The New York State Chiropractic Association is proud to announce the May 2008 election results. The individuals below are elected to the Board of Directors: Lloyd M. Angel, DC – NYSCA District 6 Steven Breines, DC* – NYSCA District 5 Robert Brown, DC – NYSCA District 16 David L. Heffer, DC* – NYSCA District 15 James Hildebrand, DC* – NYSCA District 15 Janusz R. Richards, DC – NYSCA District 8 (* serving for a 2nd term) The new Directors will assume their elected office on June 1, 2008. NYSCA thanks all the candidates that participated in this year’s election and congratulation to the winners.

37,000 Small Businesses in New York Will Receive Payments Refund Points to Need for Insurance Law Reform Governor David A. Paterson and New York State Insurance Department Superintendent Eric Dinallo today announced that Oxford Health Insurance, Inc. has agreed to refund $50 million to approximately 37,000 small businesses in New York City, Long Island and the northern suburbs for overcharging on health insurance policies in 2006. The refund highlights the need for legislation to reinstate the Insurance Department’s authority to approve rate increases before they go into effect, something the Insurance Department is pursuing this legislative session. Prior to 1996, the New York State Insurance Department had the authority to pre-approve rate increases for health insurance, a process that helped keep rates relatively stable for decades. Since the law was changed to eliminate the Insurance Department’s prior approval authority, the Department has only been able to look at the rate increases a year after they take effect. For more than a decade the only consequence for excessive rate charges has been repayment in subsequent years. “We must make New York a good place to do business by keeping costs competitive. We know that small businesses are the engine of growth in this State and the rising cost of health insurance is one of their major complaints,” said Governor Paterson. “If it can help protect business and keep premium rates down for New Yorkers, we should update the laws to give the Insurance Department more oversight.” Superintendent Dinallo said: “I am pleased that the Department was able to get these refunds for small businesses. But an after-the-fact settlement in 2008 does nothing for those businesses that may have had to drop coverage in 2006 because they could not afford a larger than necessary premium increase. These refunds would be unnecessary if the NYS Insurance Department had the authority to pre-approve rate increases for health insurance premiums. Requiring health plans to get approval from the Department before increasing rates would help keep New Yorkers insured. Lawmakers should restore to the Department the tools to better monitor and manage the marketplace for health insurance rates.” The $50 million settlement will be paid to 36,746 small business policyholders with approximately 300,000 employees and family members. The refund will vary depending on the number of covered individuals. It amounts to an average of $1,360 per business, which is about 5.5 percent of the total average annual premium in 2006. The Insurance Department initiated a review after Oxford reported to the Department that Oxford’s loss ratio for small group policies in 2006 was below the 75 percent minimum. Oxford paid benefits equal to 70.58 percent of its overall premiums in 2006. The vast majority of health insurers, like Oxford in this case, raise premium rates without first getting approval from the Insurance Department by utilizing a “file and use” procedure. If a health insurer using this method does not pay benefits equal to at least 75 percent of overall premiums in a calendar year, the insurer must refund the excess premium to policyholders in the form of cash payments or credits against future premiums. Superintendent Dinallo also said: “Oxford did the right thing in working with the Insurance Department to make sure consumers got their money back. But it is unfortunate the Department lacks the legal authority to pre-approve health insurance premium rate increases and prevent premiums that turn out to be larger than the law allows.” Elisabeth Benjamin, Director of Healthcare Restructuring Initiatives at the Community Service Society of New York, said: “This case just proves the old adage that ‘an ounce of prevention is worth a pound of cure. New York needs to revoke the insurance industry’s ‘E-ZPass’ on their ever-increasing rate increases. And the only way to do that is to restore the Insurance Department’s ability to approve rate increases in advance, and with public input.” The settlement affects policyholders of Oxford’s small group Freedom Plan Direct, Freedom Plan Metro and Freedom Plan EPO products. It does not affect Oxford’s small group and direct pay HMO and “point of service” (HMO/POS) policyholders. This case was handled for the Insurance Department by Deputy Superintendent and General Counsel Robert Easton, Deputy Superintendent for Health Troy Oechsner, Assistant Deputy Superintendent for Health John Powell, Deputy Bureau Chief Lou Felice, Chief Actuary Michel Laverdiere, Supervising Insurance Examiner Jim Carroll and Assistant Deputy Superintendent and Counsel Jon Rothblatt.

