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Chiropractic News..HCFA

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In a message dated 6/17/99 5:43:53 PM Eastern Daylight Time,

atrumbul@... writes:

<< It is also clear that enrollees in Medicare HMOs continue to be cheated

out of chiropractic services mandated by Congress and that HCFA's lame

excuses for having been wrong have not corrected the gross injustice to the

senior citizens that continue unabated. HCFA's continued inaction speaks much

louder than its belated apology.'' >>

I am not so sure on how such an aggressive tone works when trying to work

with HCFA

Steve Marcum PT

Director of Rehabilitation Services

Pattie A. Clay Hospital

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Thursday June 17, 11:16 am Eastern Time

Company Press Release

SOURCE: American Chiropractic Association

HCFA Policy Reversal Prohibits Physical Therapists From Performing Spinal

Manipulation to Correct a Subluxation

ARLINGTON, Va., June 17 /PRNewswire/ -- In a June 14 meeting with the Practicing

Physicians Advisory Council (PPAC), the Health Care Financing Administration

(HCFA) reversed its policy extending back to the early 1980s allowing physical

therapists to perform manual manipulation of the spine to correct a subluxation

as a Medicare service. A representative of the American Chiropractic Association

(ACA) attending the meeting commended HCFA for recognizing the need to make this

reversal.

This reversal is a direct result of the ACA lawsuit against HCFA and the

Department of Health and Human Services (HHS) on this policy and others.

According to ``Count Two'' of the ACA's Amended Complaint filed on May 18, ``a

physical therapist is not a 'physician' pursuant, (to the Medicare statute)''

and ``manual manipulation of the spine by a physical therapist is not a Medicare

covered service and may not be substituted by a Medicare HMO, Competitive

Medical Plan (CMP) or Medicare+Choice organization for manual manipulation to

correct a subluxation performed by a chiropractor.''

During the PPAC meeting, Gustafson, Director of HCFA's Plan and Provider

Purchasing Policy Group, responded to a question posed by Dr. Jerilynn Kaibel,

PPAC member and a chiropractor.

``There has been some confusion about the ability of physical therapists to be

paid for delivering this service under Medicare. And I believe at one time, our

interpretation was that it was ok,'' stated Gustafson. ``We have come to a more

mature understanding of what the statute in fact provides, and physical

therapists are not permitted to bill Medicare for this service. If we have not

already made this clear to managed care plans, we will be doing so in the

Operational Policy Letter (OPL) this fall,'' concluded Gustafson.

``The first victory in our lawsuit against HCFA was receiving the report that

Congress ordered HCFA to submit nine years ago. This reversal by HCFA is victory

number two,'' said ACA President, Dr. Pedigo. If followed up by

directives with teeth in them, and sanctions for disregard of the directives,

more HMOs may start recognizing their legal obligations to provide chiropractic

services by chiropractors at meaningful levels to senior citizens.``

``With these two victories, we've won half the battle,'' said ACA General

Counsel and lead attorney in the lawsuit against HCFA, Mcs. ``While

we are pleased with this development, HCFA still maintains the position that

medical doctors and osteopaths can perform manual manipulation of the spine to

correct a subluxation when only chiropractors are qualified to do so. Just as

importantly, HCFA policy continues to permit medical doctors in HMOs to

determine the medical necessity of chiropractic care. We must continue with our

lawsuit until these policies are changed. It is also clear that enrollees in

Medicare HMOs continue to be cheated out of chiropractic services mandated by

Congress and that HCFA's lame excuses for having been wrong have not corrected

the gross injustice to the senior citizens that continue unabated. HCFA's

continued inaction speaks much louder than its belated apology.''

SOURCE: American Chiropractic Association

Allan B. Trumbull, Director P.T.

Mount Clemens General Hospital

Mt. Clemens, MI 48043

atrumbul@...

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