April 2001

Physical Therapists Ask Court to Intervene
in ACA Subluxation Lawsuit

ARLINGTON, VA. - Calling the American Chiropractic Association's (ACA) lawsuit against the U.S. Department of Health and Human Services (HHS) and the Health Care Financing Administration (HCFA) "a direct attack on the interests of its members," the American Physical Therapy Association (APTA) has requested that the court allow it to intervene in the ACA's lawsuit. The APTA is attempting to take steps to reverse a recent legal position taken by HHS and HCFA in response to ACA's lawsuit. The position officially acknowledges physical therapists cannot provide manual manipulation of the spine to correct a subluxation under Medicare.

"In recent years, chiropractic organizations have made a concerted effort to obtain legislation that restricts the ability of physical therapists to perform manual manipulation as part of a physical therapy plan of care," the APTA stated in its mid-April pleading to the U.S. District Court of the District of Columbia. "Indeed, this lawsuit can fairly be viewed as another front to this ongoing campaign."

ACA officials are expected to oppose APTA's intervention into the lawsuit."We are resolute in our determination to assure the chiropractic service of manual manipulation of the spine to correct a subluxation is provided exclusively by doctors of chiropractic," said Dr. James A. Mertz, ACA president. "We believe the policy articulated by the government as it pertains to physical therapists providing the service is a correct one. This change in policy came only after the initiation of the ACA lawsuit. We will argue to the court that HCFA should not be permitted to reverse its prior statements to the court based on pressure from the APTA."

In its September 1999 motion to dismiss ACA's lawsuit, HHS agreed physical therapists are not qualified to provide the "physician service" of manual manipulation of the spine to correct a subluxation because physical therapists do not meet the definition of "physician" under Medicare regulations.

"We agree with [the American Chiropractic Association] that a Medicare+Choice organization could not purport to make this physician service available to enrollees through a physical therapist, and must have physicians available to perform this service (whether it be chiropractors or other physicians who perform manual manipulation)," HHS stated.

However, in a private letter to the APTA not shared with ACA's legal team, a HCFA attorney conveyed a viewpoint that conflicted with statements made by the government in court documents. That HCFA attorney has since been replaced by the agency. The APTA now claims the letter from the attorney represents actual HHS and HCFA policy, rather than the statements made by the government to the federal court.

The APTA argues "it is precisely the ACA's effort to challenge that policy and to preclude physical therapists entirely from performing this service, that requires the APTA to seek to intervene in this lawsuit." APTA hopes to ensure "physical therapists retain their current standing to provide this service."

Sources: The American Chiropractic Association and Staff Reports

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