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MILITARY and VETERANS CORNER

Chiropractic care is included in the Medical Benefits Package, the standard health benefits plan generally available to all enrolled Veterans. It is VA policy that access to chiropractic care is consistent with policy for access to any other specialty. Consultation for chiropractic care can be initiated by the patient’s primary care provider or another appropriate VA clinician. Referral for chiropractic care will not be subject to requirements or authorizations other than those for referral to any other specialty care at a VA facility or through the outpatient Community Care program.

Chiropractic care at VA facilities may be provided through appointment of, or contracts with, licensed doctors of chiropractic (DCs), dependent upon the needs of the VA facility and consistent with Section 204(e)(1) of the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001, Pub. L. 107-135. The Consolidated Appropriations Act, 2018, requires on-station chiropractic care be provided at no fewer than two medical facilities or clinics in each VISN by December 31, 2019, and at no fewer than 50 percent of all medical centers in each VISN by December 31, 2021.

From fiscal year 2004 to 2017, VA increased its number of chiropractic clinics by approximately 9.4 percent annually, and the number of Veterans receiving on-station chiropractic care increased approximately 18 percent annually. As of June 2019, there are approximately 180 chiropractic physicians providing patient care at 101 VA facilities. Chiropractic clinics are administratively aligned in physical medicine, primary care, pain medicine or other service lines consistent with local facility needs. Additionally, there are five chiropractic residency trainee positions across five VA chiropractic residency training programs, the first and currently only accredited chiropractic residency programs in the United States.

INTEGRATION

Integration of Chiropractic Care and VA/Military Facilities
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Department of Defense (DOD)

In recent years, in recognition of the value and benefits of chiropractic care, Congress has passed, and the President has signed into law, legislation establishing a permanent chiropractic care benefit for both active duty military personnel and veterans. Furthermore, a doctor of chiropractic is now stationed in the U.S. Capitol to provide necessary care to members of Congress

To date, there is a doctor of chiropractic at 60 military bases around the country; however, according to a 2005 Government Accountability Office report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. It is still necessary more is done to increase chiropractic access and availability.

Chiropractic Clinics in DOD Facilities

Veterans’ Affairs

A Department of Veterans Affairs policy enforces that veterans have access to chiropractic care. How this service becomes available will depend on the availability of a chiropractic doctor on staff. If a chiropractor isn’t on staff, a veteran can ask for a referral to a chiropractic doctor outside the system. While a referral from a physician is necessary the veteran has certain appeal rights.

The Department of Veterans Affairs (VA) has initiated the process of providing veterans with access to chiropractic care by placing chiropractic doctors on staff at VA hospitals.

The VA now provides chiropractic care (via hired or contracted staff) at approximately 40 major VA treatment facilities within the United States. Unfortunately, an overwhelming majority of America’s veterans still do not have access to chiropractic care because the VA has taken no action to provide chiropractic care at approximately 120 of its major medical facilities.

Chiropractic Clinics in VA Facilities

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Chiropractic On The Front Lines For Veterans

 Doctors of chiropractic (DCs) are specifically trained to evaluate, diagnose and manage neuro-musculoskeletal conditions – a leading complaint among Veterans – including acute, subacute and chronic low back and neck pain, as well as headaches and general health concerns. In addition, DCs are integrated with primary care, rehabilitation, pain management and other specialty teams to provide safe, effective and drug-free care to active-duty military personnel and Veterans.

Military life is fraught with physical challenges. Carrying heavy loads, running with body armor, and jumping out of planes can have a long-term impact on a person’s body.  Of the 9 million patients served annually in the department of Veterans Affairs (VA) facilities, more than half experience chronic pain.  25% of Veterans consistently report low back pain (LBP).  Veterans are 2x more likely than non-veterans to die from accidental overdoses of highly addictive painkillers.

Solution: Make chiropractic part of the integrated care that Veterans receive for LBP. The VA now provides chiropractic care at approximately 70 major VA treatment facilities within the U.S. There is currently an effort to require the VA to provide chiropractic care to all its medical treatment centers by the end of 2020.

During 2012-2017, overall opioid Rx reduced by as much as 66% in some VA facilities.  VA now offers non-drug treatment options for chronic pain, such as chiropractic care, which includes spinal manipulation therapy.

Chiropractic care is included in the Veterans Affairs (VA) Medical Benefits Package, the standard health benefits plan generally available to all enrolled Veterans.

Evidence shows teat patients receiving chiropractic care are:

  • Less likely to use other healthcare services that are more costly and have greater risk, such as opiate medications, spinal imaging and injections, and elective spinal surgeries
  • Have lower overall healthcare costs for episodes of non-operative spine-related disorders

Eligible Veterans (VA members) can receive chiropractic care through the VA’s outpatient fee-basis program after a referral by their primary care provider (PCP), and prior authorization approval by the VA department or the VA third-party administrator (TPA), TriWest. In addition, Veterans can obtain chiropractic care in community chiropractic facilities for musculoskeletal pain and dysfunction.

