The Senate introduced two bills in an attempt to preserve the Medicare Physician Fee Schedule, which has been threatened with cuts every year since 2003; however, as of press time, both pieces of legislation appear to be dead in the water.

The U.S. House of Representatives has passed H.R.5658, a bill authorizing defense programs for fiscal year 2009. Approved by the full House on May 22, 2008, following passage by the House Armed Services Committee on May 14, Section 704 of the bill makes clear that chiropractic care is a standard benefit for all active-duty military personnel and directs the Secretary of Defense to make such care available. H.R.5658 also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic.

Chiropractic care has been mandated for military personnel for years, but has been poorly implemented, and the profession has fought repeatedly to improve access. H.R.5658 comes on the heels of concurrent resolutions passed by the House and Senate in April (see "Senate Wants DCs Commissioned" in the May 20, 2008 issue of Dynamic Chiropractic). These resolutions request that Secretary of Defense Robert Gates immediately establish a career path for DCs within all branches of the military.

Section 704 of H.R.5658, the National Defense Authorization Act for Fiscal Year 2009, is titled "Chiropractic Health Care for Members on Active Duty" and states:

Requirement for Chiropractic Care – Subject to such regulations as the Secretary of Defense may prescribe, the Secretary shall provide chiropractic cervices for members of the uniformed services who are entitled to care under section 1074(a) of title 10, United States Code. Such chiropractic services may be provided only by a doctor of chiropractic.

Demonstration Projects-The Secretary of Defense may conduct one or more demonstration projects to provide chiropractic services to deployed members of the uniformed services. Such chiropractic services may be provided only by a doctor of chiropractic.

Definitions-In this section:

The term 'chiropractic services'

includes diagnosis (including by diagnostic X-ray tests), evaluation and management, and therapeutic services for the treatment of a patient's health condition, including neuromusculoskeletal conditions and the subluxation complex, and such other services determined appropriate by the Secretary and as authorized under State law; and

does not include the use of drugs or surgery.

The term 'doctor of chiropractic' means only a doctor of chiropractic who is licensed as a doctor of chiropractic, chiropractic physician, or chiropractor by a State, the District of Columbia, or a territory or possession of the United States.

"H.R.5658 is a bipartisan bill that explicitly states that chiropractic is an integral component of the Pentagon's health care delivery system, and it is the committee's intention that this language will increase access to chiropractic care at more facilities worldwide," said ACA President Glenn Manceaux, DC.

Chiropractors might remember that in 2000, Congress passed and President Bush signed a similar authorization bill containing language calling on then-Secretary of Defense Donald Rumsfeld to develop a "plan" to get the chiropractic benefit to all active-duty service members. Currently, there is a doctor of chiropractic at 49 military bases around the country but none currently stationed at military bases overseas. According to a 2005 Government Accountability Office report, only 54 percent of military personnel eligible for chiropractic care can reasonable access the benefit. H.R.5658 no longer acknowledges the "plan" and simply states that chiropractic care is a standard health care benefit.

"The House Armed Services Committee is to be commended for strengthening current law," said Dr. Carl Cleveland III, president of the Association of Chiropractic Colleges, on May 19. "This strong statement by the committee will pave the way for expanded access to this critical component of the military health care system – both here at home and overseas." The ACC and the ACA recommended inclusion of the chiropractic language in the bill

As of press time, H.R.5658 is under consideration by the Senate.

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