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Chiropractors hope Affordable Care Act levels field for treatment, reimbusements

This article first appeared in the St. Louis Beacon, Nov. 27, 2012 - Last spring, Missouri lawmakers rejected a bill allowing licensed chiropractors to get reimbursed for services provided to Medicaid-eligible patients. By summer, Illinois lawmakers had voted to eliminate adult chiropractic care from Medicaid services to close a state budget deficit.

Chiropractors are hoping the Affordable Care Act will make it easier for them to expand their services through insurance reimbursements.

“With the passage of the Affordable Care Act, the situation is beginning to look more promising for chiropractic access,” says Daniel Sosnoski, editor of Chiropractic Economics.

Sosnoski and others say Section 2706, a nondiscrimination provision in the health-reform law, could open the door to more chiropractic services.

He interprets Section 2706 to mean that chiropractors and certain other providers operating within their scope of practice would get equal consideration for reimbursements from insurers as other service providers, such as physicians. “In theory, a state could not say you can use our (Medicaid) insurance to see an M.D., but you can’t use it to see a D.C.,” or doctor of chiropractic.

Some may be surprised that Missouri HB1533, which extends Medicaid payments to chiropractors, was filed by Rep. Shane Schoeller, a lawmaker from Willard in conservative Greene County. 

As a group, House Republicans generally have been against adding providers to Medicaid for any purpose. Schoeller had worked with the state chiropractors association in drafting the legislation.

“We were basically saying that whatever services are used, if a chiropractor can do it, then they should be able to do it and get reimbursed,” said Jeremy Cody, Schoeller's spokesman.

There is also the argument that chiropractors should have access to Medicaid patients because they might be able to provide some services more cheaply.

Loree Kessler, executive director of the Missouri Board of Chiropractic Examiners, says services chiropractors are licensed to provide varies from state to state.

In Missouri “they can provide an examination, diagnosis, (spinal) manipulation and treatment,” she says. “They cannot perform surgery or prescribe drugs. In some states, chiropracto0rs have prescription authority; they can do minor surgery, setting bones, for example.”

Daniel Redwood, a professor at Cleveland Chiropractor College in Overland Park, Kan., isn’t sure how far the provision will go in requiring insurers to pay for chiropractic services.

Generally, he says, insurance for chiropractic services is limited to spinal manipulation even though the insurance policy itself might cover other procedures, such as rehabilitation services or supervised exercise, that aren’t reimbursed when provided by a licensed chiropractor

Redwood expressed guarded hope that the climate might improve for chiropractors when ACA takes full effect in 2014. But he cautioned "things may be somewhat worse or they may turn out to be a wash. At this point a great deal is unresolved.”

Among issues unresolved is a roadblock by the American Medical Association. The group’s House of Delegates passed a resolution last year, urging federal lawmakers to scrap the nondiscrimination section altogether. The AMA has historically fought against certain health services being provided by those lacking degrees from medical schools.

But some influential federal lawmakers, including Democratic Sen. Tom Harkin of Iowa and now retired Sen. Chris Dodd of Connecticut, have gone to bat for chiropractors. The two were responsible for including the Section 2706 nondiscrimination clause in the health-reform law.

Even if the non-discrimination clause isn’t changed by the AMA and other opponents, Redwood sees additional hurdles. He thinks court decisions could grow out of coverage issues under the nondiscrimination clause. An example, he says, might be whether the clause would allow medical doctors or physical therapists to be paid more than chiropractors for providing the same services.

Under ACA, millions of Americans will get access to health insurance through exchanges set up in each state. Redwood notes that chiropractors are concerned about how robust state-created exchanges will be in embracing adding services provided by chiropractors. It’s unclear at this point what benefits will be included in exchanges created by the federal government, which will happen in Missouri.

The American Chiropractic Association has taken up this issue. In a letter to HHS Secretary Kathleen Sebelius, the association expressed concern that states setting up their own exchanges might choose essential health benefit packages that could exclude coverage by certain licensed providers, including chiropractors.

“Discrimination against providers is also discrimination against patients” to “select the provider and the service of his or her choice,” the association said it its letter.

The group’s spokeswoman says it is awaiting Sebelius’ reply.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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