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Memorandum
To: ACA Members, House of Delegates, Board of Governors and Other Interested Parties
From: Gary Cuneo
Re: ACA EVP Weekly Activity Report
Date: January 27, 2003
The following issues are covered in this week's report:
1. ACA TO HOLD LIVE TELECONFERENCE ON HIPAA PRIVACY RULE
2. ACA EXPLORES ADDITIONAL COVERAGE UNDER FEDERAL EMPLOYEE PROGRAM
3. CMS HIRES A DOCTOR OF CHIROPRACTIC
4. CAC CONFERENCE AT NCLC
5. NEW DOCTOR PROGRAM AT NCLC
6. ACA WORKS TO IMPROVE WEBSITE CONTENT OF MAYO CLINIC
7. NAIC CONSIDERS UTILIZATION AND BENEFIT DETERMINATION MODEL ACT
8. CAN'T ACCESS THESE LINKS?
1. ACA TO HOLD LIVE TELECONFERENCE ON HIPAA PRIVACY RULE
The Privacy Rule was designed to protect patient information as it is transmitted through electronic means and to notify patients of this protection. To help you prepare your practice for the HIPAA Privacy Rule compliance date of April 14, 2003, ACA will hold a live teleconference titled "Introduction to the HIPAA Privacy Rule."
Date: February 12, 2003
Time: 1:30-3:00 pm ET
About the Speaker: Linda Sanches is a senior advisor on HIPAA privacy to the Office for Civil Rights of the U.S. Department of Health and Human Services. In her previous position as a senior health policy analyst in the Office of the Assistant Secretary for Planning and Evaluation, Sanches was a lead member in a team that created the health information privacy regulation. She has also represented the Office of the Secretary in the development of the other HIPAA administrative simplification standards.
For more information, call 800-986-4636.
2. ACA EXPLORES ADDITIONAL COVERAGE UNDER FEDERAL EMPLOYEE PROGRAM
As you may be aware, the ACA was able to include a first-time chiropractic manipulation benefit into the "Basic Option" for the Blue Cross/Blue Shield Federal Employee Health Benefit Plan. This inclusion was part of our settlement with the national Blue Cross/Blue Shield Association (BC/BSA) in the Trigon litigation. We have also been exploring ways in which this coverage could be expanded, including assisting in the efforts of an Ohio chiropractor, Dr. Lou Rossi. Dr. Rossi and we have been arguing for a number of years that doctors of chiropractic should be paid for all covered services within their scope of practice, even though the there is no "chiropractic benefit" under the applicable federal plan. It now appears that ACA's inclusion of a specific - although limited - chiropractic benefit in the basic option under the BC/BSA federal plan changes the whole nature of a chiropractor's status under the plan, according to the federal Office of Personnel Management (OPM). They have indicated to us verbally and in a short letter to Dr. Rossi that, because of the inclusion of a limited chiropractic benefit, chiropractors are now considered "covered providers" and may be reimbursed for covered plan services, such as physical therapy services, within their state-authorized scope of practice on an out of network basis. OPM has therefore instructed BC/BSA to pay for physical therapy services rendered by
Dr. Rossi back to January 1, 2002, the effective date of ACA's inclusion of the chiropractic benefit into the basic option. We understand that this new coverage applies to both standard and basic options under the BC/BSA federal plan. ACA legal counsel has written to OPM to confirm this policy and clarify the extent and conditions of this coverage. We will keep you informed as to what we learn. Although we still need to verify things, this could clearly be another "ripple effect" of our litigation efforts.
3.. CMS HIRES A DOCTOR OF CHIROPRACTIC
We are very pleased to report that Dr. Richard Lawlor has been appointed as Senior Outreach Specialist in the Office of the Administrator for CMS (Centers for Medicare and Medicaid Services, formerly HCFA). He reports to the executive assistant of the Administrator. Dr. Lawlor works with four or five other specialists in maintaining a liaison with various health care groups regarding Medicare problems. Secretary Tommy Thompson had pledged, as did the Administrator, that CMS would attempt to become more provider-friendly, and these specialists would serve as liaisons with the health care community. While Lawlor will work with other health care groups, he will naturally be called on for comment regarding chiropractic issues..
Dr. Lawlor practiced for eight and one half years in Austin, Texas, and then pursued an MBA. He visited our office recently, where we had a chance to brief him on chiropractic issues.