Late yesterday, the U.S. House of Representatives passed H.R. 5658, (Sec. 704. Chiropractic health care for members on active duty) the National Defense Authorization Act for FY2009, which includes language declaring chiropractic care a standard benefit for all active-duty military personnel. The bill—supported by the American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC)—also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic. According to ACA’s department of government relations, this most recent legislation strengthens current law and, if enacted, will increase access to chiropractic care at more facilities worldwide. To date, there is a doctor of chiropractic at 49 military bases around the United States; however, servicemen and women serving overseas do not have access to the chiropractic benefit.

Cleveland Chiropractic College will host an open house on June 11 from 4 to 6 p.m. to celebrate the official opening of its Overland Park Health Center. A ribbon-cutting ceremony for the Health Center, part of the college’s new 34-acre campus at 10850 Lowell Ave., will take place at 5 p.m. Dr. Carl S. Cleveland III, president, will be joined at the celebration by dignitaries from around the metro area, including Overland Park Mayor Carl Gerlach. In the college’s state-of-the-art health care facility, interns, under the supervision of licensed doctors of chiropractic, provide chiropractic care and other services to the public. Cleveland also maintains a health center in the Brookside area of Kansas City, Mo., which received more than 40,000 patient visits last year. The ribbon-cutting ceremony for the entire campus will take place in October in conjunction with the college’s annual homecoming festivities. For more information on these events, call 913-234-0600.

Abstract Background Back problems are often recurring or chronic. It is therefore not surprising that chiropractors wish to prevent their return or reduce their impact. This is often attempted with a long-term treatment strategy, commonly called maintenance care. However, some aspects of maintenance care are considered controversial. It is therefore relevant to investigate the scientific evidence forming the basis for its use. Objectives: A review of the literature was performed in order to obtain answers to the following questions: What is the exact definition of maintenance care, what are its indications for use, and how is it practised? How common is it that chiropractors support the concept of maintenance care, and how well accepted is it by patients? How frequently is maintenance care used, and what factors are associated with its use? Is maintenance care a clinically valid method of approach, and is it cost-effective for the patient? Results Thirteen original studies were found, in which maintenance care was investigated. The relative paucity of studies, the obvious bias in many of these, the lack of exhaustive information, and the diversity of findings made it impossible to answer any of the questions. Conclusion There is no evidence-based definition of maintenance care and the indications for and nature of its use remain to be clearly stated. It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial. Chiropractic & Osteopathy 2008, 16:3doi:10.1186/1746-1340-16-3

On the May 2nd WFAN 66AM Sports Radio Show, Boomer & Carton, hosted by Boomer Esiason and Craig Carton, the topic of discussion was the rib injury suffered by the Yankees pitcher, Phil Hughes. During the discussion, a caller, identifying himself as “Dr. Ron” and a chiropractor in Orange County, NY, attempted to give his explanation about the complexity of the injury and how it could affect his ability to play. However, before this doctor was able to offer an explanation regarding Hughes’ condition, Carton rudely interrupted the doctor and began a long-winded chiropractic bashing, replete with a quack attack that berated the profession and mocked chiropractic education. (To hear the replay go to and listen to the audio clips dated 5/2/08, entitled “ You SIR, are not a doctor ” and 5/9/08 entitled “ Harry Carson.”). After receiving numerous complaints from the NYSCA membership, a letter was crafted by NYSCA President, Dr. Mariangela Penna and Executive Director, Dr. Karl Kranz, chastising Carton for his insulting remarks. This letter was sent to WFAN’s program director and the NYSCA is eagerly awaiting his response. The swift action that the NYSCA took on this matter is just another example of how we are constantly protecting your right to practice chiropractic in this state. The ACA and the NY Chiropractic Council have also voiced their displeasure with Carton’s remarks and chiropractic organizations in adjacent states have been alerted of the talk show host’s potentially libelous remarks. We look forward to continuing to serve you and all of the chiropractors practicing in New York. To see a copy of this letter click on the link below:

