November 2004

CMS identifies 4 demo sites for expanded chiropractic care

Beginning in April 2005, chiropractors who are located in any of the four demonstration project areas identified by the Centers for Medicare and Medicaid Services (CMS) will be able to provide expanded services to Medicare recipients, according to CMS Administrator, Mark B. McClellan, MD, PhD.

The demonstration, which was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act, will be conducted in the entire states of Maine and New Mexico, and in the Chicago Metropolitan Statistical Area (MSA) and 17 central counties in Virginia. The statue specified that the demonstration must include four sites, two urban and two rural, and one site of each must be in a health professional shortage area (HPSA).

The statute requires an evaluation of the demonstration to assess cost effectiveness, cost benefit, beneficiary satisfaction, and other issues as the Secretary of Health and Human Services determines to be appropriate.

“We recognize that many Medicare beneficiaries seek the services of chiropractors for back pain and other conditions,” McClellan said. “This demonstration provides the opportunity to evaluate whether expanding coverage of chiropractic services reduces overall Medicare expenditures for neuromusculoskeletal conditions.”

Chiropractors who are located in the demonstration areas will be able to provide services to any beneficiary enrolled under Medicare Part B. The demonstration will expand coverage for the services for neuromusculoskeletal conditions, including diagnostic and other services such as the provision of x-rays and therapy services.

Current Medicare coverage for chiropractic care is limited to manual manipulation of the spine to correct a subluxation, which is defined as a malfunction of the spine. Treatment may only be provided for the active correction of a documented subluxation, not for prevention or health maintenance. Treatment for the subluxation must be related in terms of a neuromusculoskeletal condition in which there is a reasonable expectation of recovery or functional improvement.

The goal of the demonstration is to evaluate the feasibility and desirability of covering additional chiropractic services under Medicare beyond the current coverage. CMS has scheduled an Open Door Forum on November 18 to solicit input from interested groups regarding benefits of this demonstration and implementation of its budget neutrality requirements.

Source: Centers for Medicare and Medicaid Services, www.cms.gov

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