Clarifications Regarding the Scope Modernization Bill

Recently, the New York Chiropractic Council (the Council) released a video regarding the Scope Modernization Bill. As a result of this video, we felt that some clarification is in order.

History of the Bill

For a bit of history, the Scope Modernization bill was negotiated between the leadership and legislative committees of both the NYSCA and the Council along with our respective legislative counsel, Amy Kellogg for NYSCA and Perry Ochacher for the Council. These negotiations took place over many months with every word, punctuation mark, and word order discussed, compromised over, and agreed to prior to the final bill being released.

In an effort to maintain transparency and to get feedback from the profession and not just organization members, the bill language was posted to the NYSCA website with the profession having the ability to ask questions, comment, and provide feedback. The NYSCA’s goal has always been to create bill language that would serve all members of the profession regardless of philosophy or practice style and allow New York to become a state where graduates would want to stay and thrive.

Once this process was concluded, the bill was introduced in both the Senate and the Assembly in 2018. Since the bill’s original introduction, no changes were made to the bill.

Performance of X-rays

While the video released by The Council states that the bill takes away the ability of chiropractors to perform x-rays, this is simply not true.   Section 6551(2)(a) of the bill reads:

The practice of chiropractic may include, but not be limited to, physical and functional examination of patients, health assessment, work capability assessment, handicap eligibility assessment, school and other sports assessment, school attendance assessment, spinal health assessment, analysis, or to give consultation, advice, recommendations and counseling regarding anatomy, physiology, neurology, general health matters, wellness and health optimization by any means of communication, the use of imaging studies using ionizing and non-ionizing imaging methods, adjustment, mobilization, manipulation, traction, and decompression, and ancillary procedures consisting of but not limited to, heat, cold, light, air, water, sound, electricity, massage, manual therapies, therapeutic exercise with or without assistive devices and clinical laboratory testing methods approved by the department as being appropriate to the practice of chiropractic.

Again, this is the original language that was negotiated and vetted by the profession.

It appears that the confusion over this issue has arisen because one particular section is being focused on. With a bill of this nature, you cannot look at each section as its own part. You must read the bill in its entirety to get a full sense of what is being accomplished and changes. While reading one part of the bill may appear to be removing x-ray, reading the full bill makes clear that x-ray (which is being updated to the term diagnostic imaging) is absolutely included and has been moved to a more prominent section that outlines fully what a doctor of chiropractic can do under the updated scope of practice.

Insurance Reimbursement and Denials

As we’ve attempted to learn more about this concern and from where it came, it appears the heart of the issue is not really a scope of practice issue but a reimbursement issue. If anyone is having an issue with insurance companies denying their x-rays, please let us know. The NYSCA Insurance Committee works on issues just like this. In fact, we have offered the services of the Insurance Committee to the Council as well. For the Insurance Committee to proceed, we will need sanitized/redacted documentation of the denial so that we can follow up accordingly. To date, we have not received any documentation from the Council, but we stand at the ready should we receive any.

Choosing Wisely

As far as bringing Choosing Wisely into the issue, additional clarification is required. This program was developed by the American Board on Internal Medicine with a mission of promoting conversations between clinicians and patients by helping patients choose care that is: supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary. The American Chiropractic Association merely provided comment on x-ray use, citing evidence-based guidelines with special consideration to cases where the adjustment might be contraindicated. This does not rule out the provider’s clinical judgement of medical necessity and does not preclude the chiropractor from taking x-rays.

Insurance reimbursement is a separate issue.

In Conclusion

The main legislative priority for NYSCA is the Scope Modernization bill, and we will continue to advocate for its passage in Albany. Passage of this legislation will allow for a better practice environment for our entire profession and all the patients we serve. We hope that our partners at the Council feel the same.

With these clarifications in mind, it is our hope that the Council leadership will see its way clear to continue to support scope modernization in hopes of attracting new DCs to our great state of New York and to allow for a better practice environment for our entire profession and all the patients we serve.

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