Former Gov. Eliot Spitzer charged Insurance Dept. Supt. Eric Dinallo to create new medical treatment guidelines. Mr. Bruce Topman was selected as the Chairman of a Workers Compensation Task Force which made recommendations to then Governor Spitzer and Mr. Dinallo in December 2007. The NYSCA has reviewed the Task Force's recommendatiions and questions the headlong rush to adopt medical treatment guidelines. It is the NYSCA’s understanding that the Workers’ Compensation Board is in the process of reviewing the guideline drafts provided by the Department as the Board toils with promulgating the regulations needed to implement the guidelines necessary to meet former Governor Spitzer’s agenda. In anticipation of the forthcoming rules and regulations, the New York State Chiropractic Association (NYSCA) offers the following observations giving voice to the profession’s concerns. The New York Chiropractic Council concurs with the NYSCA analysis and its conclusions. To view the entire NYSCA WC Position Statement click on the link below:

The National Board of Chiropractic Examiners (NBCE) reports on the latest events at NBCE. The National Board of Chiropractic Examiners (NBCE) hosted a number of meetings including Practice Analysis Advisory Committee, Part IV Case Development Committee workshop, and Part IV Standardized Patient Trainers Workshop. To view the full report click on the link below.

GREELEY, Colo.—The National Board of Chiropractic Examiners (NBCE) re-elected officers during the Board’s organizational meeting May 2, 2008 in Atlanta, GA. These officers form the NBCE Executive Committee. Dr. Vernon R. Temple, D.C., (VT) was re-elected to serve as president of the National Board. Dr. Temple is a graduate of Palmer College of Chiropractic in Davenport, Iowa, and has been in practice in Vermont since 1978. He is a diplomate of the American Board of Chiropractic Orthopedists. He is a former chairman of the Federation of Chiropractic Licensing Boards and has also served as president of the Vermont Board of Chiropractic Examination and Regulation. Dr. N. Edwin Weathersby, D.C., (AZ) was re-elected as NBCE vice president. Dr. Weathersby is a graduate of Western States Chiropractic College and currently owns a multi-disciplinary practice in Glendale, Ariz. He is the past president of the Federation of Chiropractic Licensing Boards. He is a past chair of the Arizona Board of Chiropractic Examiners and former vice president and president of the Arizona Association of Chiropractic. In 1993, Theodore J. Scott, D.C., of Kaysville, Utah, was re-elected to serve a second term as District IV director and was re-elected as treasurer of the National Board of Chiropractic Examiners (NBCE) during the Annual Meeting on May 2, 2008, in Atlanta, GA. Dr. Scott will serve three years as District IV director, which includes the states of Arizona, California, Colorado, Hawaii, Kansas, Nevada, New Mexico, Oklahoma, Texas and Utah. Dr. Scott has served as chairman of the Utah State Chiropractic Physicians Licensing Board, and was reappointed to this position in 2004 for a four-year term. In addition to his NBCE responsibilities, Dr. Scott maintains a private practice in Layton, Utah. Dr. Scott is a 1978 doctor of chiropractic graduate from Texas Chiropractic College. He served as chairman of the Utah State Professional Standards Committee from 1989 to 2001. Dr. Scott is a past member of the Utah Chiropractic Physicians Association and the past convention chairman for the Utah Chiropractic Association. Dr. Mary-Ellen Rada, D.C., (NJ) was re-elected as secretary for the NBCE. Dr. Rada is a graduate of Sherman College of Straight Chiropractic in Spartanburg, S.C., and has been in practice in New Jersey since 1990. She is the former president and a current member of the New Jersey State Board of Chiropractic Examiners, where she has served since 2000. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

