American Chiropractic Association Issue Brief: Chiropractic Services in Medicare

Existing policy as it relates to the availability of Chiropractic Services in Ohio Medicaid is arbitrarily restrictive, anti-competitive, and works against the interests of beneficiaries

Congress should take decisive action to correct this unfortunate reality

Current Medicaid policy regarding chiropractic physician services is blatantly anti-competitive: As currently written, existing regulatory language favors an anti-competitive provisioning of Medicaid services by “competitor” providers to doctors of chiropractic who experience an artificial market advantage over doctors of chiropractic (DCs) who are not reimbursed for existing covered Medicaid services that fall within their scopes of practice. The artificial limitation that restricts DCs to providing spinal manipulation, acupuncture and x-rays only, serves to channel patients to other providers who, for all practical purposes, are provided a “franchise” to offer Medicaid beneficiaries a range of services that DCs are not allowed to “compete” to offer in the Medicaid beneficiary marketplace.

Ohio Medicaid’s current restrictive policy is the result of a pervasive and illegal competitor-led campaign to restrict access to doctors of chiropractic in direct violation of the nation’s Anti-Trust Statutes: OAC 5160-8-11 is a copy of Medicare’s chiropractic policy (except that chiropractors are physicians in Medicare). The chiropractic profession’s inclusion in Medicare dates back to 1972, during the height of a multicompetitor orchestrated campaign to damage the reputation of the profession and to limit access to chiropractic services in Medicare. While legitimate consumer demand for chiropractic services led to the inclusion of DCs in Medicare in 1972, the profession’s competitors (major elements of organized medicine) had sufficient influence within Congress and the former HEW to ensure the statute including DCs in Medicare was written in a restrictive manner and that the implementing regulations would be written in an even more restrictive fashion. (Note: The widespread campaign directed against the chiropractic profession was well documented in Wilk v. AMA, resulting in permanent federal court injunction against the AMA, which remains in force).

Current policy channels Medicaid beneficiaries to more costly providers, which often results in patients being subjected to expensive and higher-risk procedures that often are unnecessary: Because current policy towards chiropractic services is “anti-competitive,” patients are, in effect, channeled to other providers whose standard treatment regimen involves the use of drugs, spinal injections, and surgery for a range of spinal conditions, for which, chiropractic care could be a less costly and safer alternative -- frequently avoiding the use and dangers of drugs (opioids in particular) and unneeded spinal surgeries and injections. Spinal-related “pain” is widespread in society including the population of Medicaid beneficiaries – and Medicaid policy should seek to prevent the use of unnecessary drugs and surgery especially in the Medicaid population that is already a “higher risk” cohort than the population at large. To the extent that current policy arbitrarily restricts access to chiropractic services, it exacerbates these problems.

Correcting current Medicaid policy as it relates to chiropractic services would add no new services (not currently covered) by Medicaid: The Northeast Ohio Academy of Chiropractic and the chiropractic profession at large, does not seek to create or add “new” reimbursable services to Medicaid that are not currently covered services that are provided by existing providers such as MDs, DOs and others. We seek only a modification of existing regulation to ensure that doctors of chiropractic are reimbursed for “existing covered services” which they are currently lawfully permitted to do under state law.

Current Ohio Medicaid policy fails to recognize, nor respect, appropriate state licensing authority of chiropractors: Ohio statutory law recognizes the ability and training of DCs to examine, diagnose, treat and refer. As it relates to chiropractic services in Medicaid, there is no legitimate reason that coverage and reimbursement for existing covered services in Medicaid does not reflect the relevant scope of practice determined appropriate by state statutory authority, in the same manner that it does for other providers in Medicaid such as MDs, DOs, DPMs, PTs, OTs, NPs, PAs and Mechanotherapists.



Existing policy as it relates to the availability of Chiropractic Services in Ohio Medicaid is arbitrarily restrictive, anti-competitive, and works against the interests of beneficiaries

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