ARLINGTON, Va., Nov. 12 /PRNewswire/ -- The American Chiropractic Association (ACA) today filed a lawsuit in the United States District Court for the District of Columbia as an initial step in an effort to block impending Health Care Financing Administration (HCFA) regulations governing Medicare+Choice programs (Medicare Part C) that pose a direct threat to the chiropractic profession and Medicare patients. The legal action will be the first step in a two-pronged effort to force HCFA to adopt policies that guarantee enrollees in Medicare/managed care programs access to chiropractic care delivered by doctors of chiropractic.
The heart of the Medicare Part C (also known as Medicare+Choice) controversy centers around HCFA regulations preliminarily implemented July 27, 1998, which, in ACA's view, illegally allow Medicare managed care plans to substitute as a benefit spinal manipulation performed by medical doctors, osteopaths, physical therapists, and other providers, in lieu of spinal manipulation to correct a subluxation performed by chiropractors. Chiropractic spinal manipulation to correct a subluxation, a guaranteed benefit available to all beneficiaries in the Part B fee-for-service component of Medicare, was determined by Congress in 1972 to be a uniquely chiropractic concept and procedure no other profession was either trained or expected to administer. For this reason, ACA's view is that the Balanced Budget Act statute requires that chiropractic services -- performed by chiropractors -- be made available to all Part C beneficiaries.
The Balanced Budget Act statute clearly states that "Each Medicare+Choice plan shall provide to members enrolled under this Part ... those items and services (other than hospice care) for which benefits are available under Parts A and B to individuals residing in the area."
Senate Minority Leader, Tom Daschle (D-SD) made last-minute efforts to persuade HCFA to voluntarily reverse course and issue corrected regulations guaranteeing access to chiropractic care.
In addition, Rep. Lane Evans (D-IL) has expressed his concerns about the regulations' impact on doctors of chiropractic and their patients. "I understand that chiropractic patients in Medicare have encountered near total exclusion from chiropractic services once they enter into a Medicare HMO," Evans wrote in an October 21 letter to HHS Secretary Donna Shalala. "Further, while some Medicare HMOs may offer a service of manual manipulation by licensed providers other than chiropractors, it appears that the service is rarely utilized; and that such other providers cannot properly provide the unique chiropractic service of manual manipulation to correct a subluxation of the spine that is guaranteed to Medicare beneficiaries."
In the initial lawsuit, ACA will file a petition for a writ of mandamus coupled with a request under the Administrative Procedure Act to force the Department of Health and Human Services (HHS), the agency that oversees HCFA, to provide a report on chiropractic utilization by Medicare HMOs that was mandated by Congress in 1990 but never supplied to Congress. This report would demonstrate the amount, or lack thereof, of chiropractic benefits available within the current Medicare HMO program, which will be folded into Medicare Part C. ACA contends that HCFA should not have issued regulations without consideration of these findings and contends that Congress should have had an opportunity to review the results of the study before HCFA embarked on a historically revisionist attempt to deny chiropractic care to patients. The second lawsuit will attempt to block the objectionable regulations when they become final in January.
"We have been communicating with HCFA at a high level, and hoped they would see reason on this issue," said ACA President, Dr. Michael Pedigo. "We believe we have now exhausted every administrative and legislative avenue and have no choice but to take legal action against the federal government," Dr. Pedigo concluded.
The ACA considers the new regulations from HCFA to be highly significant, not only because they relate to the large and growing Medicare Part C program, but because Medicare frequently serves as a model for private-sector insurance and health plans. In many states the managed care regulatory model is utilized by the private sector managed care plans. ACA General Counsel George McAndrews, the attorney who successfully led the chiropractic profession's battle against the American Medical Association in the Wilk v. AMA anti-trust suit, will lead ACA's legal team in both legal actions against HCFA.
SOURCE American Chiropractic Association
CO: American Chiropractic Association; Health Care Financing Administration; United States Department of Health and Human Services