The American Chiropractic Association today announced that it has sent a letter to state chiropractic licensing boards urging them to ramp up continuing education programs aimed at improving Medicare documentation and reducing the number of claims errors. In a letter dated April 4, ACA President Glenn Manceaux, DC, noted that the Centers for Medicare and Medicaid Services (CMS) is scheduled to issue a special report to the U.S. Congress in 2009 detailing the results of the Medicare Chiropractic Demonstration Project. ACA fears that continued high claims error rates will be used as an argument to thwart efforts to allow chiropractors to provide additional services under Medicare, even if results from the demonstration project are favorable. “It is abundantly clear that unless we can convincingly demonstrate that our profession has put into place various educational and training programs, along with policies and requirements that will collectively lead to a significant reduction in Medicare claims errors, then the U.S. Congress will likely reject any proposals allowing DCs to provide additional services within Medicare,” Dr. Manceaux wrote. ACA is also anticipating the Department of Health and Human Services Office of the Inspector General (OIG) to soon issue a follow-up to its 2005 report on chiropractic documentation. The 2005 OIG Report, which was based on a random sampling of claims data from 2001, concluded that 67 percent of the claims examined as part of the study contained documentation errors or omissions that led to what the OIG considered to be inappropriate reimbursement under Medicare. “ACA is fully prepared to wage an intensive battle to secure expanded and permanent chiropractic benefits under the Medicare program; however, we need the support of every chiropractic organization and every chiropractic office across the country,” Dr. Manceaux said. To read ACA’s letter to the state chiropractic licensing boards, click on the link below:

Seneca Falls, NY: New York Chiropractic College conferred the Doctor of Chiropractic degree upon 48 graduates on Saturday, April 5, 2008, during a commencement ceremony held in the NYCC campus Athletic Center. The commencement address was delivered by Congressman Michael Arcuri, JD, BA, a native of Utica, NY and strong advocate for higher education. Arcuri stressed the importance of providing service to one’s community and he urged the assembled professional graduates to contribute their talents, time and good fortune to worthy causes. Matthew A. Murphy, valedictorian, addressed his classmates. Salutatorian was Brian M. LaBaron. Among those honored at the commencement exercises through induction as fellows into the American College of Chiropractic included Jack Stuart Beige, DC, JD (NYCC 1966), past president of the New York State Chiropractic Association, Matthew C. Coté, DC, DABCO (NYCC 1980) Senior Faculty Clinician at NYCC’s Depew Health Center, Joseph J. Lombino, DC (NYCC1981) and Diane Carol Dixon, Executive Director of Enrollment Management at NYCC was presented with a Doctor of Humane Letters Honoris Causa. Thomas R. Ventimiglia, DC, FACC (NYCC 1980), Director of NYCC’s Post Graduate and Continuing Education, was inducted as a Fellow into the International College of Chiropractic. For information on New York Chiropractic College’s degree programs please visit the college’s Web site at:

