Chiropractors quietly put back in budget plan

Medicaid move could cost extra $25 million

BATON ROUGE -- With virtually no public debate or scrutiny, the nearly $30 billion state budget was amended by the Legislature this month to let chiropractors participate in the Medicaid program and give them higher reimbursements than the state pays to doctors.

It's a move that could end up costing the taxpayers $25 million a year, according to the Louisiana State Medical Society, or force the state to reduce what it pays to other health care providers through its Medicaid program, which finances health care services for the poor, elderly and disabled.

Health and Hospitals Secretary Alan Levine said the administration is opposed to the change, which was slipped into the budget proposal -- House Bill 1 by Rep. Jim Fannin, D-Jonesboro -- over objections from his department. The budget bill could be on its way to Gov. Bobby Jindal's desk as early as today if the House, as expected, gives final approval to changes made by the Senate.

--- No money in budget ---

Levine said adding chiropractic care as a covered service makes little sense, especially since there was no money included in the budget bill to pay for it at a time when lawmakers are demanding cuts to other areas of Medicaid. The money to pay the chiropractors would either come from mid-year additions to the budget, or by cutting the rates paid to other providers in the program.

"Adding another service without adding any money to pay for it doesn't seem logical right now," Levine said, adding that such policy changes deserve more of a public hearing than this one received in the Legislature.

Kathy Chittom, executive director of the Chiropractic Association of Louisiana, said the change won't cost the state any money because the Medicaid program already pays to treat people suffering from back problems.

"It's just increasing the number of people who can provide the service. It's not an additional cost to the program," Chittom said. She said adding chiropractors to the list of health care providers who can treat Medicaid patients will improve access in areas of the state that are medically underserved.

The move comes more than a decade after Jindal, then a rookie in state government serving as the secretary of the Department of Health and Hospitals, made the chiropractic program one of his first budget-cutting targets as he tried to contain mushrooming Medicaid costs.

At the time -- in 1996 -- the chiropractic program had become a symbol of waste and fraud in Medicaid, thanks to a few providers who were bilking the government by billing for phantom office visits or unnecessary treatments.

"It's the old story of a few bad apples tainted everybody," said Dr. Vincent Culotta, chairman of the legislative council of the Louisiana State Medical Society.

--- History with Jindal ---

Under Jindal's stewardship, the health department eliminated state support for chiropractic services to adults, and put new safeguards in place for services to children. The changes helped bring down costs from a high of nearly $15 million in 1994-95 to less than $1 million in 1997-98, the year he left to head a national Medicare commission.

Two years later, in 1999-2000, chiropractors were cut from the Medicaid budget altogether, except for children who are recommended for chiropractic treatment by a doctor.

After almost a decade's absence, Chittom said the Chiropractic Association decided this year was a good time to try to get back into the Medicaid program because of the number of freshman legislators in Baton Rouge.

"The board came to me and said, 'This year we're going to take a fresh new look at things because the Legislature is fresh and new,' " Chittom said.

--- Bigger payments ---

Chittom said she asked for the amendment in the House Appropriations Committee on a day set aside for public testimony. Days later on the House floor, Rep. Gary Smith, D-Norco, by unanimous vote, got an amendment tacked on to the bill that would make chiropractors eligible for Medicaid payments starting Nov. 1, and mandating that they be paid at the same rates as Medicare pays for such services.

Doctors who participate in the program, by contrast, are paid at 90 percent of what Medicare reimburses -- a rate that critics say discourages many doctors from participating.

Smith's amendment was stripped off the bill by the Senate Finance Committee, which made hundreds of changes to the proposal earlier this week. But a day later, it was put back in the bill as part of a batch of amendments that the committee's chairman, Sen. Mike Michot, R-Lafayette, described as "technical" in nature.

"There's a guardian angel out there that's looking out for the chiropractors," Culotta, of the medical society, said.

Neither Michot nor Smith returned calls seeking comment on Friday.

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Jan Moller can be reached at jmoller@timespicayune.com or (225) 342-5207.