Special Alert: MMA Section 651 Expansion of Coverage of Chiropractic Services Demonstration
Q: Can trained office staff who are not chiropractors, such as chiropractic assistants, provide therapy services "incident to" the chiropractor?
A: Due to pending litigation, CMS has agreed to delay implementation of the regulation and manual provisions governing qualifications for auxiliary personnel furnishing services billed as physical therapy and occupational therapy services incident to the services of a physician or nonphysician practitioner. We anticipate this delay to be temporary, probably less than two months. By its terms, CMS's agreement to delay implementation will expire on July 22, 2005, unless the court enters an injunction order prohibiting implementation of the qualification provisions described above. If the court rules in favor of CMS before July 22, 2005, CMS will issue instructions requiring implementation of the provisions of the regulation and manual. In light of CMS's agreement to delay implementing new Chapter 15 manual provisions and certain provisions of the regulations regarding "incident to" therapy services, chiropractic assistants, physical therapy assistants, or other trained office staff may provide therapy services incident to a chiropractor as of the beginning of the demonstration, April 1, 2005. Please note that the court has ordered that any hearing on the issue, if necessary, will take place on July 1, 2005. The incident to requirements for this demonstration will then mirror the court's ruling regarding implementation of these manual provisions. If the court allows the CMS manual provisions to take effect, then chiropractors under the demonstration will also be subject to these requirements as of the effective date. This means that when a physical therapy service is provided "incident to" the service of a chiropractor, the person who furnishes the service must be a physical therapy qualified practitioner other than licensure (meeting the physical therapy definition at 42 CFR 484.4 other than licensure).