Over the last few years many of you have heard the cries of our fellow chiropractic practitioners in California over the revisions in their Workers Compensation system. In 2004 the California legislature adopted the American College of Occupational and Environmental Medicine (ACOEM) guidelines for use in that system. Only those interventions recommended in the ACOEM guidelines are now reimbursable under California law. The only exception available under this law is that the ACOEM guidelines may be supplemented by other nationally published guidelines. In December of 2007 Gary Globe, DC, MBA, PhD, who is serving as the California Chiropractic Association (CCA) representative on the California Workers Compensation Advisory Board, contacted the CCGPP for assistance. Dr. Globe indicated that there was a brief window of opportunity for the chiropractic profession to provide a nationally published supplemental guideline to clarify weaknesses in the ACOEM guidelines as it pertains to chiropractic care for low back and chronic pain conditions. However, for this opportunity to be realized, that supplement had to be available for the next regularly scheduled meeting of the California Workers Compensation Advisory Board on March 19, 2008. As many of you are aware, in September, 2007 the CCGPP's Rapid Response Team initially penned a letter to United Healthcare demonstrating the inappropriateness of their newly adopted policy of non-coverage for chiropractic care of pediatrics and headaches. That letter was subsequently endorsed by the ACA, ICA, FCER, COCSA, ACC, etc. In response to that letter, in October, 2007 United Healthcare suspended both policies for additional review. They have recently announced they have retracted the pediatric policy altogether and have reworked the headache policy. Due to the rapidity and success of this response, Dr. Globe was prompted to contact the CCGPP for assistance with the California Workers Compensation situation. The CCGPP at its inception was charged with the evaluation of any guidelines, parameters, protocols, best practices, and standards of practice. This also means taking a stand for the profession when a problem or potential assault is noted. Therefore, the CCGPP accepted the California challenge and has undertaken a new initiative. We are currently involved in a Delphi process to generate consensus opinion of Doctors of Chiropractic from across the country regarding the care of low back pain, especially chronic pain. After conducting its extensive literature synthesis on low back conditions initially posted on the Internet in May of 2006, the CCGPP is acutely aware that there is inadequate literature on various areas of common chiropractic practice. Many of those studies that do exist have a medical bias that needs to be tempered with a chiropractic lens, as provided by the CCGPP's team of low back experts. The purpose of the Delphi technique is to elicit information and judgments from participants to facilitate problem-solving, planning, and decision-making. It does so without physically assembling the contributors. Instead, information is exchanged via mail, FAX, or email. It is structured to capitalize on the merits of group problem-solving and minimize the liabilities of group problem-solving. Consensus derived from a rigorous Delphi process is considered to be expert evidence, and while not as highly valued as some forms of research, it is nevertheless widely used and accepted, particularly in addressing areas where high quality research is lacking. Indeed, other national guidelines have used medical expert opinion to address issues of chiropractic care when more definitive literature was not available. The purpose of the CCGPP conducting the present Delphi process was to look at the same literature base others have, through a chiropractic expert perspective. The Delphi technique requires a Coordinator to organize requests for information, information received, and to be responsible for communication with the participants. The Delphi technique requires an efficient communication channel to link the Coordinator with each of the participants. Therefore, this Delphi process is being undertaken in an effort to clarify the role of chiropractic in these areas of care, especially as they are impacted by the Workers Compensation system and their incorporation of external guidelines, e.g. ACOEM, ODG, etc. CCGPP solicited seed panelists from chiropractic's national organizations, e.g. ACA, ICA, etc., and from the state associations through COCSA. These 39 panelists are all actively involved in chiropractic practice from across the country with a diverse variety of philosophy, technique and practice situations. As background material, those panelists were provided the CCGPP's Low Back literature synthesis, along with Dr. Gert Bronfort's recent study published in the Spine Journal. After reviewing the ACOEM guidelines, the CCGPP's Seed Committee then developed 27 seed statements defining areas of concern within those guidelines. Those seed statements were then submitted to the panel for review and comment. After the first round of review, there was greater than 80% consensus on 24 of the 27 seed statements. On the 3 outstanding seed statements, the panelist's comments were reviewed by the Seed Committee and utilized to revise those statements. Those revised seed statements were then submitted to the panelists for a second round of review and comment. After the second round, the 3 remaining outstanding seed statements again achieved greater than the 80% threshold for consensus that the Seed Committee had required at the outset of the project. The Seed Committee is currently in the process of incorporating the acquired commentary into a final consensus report. The CCGPP is hopeful of having the final version available by the beginning of June for use in the California Workers Compensation process. That consensus report will also be posted on the CCGPP's website when it is available. The CCGPP Scientific Commission Chair, Dr. Cheryl Hawk, also has a verbal commitment from the Journal of Manipulative and Physiological Therapeutics to publish the available literature syntheses chapters, inclusive of this consensus report, in the November/December 2008 issue. CCGPP has studiously avoided entering into the "guidelines" development process for a number of years, especially following the furor raised over the "Mercy" guidelines. They were widely condemned, particularly by those who never took the time to read them or learn how to properly apply them to obtain the care their patients needed. However, "Mercy" was a long time ago, given the pace of change in health care over the last decade and a half, and the literature needed to be updated. Third party payors, government agencies, other guideline organizations, patients, and yes, even DC's now want to know what kind of care is supported by evidence. Our profession's refusal to address this issue has led to the inevitable result that MD's, insurers and bureaucrats are now deciding what reasonable chiropractic care should be, based on their interpretation of the currently available scientific literature. We must remember that we exist as a profession to provide a service our patients need and want and not to advocate for what is best for our own benefit. Need proof? Our market share has not increased (and some would argue it has declined) despite the greatest increase in the use of CAM in recent history. We continue to have little cultural authority, meaning in part that the public still does not clearly understand our role and areas of expertise in the health care market. Physical therapists are publishing widely accepted papers on indications for manipulation of the low back, and have made it clear that they intend to take over chiropractic's traditional place in the health care market. The good news is that there is a great deal of evidence for what we do, as revealed by the CCGPP Low Back Literature Synthesis, as well as the subsequent CCGPP condition related chapters. The crisis in California (where nearly one-quarter of US doctors of chiropractic practice) has provided an opportunity to address what many of us consider to be mis-interpretation of the scientific literature, and to instead re-interpret the scientific literature viewed through a chiropractic lens. This Delphi process was in part developed by the CCGPP in response to what we heard at COCSA in Baltimore in 2006, where one of the primary concerns voiced by our critics during our round table discussion was that not every aspect of chiropractic practice had yet been subjected to randomized controlled trials. Now some of those same critics have already begun to naively criticize this effort as "unscientific." Nothing could be further from the truth. CCGPP conducted a multi-year, scientific evaluation of the current literature based on internationally accepted standards and resulting in the aforementioned Low Back Literature Synthesis. We also included additional, newly released research, published in interim since the completion of the Low Back Literature Synthesis. This formed the framework for the subsequent Delphi consensus process, which is widely viewed as an appropriate, defensible and scientific methodology for addressing areas where scientific literature is lacking. The issue of "dosage" is a perfect example of the need for a scientific consensus process. Patients, insurers, DC's and others want to know what reasonable parameters of chiropractic care are for a given condition. Is it short trials of treatment to see if it helps, or 75 visits and year-long contracts? Most published literature on this subject is based on treatment restrictions which do not realistically reflect actual practice, but reflect necessary limitations imposed by clinical study protocols. Accordingly, the most appropriate and valid methodology for addressing the gaps between scientific studies and clinical practice is a rigorous consensus process. We chose to use the Delphi process because of its economy in terms of both costs and timeliness. We chose to ask every state association and national organization in the country to provide participants who were conversant with using published literature, represented a wide variety of practice styles, philosophies and locals, and who were willing to work collegially to try to reach accord. Is the end result what we wanted? No, if the goal was the ability of the individual chiropractor to practice unfettered by any constraints (and we are unaware of any other health care profession with such a privilege). But if the goal was to draft a guideline which reflects the mainstream of chiropractic practice, provides advice and benchmarks for extending trials of treatment, and most importantly safeguards our patients' rights to demonstrably effective, conservative chiropractic care, then we believe this is a good start. We anticipate that this type of consensus process will eventually have national impact, as New York, Ohio and other states are also incorporating the ACOEM or other guidelines into their Workers Compensation systems. As an example, the CCGPP was contacted in early March by the ACA to participate in their recently established Guideline Review Task Force. This task force has been established in response to a request by the ACA Delegate in Tennessee, Dr Michael Massey. BCBS of Tennessee has requested a critique of the Milliman Care Guideline, 12th Edition, as it applies to chiropractic care. Once that review has been completed, the task force members are hoping to again put together an intraprofessional coalition to sign onto the review, such as was done with the successful effort to convince United Healthcare to change its Pediatric and Headache Guideline. It is the hope of the involved parties that this review will be used to enter into a collaborative effort with Milliman and Robertson to improve their product, beyond its application to BCBS of Tennessee. For further information or if you are interested in assisting with this process, please visit the CCGPP website at www.ccgpp.org Ultimately, the CCGPP views this type of consensus development as one of the next phases of the progression from the literature syntheses to the "best practices" development process we have dubbed the "Chiropractic Clinical Compass". This is also another example of the CCGPP's Rapid Response Team model, where the fluidity of our organization is able to mobilize our teams of experts and effectively address an immediate issue. However, we were only able to conduct this process due to the generous donation of time by all participants, or the generosity of the institutions at which they are employed. ABOUT THE AUTHOR: Dr. Mark D. Dehen is a second generation Doctor of Chiropractic practicing in North Mankato, MN. He does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the MN Chiropractic Association and recipient of the MN Chiropractor of the Year award. Currently, he serves as Chair of the CCGPP.