Veteran’s Choice Program

A Veteran can receive care from a community provider, paid for by the Department of Veterans Affairs, through a program known as the Veterans Choice Program (VCP). If the VA is unable to provide a certain type of care in a timely manner, or if the nearest VA medical facility is too far away from the Veteran, than he or she may be eligible for care through the VCP. To use the VCP, Veterans must receive prior authorization from VA to receive care from a provider that is part of VA’s VCP network of community providers. The authorization is based on specific eligibility requirements and discussions with the Veteran’s VA provider. VA must authorize care that is needed beyond the scope of the first authorization.

Care eligibility is based upon the following requirements:

  • VA can’t provide the services the Veteran needs
  • VA can’t make an appointment for the Veteran at the nearest VA medical facility within 30 days of the clinically indicated date (the date the Veteran and their VA provider agree should be the next date the Veteran is seen for care)—or, if VA can’t determine this date—the date the Veteran prefers to be seen next
  • Veteran lives more than 40 miles (driving distance) from the nearest VA medical facility with a full-time PCP
  • Veteran has to travel by air, boat or ferry to get to the nearest VA medical facility
  • Veteran faces an excessive burden in traveling to the nearest VA medical facility (such as geographic challenges, environmental factors or a health problem that makes it hard to travel)

How to Become a VCP Provider

If you are a community provider, such as a doctor of chiropractic (DC), interested in providing care for Veterans through VCP, you must establish a contract with the VA’s TPA, currently TriWest Healthcare Alliance, https://triwest.com/.

In order to be considered eligible to become a Community VCP Provider, you must meet the following requirements:

  • Must accept Medicare rates
  • Must meet Medicare Conditions for Coverage and Conditions of Participation, or other criteria established by VA
  • Be in compliance with all applicable federal and state regulatory requirements
  • Have same or similar credentials as VA staff
  • Submit a copy of the medical records to the TPA for medical care and services provided to Veterans for inclusion in the VA electronic record
  • Must be eligible according to the U.S. Department of Health and Human Services Office of Inspector General Exclusion Program

Sources: Department of Veterans Affairs, Reuters, DrugRehab.com

U.S. Department of Veterans Affairs (VA) 2019 MISSION Act

Starting on June 6, 2019, under the MISSION Act, eligible Veterans will have more ways to access healthcare. The MISSION Act strengthens the VA’s ability to deliver trusted, easy to access, high quality care at VA facilities, virtually through telehealth, and within communities. That means that eligible Veterans get the care and services they need, where and when they need them.

Care can be provided within the VA’s network and through approved non-VA medical providers in eligible Veterans’ communities, called “community care providers.” For example, if a certain type of health service isn’t provided by VA—eligible Veterans may be able to go to a non-VA provider, using VA coverage.

Eligible Veterans can use VA healthcare services nationwide, including mobile health clinics that serve rural areas and via telehealth. Note: Eligible Veterans need to be enrolled in VA healthcare to use community care benefits.

For general MISSION Act healthcare quesions, contact VA311 (1-844-698-2311).

For additional information, please visit: https://missionact.va.gov/

In the VA, DCs are licensed, independent practitioners who provide examination, diagnosis, treatment and management of neuromuscular and musculoskeletal conditions using non-pharmacologic and non-operative methods. A DC typically completes four years of baccalaureate training and four years of chiropractic training. Residency training is one year beyond attainment of the chiropractic degree, and fellowship training is for one to two years beyond the completion of residency training.

DCs utilize standard medical evaluation procedures, along with biomechanical assessments, to establish a diagnosis and formulate a management plan. They consult with other healthcare providers and refer patients in accordance with accepted medical indications. Chiropractic treatment includes a number of options such as patient education, therapeutic exercise, lifestyle recommendations and other interventions such as joint manipulation and mobilization, soft tissue therapies and physical modalities. DCs may also be trained and licensed to deliver a number of interventions currently classified as Complementary Integrative Health (CIH) therapies such as acupuncture, biologically based preparations and mind-body therapies.

Chiropractic care is included in Joint Commission pain management standards. Scientific evidence shows that patients receiving chiropractic care are less likely to use other healthcare services that are costlier and have greater risk, such as opiate medications, spinal imaging and injections and elective spinal surgeries. Patients using chiropractic care also have been found to have lower overall healthcare costs for episodes of non-operative spine related disorders. One study reported that among Veterans who were not receiving VA chiropractic care, 75 percent were in favor of receiving such care at their VA facility.

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