Almost a year ago, George McAndrews was at the home of Secretary Thompson along with Dr. Ken Luedtke and Bill Gerard regarding the lawsuit. When the discussion ended, Mr. McAndrews commented that among the 65,000-plus employees of HHS, there wasn't a single chiropractor. The Secretary didn't believe it. George asked him to check it out. We believe that with the exception of Dr. Christine Goertz who worked for NIH, there has never been a full-time chiropractor appointed in any of the HHS agencies. It took us a while to make this happen, but we were finally successful. We are continuing to push the Department to hire additional doctors to key policy making positions in the agency.
Dr. Lawlor has agreed to speak at our CAC conference at NCLC.
4. CAC CONFERENCE AT NCLC
The Chiropractic Carrier Advisory Committee (CAC) members will be meeting in an all-day conference on Friday, March 7, at the Hyatt in conjunction with ACA's National Chiropractic Legislative Conference (NCLC). Chiropractic representatives on all the Medicare carriers throughout the country will be sharing success and problems in working with local carriers and interacting with CMS officials. Dr. Ritch Miller, Chairman of the Medicare Committee and a CAC member, has put together a program that will help each CAC member do his or her job better. Already confirmed is Dr. Rich Lawlor -- the first chiropractor hired at CMS -- and Dr. Joe Johnson of Florida who serves as the chiropractic member of the HHS Primary Physicians Advisory Committee. The agenda for the meeting includes the CMS's Provider Outreach Program; an update on PPAC activities; Overview of the CAC and its responsibilities from CMS perspective; LMRPs and Medical Review; and ABNs. A complete copy of the agenda and an updated list of the confirmed speakers will be on the ACA web page..
5. NEW DOCTOR PROGRAM AT NCLC
Dr. Lance Armstrong from Cocoa Beach, FL, has developed a national version of the highly successful Right Start Program of the Florida Chiropractic Association for the ACA, to help new practitioners enjoy a successful start in their practice. Speakers joining Dr. Armstrong for the debut of this one-day program on Saturday of NCLC include Dr. Mark Sanna of Breakthrough Coaching and Dr. Bud Passerro of NCMIC. The program will cover a number of important topics including licensure, insurance, chiropractic and other office equipment, associating vs. buying a practice or starting from scratch, financial classifications of patients, risk management, record-keeping, coding procedures, managed care procedures and common mistakes, how to obtain patients, political involvement, professional memberships, and mentor programs. The ACA Accurate Start program is FREE to all ACA members and $50 for all non-members.
6. ACA WORKS TO IMPROVE WEBSITE CONTENT OF MAYO CLINIC
At the request of Peter Spencer, DC, Blue CCHIP Liaison for northern California and President of the California Chiropractic Association, ACA sent a letter to the Mayo Clinic asking them to revise the content of their web material regarding chiropractic care. Blue Cross/Blue Shield of California, the local plan that Dr. Spencer works with, contracts their website through Mayo
Clinic, which provides information on chiropractic and all modalities of medicine to their subscribers. The information suggests that doctors of chiropractic should be supervised by MDs who have little or no training in neuromusculoskeletal conditions. If you would like to visit the website yourself, you may do so at the following link: <https://www.mylifepath.com/bsc/hw/healthlibrary/CAM/hw_cam_main.jhtml>. >From this link, select "Mind & Body Modalities," then "Chiropractic Treatment." ACA has offered to assist Mayo Clinic in accurately revising their information.
7. NAIC CONSIDERS UTILIZATION AND BENEFIT DETERMINATION MODEL ACT
A taskforce of the National Association of Insurance Commissioners (NAIC) has issued a draft model bill for comment. The model bill compliments, and in some ways strengthens, the protections recently established by the U.S. Department of Labor regulation dealing with claims review and appeals procedures for ERISA benefit plans. Among other things, the NAIC model bill would require a health carrier to implement "a written utilization review program" and ensure that such a program is evaluated for "medical necessity, appropriateness, efficacy or efficiency of health care services." Such program would also be required to identify and describe the review criteria used in the decision-making as well as the mechanisms used to ensure consistent application of clinical review policy. The model bill would also prohibit any incentive given to a reviewer to make "inappropriate review decisions" as well as prohibit compensation based on the "quantity or type of adverse determinations rendered." The draft model bill can be viewed at
<http://www.naic.org/1papers/models/docs/UR4.pdf>
8. CAN'T ACCESS THESE LINKS?
Some of you have been unable to download my PDF links. To view these file types,
you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com.
If you need further assistance viewing anything referred to in this report,
please e-mail me at gcuneo@amerchiro.org.
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