The OSMA-sponsored Healthcare Simplification Act (HB 125) will bring significant, positive changes to contracts between health insurers and physicians -- putting physicians on a more equal footing with the insurers. While the Healthcare Simplification Act will not address every problem you have with payers – it’s a good first step toward building a better way of doing business with insurance companies. The OSMA will not stop working on these issues until our members can enter into agreements with insurance companies that are fair, transparent, and simplify doing business. Most importantly, the agreements must be in the best interests of the doctor-patient relationship. The Healthcare Simplification Act (HB 125) Helps Physicians in Three Major Areas: • Transparency in Contracting • Fairness in Contracting • Standardized Credentialing Transparency • The Healthcare Simplification Act will ensure that physicians get a copy of the full fee schedule from HMOs, Third Party Administrators (TPAs) and other insurers, so that the physicians will know what they will be paid for their services. • The Healthcare Simplification Act requires HMOs, TPAs, and other insurers to provide physicians with a summary disclosure form of the contract that outlines, in plain language, important terms including: compensation terms, categories of coverage, duration of the contract, the entity responsible for processing claims, and the method of dispute resolution. The Act also requires specific notice be given to the physicians of any addenda to the contract. • The Healthcare Simplification Act restricts the selling or renting of a physician’s contract to another company unless the rental is disclosed and all of the terms of the original contract are honored. • The Healthcare Simplification Act prohibits “Most Favored Payer” clauses in contracts that force doctors to provide healthcare services at a lower price than originally called for in the contract. • The Healthcare Simplification Act requires insurance companies to notify doctors 90 days in advance of changes to a contract that either: decrease payment, increase administrative expenses or add a new product. • The Healthcare Simplification Act restricts the use of “all products” clauses that force physicians to participate in all of an insurer’s products. • The Healthcare Simplification Act prohibits an insurer from forcing a physician to accept their future product offerings. Standardization • The Healthcare Simplification Act designates the Council for Affordable Quality Healthcare (CAQH) credentialing form as the sole credentialing form to be used by insurers in Ohio. No additional information can be solicited by individual insurers from physicians seeking to be credentialed. • The Healthcare Simplification Act requires that all physicians be credentialed within 90 days. • The Healthcare Simplification Act establishes a $500 per day penalty or requires retroactive reimbursement if an insurer fails to meet the 90-day credentialing deadline.

