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Orange County Chiropractic District
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Memorandum To: ACA Members, House of Delegates, Board of
Governors and Other Interested Parties The conference recommendations must now be sent to both the Senate and House for a vote. While it is considered close, most believe that there will be sufficient votes to get the measure out of both houses--particularly with the support of AARP. We should know for sure in the next couple of days. As an aside, the physical therapists were unsuccessful in including in the Medicare bill either a study of or demonstration project for direct access to physical therapy services--their legislative priority. Late breaking news: Over the weekend, the Medicare bill passed out of the House of Representatives. And today, it passed the Senate. The President is expected to sign the measure. The chiropractic demonstration pilot project will be conducted in four sites over a two-year period. The sites have not yet been determined. Under the pilot program, Medicare recipients will now be covered for the full scope of chiropractic practice paid by Medicare. Also to be tested is direct access to chiropractic care under Medicare Part C, where federally approved managed care companies administer Medicare benefits. Now we will have statistics from the government’s own sources to counter the ridiculous projections from the Congressional Budget Office that have hampered our efforts in the past. Pilot programs under DoD made our point about the cost-effectiveness of chiropractic care and led to chiropractic being offered as a permanent benefit for the armed forces. We have the same confidence regarding the outcome of this pilot project. Also included in the Medicare bill, and backed by Senator Grassley and the ACA, is a provision aimed at ensuring that beneficiaries will continue to have access to chiropractors and other physicians by replacing a 4.5% physician payment cut -- scheduled to take effect on January 1, 2004, if the bill does not pass -- with two years of payment increases. Getting the chiropractic demonstration pilot project included in the Medicare bill was a very difficult fight, as two of the most powerful members of the House and Senate on health matters—Senate Majority Leader Bill Frist, MD, and Chairman of the House Ways and Means Committee Bill Thomas--maintained their opposition to the chiropractic provision to the very end. But chiropractic had a champion in Sen. Chuck Grassley from Iowa, who is chairman of the Senate Finance Committee. He was a major player in the Medicare drug bill and doggedly fought off both Frist and Thomas to achieve this victory. It is difficult to describe the significance of Grassley’s efforts on our behalf. However, we can get a glimpse of it from comments he made at a press conference broadcast on CNN the day before the conference committee took its final action. In response to a question from a reporter asking about the status of the chiropractic demonstration provision, he read from an e-mail that he had sent to Sen. Frist the day before. In it, he used the strongest language possible to tell Frist to have his staff “back off” its opposition to the provision. Following is an excerpt from the e-mail: "I hope that this can be handled at the staff level…but your staff have been refusing my chiropractic demo…knock it off. I have been fighting AMA for years to get crumbs off the table for the chiropractors. I got $54 billion for the docs in January. You and they better not object to budgetary asterisks for chiropractors…so back your staff off of this demo." To listen to Sen. Grassley discuss his strong support for chiropractic and the chiropractic demonstration at this critical time (or read the transcript), please click on this link to the ACA Web site: www.acatoday.com. While Grassley was clearly the champion, there were others on the conference committee who also helped, including Reps. Billy Tauzin, Nancy Johnson, Michael Bilirakis and many other members of Congress outside of the conference committee who let the conferees know about their support of the demo. On the Senate side, we had many people who lent their support attempting to convince Frist to back off, including Sens. Norm Coleman, Orrin Hatch, George Allen, Tom Daschle, Ben Nelson, Chuck Hagel and others. One thing I won't forget is the strong opposition of both Thomas and Frist. Our provision was not a budget buster. We were simply trying to demonstrate our cost-effectiveness. Their opposition seemed to me to be mean-spirited. But every dog has its day; perhaps someday we will have an opportunity to express our opposition to both of them…on the campaign trail. On Sunday, the Washington Post ran a story in its “A” section on the Medicare bill, discussing the chiropractic provision and highlighting ACA’s involvement. Here’s a link to the article: http://www.washingtonpost.com/wp-dyn/articles/A6920-2003Nov22.html 2. DOD BILL PASSES OUT OF CONFERENCE COMMITTEE We also had success with a recent DOD authorization bill that was passed out of another House/Senate conference committee. A chiropractic provision accelerates the full implementation of chiropractic into the armed services by one year, increases the annual allocation for this implementation and includes report language that strengthens the hand of the chiropractic advisory committee. 3. VA CHIROPRACTIC ADVISORY COMMITTEE There has been considerable discussion lately about the actions taken by the chiropractic members of the VA advisory committee that recently submitted recommendations to the Veterans Administration (VA) Secretary in implementing the chiropractic health benefit in the (VA). ACA's goal in sponsoring the VA legislation was for veterans to have the opportunity to seek chiropractic care without unreasonable barriers. Our chiropractic representatives understood this goal, but at the same time, they were faced with the problem of being part of an advisory committee appointed by the Secretary of the Veterans Administration whose members weren't all sympathetic to the profession. We want to commend our team for working with the majority on the committee and getting them to agree to recommendations that clearly benefit n! ot only the veterans but also this profession. The Secretary isn't mandated to accept these recommendations. He stated clearly at NCLC that he would do the best he could to support our position without altering the way the Veterans Administration operates. We believe the consensus developed and the program recommended by the Chiropractic Advisory Committee will make it more likely that the Secretary will embrace the proposals.
