What is the policy?

POLICY: It is VHA policy that access to chiropractic care, through consultation from the patient's primary care provider, or another VHA clinician providing care for the condition for which chiropractic care may be helpful, must be consistent with facility policy and practice for other specialty care access; and that additional requirements or authorizations will not be placed on referral for chiropractic care at a VHA facility or through the outpatient fee-basis care program.

ACTION: Veterans Integrated Service Network (VISN) Director.

Each VISN Director is responsible for ensuring that:

(1) At least one VHA site, within the VISN, is designated to provide on-station chiropractic care. VISNs may elect to offer chiropractic care at more than one site. Chiropractic care at VHA facilities may be provided through appointment of or contracts with, licensed chiropractors, dependent upon the needs of the facility and consistent with Pub. L. 107-135, Section 204(e)(1).

(2) VISN Chief Medical Officers and facilities' management provide visible and supportive leadership in integrating chiropractic services into VHA.

b. Facility Director. Each facility Director is responsible for:

• Authorizing privileges allowing DCs to provide patient evaluation and care for neuromuscular and musculoskeletal conditions including the subluxation complex, consistent with:
  • The scope of the chiropractor's state licensure;
  • The individual's clinical competence as determined by education, training, professional experience, and peer references; and
  • The needs of the facility.
• Ensuring DCs, as independent licensed practitioners, are privileged consistent with facility practice for doctors of podiatric medicine and optometry.
• Incorporating doctors of chiropractic into a health care team.
• Providing space, equipment and supplies sufficient for efficient provision of chiropractic care.
• Ensuring appropriate VHA employees are provided training and materials in order to familiarize them with chiropractic care and how such services are provided.
• Using the outpatient fee-basis care program, when the residence of the Veteran is geographically distant from a VHA site providing on-station chiropractic care, to provide these services through community chiropractors. Chiropractic care may also be provided through Memoranda of Agreement (MOA) with Department of Defense (DOD) facilities.
  • Outpatient fee-basis chiropractic care must be designated using the purpose of visit code 75 (chiropractic care) in the fee package to ensure data can be retrieved.
  • Appropriate data must be collected on any chiropractic care provided through MOA(s) with DOD facilities. Such data needs to include the:
    • Number of patients receiving care,
    • Diagnoses (using International Classification of Diseases, 9th edition, Clinical Modifications (ICD-9-CM) codes),
    • Treatments (using Current Procedural Technology Modifications (CPT) codes),
    • Number of visits for each patient, and
    • Costs associated with the MOA.
• Developing service referral agreements for chiropractic care within 3 months of beginning chiropractic service.
• Developing approaches to ensure quality of chiropractic utilization