In a report to accompany legislation reauthorizing the National Health Service Corps (NHSC), the Senate Committee on Health, Education, Labor and Pensions made it abundantly clear that doctors of chiropractic are eligible to qualify for inclusion in the NHSC Loan Repayment program. The report language, which will accompany bill S.901, is supported by both the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). “For more than 35 years, doctors of chiropractic were excluded from the National Health Service Corps because we were not mentioned explicitly as eligible providers,” said ACA President Glenn Manceaux, DC. “Many areas of the country are experiencing shortages of qualified health professionals, and doctors of chiropractic are uniquely positioned to provide high-quality, cost-effective care to the nation’s underserved communities. I applaud the Senate committee for taking this action and I look forward to chiropractic inclusion in the program.” “This is a great victory, particularly for chiropractic students who are ready, willing and able to serve in the NHSC,” said ACC President Carl Cleveland III, DC. “Chiropractic graduates enter the profession well-qualified, prepared and most eager to serve, but many are positioned to enter practice with considerable student loan indebtedness. Thanks to the Committee’s action, doctors of chiropractic—especially the next generation of doctors graduating from our colleges—will soon have an opportunity to participate in this important loan forgiveness program.” Originally enacted in 1970, NHSC allows selected health care professionals engaged in the delivery of primary care services to be reimbursed for student loans in return for establishing and maintaining their practices in geographic areas designated as “medically underserved” by the federal government. Unfortunately, the NHSC Loan Repayment program has not included doctors of chiropractic as eligible providers. In 2002, at the request of ACA and ACC, Congress enacted language that authorized a two-year demonstration program intended to explore the feasibility of opening the program to doctors of chiropractic. The demonstration program began in 2003 and was later extended through 2007. The demonstration results are now being evaluated by the federal Health Resources and Services Administration. Report language accompanying S. 901 becomes effective once the bill has been passed by the full Senate. S. 901 has not yet been scheduled for further consideration. Watch ACA publications and the association’s Web site for more information as it becomes available. To access the full committee report Click on the link below. The information regarding inclusion of doctors of chiropractic can be found on page 19.

