(2))' after `a physician (as defined in section 1861(r))'.

(3) Section 1802(b)(5)(C) of such Act (42 U.S.C. 1395a(b)(5)(C) is amended to read as follows:

`(C) PRACTITIONER- The term `practitioner' has the meaning given such term by section 1842(b)(18)(C), and includes `chiropractor' as that term is defined in continuing care retirement community 1861(ww)(2).'.

(4) Section 1832(a)(2)(C) of such Act (42 U.S.C. 1395k(a)(2)(C)) is amended by inserting before the term `outpatient physical therapy services' the following: `chiropractic services as defined in section 1861(ww)(1)'.

(5) Section 1835(a)(2) of such Act (42 U.S.C. 1395n(a)(2)) is amended by inserting after `physician' the first place it appears the following: `or for purposes of chiropractic services (as defined in section 1861(ww)(1)), a chiropractor,'.

(6) Section 1842(a) of such Act (42 U.S.C. 1395u(a)) is amended by inserting `chiropractic services (as defined in section 1861(ww)(1)' after `physician's services'.

(7) Section 1842(h) of such Act (42 U.S.C. 1395u(h)) is amended by inserting `or chiropractor (as defined in section 1861(ww)(2))' after `physician' each place it appears.

(8) Section 1842(r) of such Act (42 U.S.C. 1395u(r)) is amended by inserting `chiropractor (as defined in section 1861(ww)(2))' after `physician'.

(9) Section 1847(d) of such Act (42 U.S.C. 1395w-3(d)) is amended by inserting `chiropractic services (as defined in section 1861(ww)(1))' after `physicians' services'.

(10) Section 1852 of such Act (42 U.S.C. 1395w-22) is amended by inserting `or chiropractor (as defined in section 1861(ww)(2))' after `physician' each place it appears.

(11) Section 1862(a)(20) of such Act (42 U.S.C. 1395y(a)(20)) is amended by inserting `or chiropractic services (as defined in section 1861(ww)(1))' after `physician's professional services'.

(12) Section 1866(a)(1)(N)(ii) of such Act (42 U.S.C. 1395cc(a)(1)(N)(ii)) is amended by inserting `or chiropractor (as defined in section 1861(ww)(2))' after `physician' each place it appears.

(13) Section 1868(a) of such Act (42 U.S.C. 1395ee(a)) is amended by inserting `and chiropractor (as defined in section 1861(ww)(2))' after `physician'.

(14) Section 1869(b)(1)(F) of such Act (42 U.S.C. 1395ff(b)(1)(F)) is amended by inserting `or chiropractor (as defined in section 1861(ww)(2))' after `physician'.

(15) Section 1876(b)(2)(i) of such Act (42 U.S.C. 1395mm(b)(2)(i)) is amended by inserting `or chiropractic services (as defined in section 1861(ww)(1))' after `physicians' services'.

(16) Section 1877 of such Act (42 U.S.C. 1395nn) is amended--

(1) in subsection (a)(1)(A) by inserting `or chiropractor (as defined in section 1861(ww)(2))' after `physician'; and

(2) in subsection (b)(1)--

(A) in the heading to read as follows: `PHYSICIANS' AND CHIROPRACTIC SERVICES'; and

(B) by inserting `or chiropractic services (as defined in section 1861(ww)(1))' after `in section 1861(q))'.

(17) Section 1887(a)(1)(A) of such Act (42 U.S.C. 1395xx(a)(1)(A)) is amended by inserting `or chiropractic services (as defined in section 1861(ww)(1))' after `which constitute professional medical'.

(18) Section 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting `chiropractic services (as defined in section 1861(ww)(1)),' after `physicians' services'.

(19) Section 1891(a)(2)(F) of such Act (42 U.S.C. 1395bbb(a)(2)(F)) is amended by inserting before the period at the end the following: `or chiropractor (as defined in section 1861(ww)(2))'.

END