4. FIRST CAC CONFERENCE CALL A SUCCESS Last Tuesday, we held the first in a series of conference calls with the chiropractic representatives of Medicare's carrier advisory committees (CAC) and state associations. This month’s call focused on those states that were covered by the following Medicare carriers: Noridian Mutual Insurance Company, Blue Cross Blue Shield of Kansas, and Blue Cross Blue Shield of Arkansas. Included on the call were representatives from Wyoming, Kentucky, South Dakota, Hawaii, Colorado, Nebraska, Arizona, Washington, Virginia, Alaska, Pennsylvania, Illinois and Arkansas. Dr. Ritch Miller, Chairman of the Medicare Committee, along with Susan McClelland and Tom Daly, facilitated the meeting. The meeting’s goal was to establish a closer dia! logue between ACA and the Medicare carrier advisory committees. The highlight of the call was Ms. McClelland providing her analysis of each of the local medical review policies (LMRP) where they were consistent with the national plan and where they were inconsistent. LMRPs can't be in conflict with the national plan. Our next CAC call is scheduled for Tuesday, December 9 at 1:00 pm Eastern. CAC and state associations from the following carrier areas will be invited to participate: Cahaba Government Benefits Administrators (GBA); Cigna Medicare; HGS Administrators of Pennsylvania; Palmetto Government Benefits Administrators; Trailblazer Health Enterprises, LLC; and Triple S. 5. CAC AND BLUE CHIP REPRESENTATIVES: MARK YOUR CALENDAR If you are the chiropractic representative of a carrier advisory committee (CAC) in your state, or the Blue Chip representative in your state, please mark your calendar for Friday, March 5 at the Hyatt Regency Hotel, Capitol Hill. These meetings will be held in conjunction with National Chiropractic Legislative Conference (NCLC) being held at the Hyatt Regency Capitol Hill, March 3-6. The ACA Medicare Committee is putting together the agenda for the CAC meeting, and ACA’s Office of Professional Development and Research is doing the same for the Blue Chip program. The CAC meeting is tentatively scheduled to begin at 8:00 am, and the Blue Chip program at 10:00, providing the Blue Chip representatives an opportunity to sit in on some of the CAC program. A tentative agen! da for both meetings is set forth below: CAC Meeting: Seminar on the National Medicare Policy and its significance in determining local medical review policies, followed by a presentation on documentation. (There will be an opportunity for CAC representatives to compare their LMRPs with the national plan.) This will be followed by a roundtable discussion, which will include CAC representatives discussing how they achieved positive results with their LMRPs. These discussions will be facilitated by Susan McClelland, ACA Medicare consultant, and Dr. Ritch Miller, chairman of the Medicare Committee. BCCHIP Meeting: a. How to deal with benefit limitations 6. ACA DISASTER RELIEF INITIATIVE MOVES FORWARD; VIDEO AVAILABLE I have reported previously on the strides ACA has made in opening avenues for doctors of chiropractic to serve in cases of natural disaster, terrorism or other tragedies, including ACA's passage of an historic resolution that aims to integrate doctors of chiropractic more freely into the disaster relief community. At ACA's recent annual meeting in Albuquerque, NM, ACA's Arkansas delegate Karen Konarski-Hart, DC, reported on the progress of the initiative and distributed-- among other materials--a video titled "First There, First Care: Bystander Care for the Injured." The video, produced by the America Trauma Society and the National Highway and Traffic Safety Administration, instructs viewers on simple steps to take to help injured victims at a trauma/disaster site. To view the video, visit: http://www.acatoday.com/about/hod2003/First_there.wvx. Note: *You will need Windows Media Player to view the video and audio capability from your system to hear it. To test whether you have this software (and download it, if necessary), click: http://www.streampipe.com/test/ 7. 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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