GREELEY, Colo.—Salvatore D. LaRusso, D.C., of Wellington, Fla., was elected on March 8 by the board of the National Board of Chiropractic Examiners (NBCE) to fill a vacancy in the roll of Director-At-Large. The vacancy was created by the untimely death of Dr. Earl L. Wiley who passed away in November 2007. Dr. LaRusso will complete the unexpired term of Dr. Wiley which will end in May 2009. At that time, Dr. LaRusso will be eligible for re-election. Dr. LaRusso is a graduate of New York Chiropractic and obtained his undergraduate degree in business administration from Seton Hall University. He has been active in many international, national, state and local organizations. In 1998, Dr. LaRusso was a gubernatorial appointee to the Florida Board of Chiropractic Medicine, serving as board chair in 2005, 2006 and 2007. From 2005 to present, he serves as chairman of the Florida Board’s Certified Chiropractic Physicians Assistant Committee. Dr. LaRusso is a long-standing member of both the Florida Chiropractic Association and the Florida Chiropractic Society (FCS) serving as president of the FCS from 1992-1993 and chairman from 1993-1997. The FCS named Dr. LaRusso Chiropractor of the Year in 1994, awarded him the Gavel Award in 1993 and honored him the Distinguished Service to the FCS in 1992. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

Last week, CMS released a new Advanced Beneficiary Notice (ABN) form for use by Medicare providers. Of the key changes, the form includes a new title, “Advanced Beneficiary Notice of Noncoverage” and this most recent version may also be used for noncovered services, in place of a Notice of Exclusion from Medicare Benefits (NEMB). Medicare providers may begin using the new form at any time during this six month transition period, but CMS will only accept this updated version after September 1. To view and/or print the new ABN form, click below. For CMS instructions on completing the form, click below. For further information, please visit the CMS Web site.

About 200 students from Northwestern Health Sciences University lobbied on Feb. 21 at the state capitol in St. Paul for chiropractic health care issues. They joined Northwestern faculty members and chiropractors from the area. Organized by the Minnesota Chiropractic Association, the day was planned in order to encourage legislators to revise Minnesota statutory language relating to the chiropractic scope of practice so it is more concise. In addition, lobbyists asked that their representatives and senators to support legislation to ban runners in Minnesota, which would make it illegal for chiropractors to hire or pay anyone who directly contacted a consumer after experiencing an automobile accident. Scott Mooring, DC, joined students in an effort to get the message across. “It’s important for our profession to stand up and fight,” Dr. Mooring said, who has participated in previous years. “The legislation is spread out into a number of different statutes which makes it difficult to interpret or apply. It’s a major impediment.” Northwestern students were equally passionate about seeing change in legislation. “I think it’s really important to have the people who represent us know how effective chiropractic care is,” said Ashley Cornetet, a T2 chiropractic student. “People are often misinformed, and it will help the community and help patients to learn more. This is more to make a statement about what we’re doing than to debate.” Tracking lawmakers down wasn’t as easy as expected, said Jami Rassmussen, a T2 chiropractic student, who added he was surprised how uninformed some were about chiropractic care. “We didn’t have a scheduled appointment, but as we were filling out the paperwork to make one, our representative overheard us and came out of his office,” Rassmussen said. “The other two students and I went into his office without a chiropractor with us and got to tell him about the bill. He didn’t know much about chiropractic care, but listened to us.” Rasmussen said it was a bit daunting to go in without lobbying experience, but exciting. “It was overwhelming at first, but exhilarating,” Rasmussen said. “It was sort of trial by fire, but I liked being thrown in like that.” Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage, human biology, and integrative health and wellness. The University has more than 900 full-time students on a 25-acre campus in Bloomington, Minn.

The American Chiropractic Association (ACA) has announced it will launch a historic and bold advocacy effort later this year by creating a national database of chiropractic patients. Designed to strengthen the profession’s political voice, the planned database was unveiled during the association’s National Chiropractic Legislative Conference (NCLC) Feb 27-28 in Washington, D.C.