Filtered by category: Insurance News Clear Filter

President Signs Sustainable Growth Rate (SGR) Fix Bill

President Obama signed into law legislation that delays for one year the scheduled 25% cut in Medicare payment to doctors.

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NYSCA IN ACTION...Membership Update

Medicare - Some good news for a change:

The Red Flags Rule requires creditors and certain businesses to develop and implement written identity theft prevention programs to help identify, detect and respond to patterns, practices or specific activities that could indicate identity theft.  The applicability of the rule to health care providers has been debated over the past several months.  On Tuesday, November 30, 2010, the Senate passed legislation (S3987) that clarifies the definition of a creditor and in effect would exempt health care providers from the Red Flags Rule.  On December 7, 2010, the House of Representatives passed S3987 and sent the bill to President Obama.  The President is expected to sign the bill before the Red Flags Rule goes into effect on January 1, 2011.

Thanks to the efforts of the ACA along with other healthcare provider groups whose efforts were instrumental in removing this additional administrative burden for doctors of chiropractic and other health care providers.

And more good news for a change:

The Senate has passed a $15 billion bill that would block the impending 25% cut in the Medicare payment rate to physicians and instead keeps rates steady through 2011. The cut was scheduled to take effect on January 1, 2011. It is likely that the House would pass the bill – it would by the fifth and longest extension of Medicare physican payment rates enacted this year and puts us back in the “yearly extension cycle” that we have all become familiar with. Unfortunately, the bill does not fix the sustainable growth rate (SGR) problem and doctors would be subject to a cut of more than 25% for treating Medicare patients in 2012 unless Congress figures out a long term solution in the meantime.

Update on NYS Workers Compensation fee schedule:

As you know, 97140 was not included in the chiropractic fee schedule. Carriers will be notified that the 97139 code (unlisted therapeutic procedures) will be used instead with the descriptor being the procedure that was performed.  This code usually requires a report for the service, but that will not be necessary. The 97940 omission will be addressed in the future.

Effective December 1, 2010 the “new” C4 family of forms must be used. The exception is in the physician shortage are in Rochester where the forms go into effect Jan 1, 2011. These are the 4 page new patient C4 and the 2 page C4.2. The forms can be found on the NYS WCB website (click on the link below):

And a reminder: Any condition that is resultant from a work related injury is compensable by workers compensation insurance. Under no circumstances, can the doctor charge the patient for any treatment related to a workers compensation injury (even if a variance is denied).

The New York State Chiropractic Association is committed to the advancement of the chiropractic profession in New York State. Our officers, directors, delegates and district officers are working diligently on your behalf to protect your right to practice and to provide the highest quality services to the patients we serve.

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U.S. Department of Health & Human Services Granted a Total of 733 Waivers to the New Federal Health Reform Law.

Many plans have limits on how much can be paid out in coverage, limits which would be phased out under the new health reform law.

The feds though have granted waivers from that law, amid worry that certain Unions and Big Companies
would drop their health insurance programs entirely. Those waivers are good for one year, and can be considered for renewal.

The list of the 222 733 Unions and Big Companies
waivers are available by clicking on the link below.


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Congress Passes Medicare Payment Bill and Legislation Exempting DCs from Onerous Red Flags Rule

Both measures expected to receive quick White House approval

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Medicare Signature Requirements for Patient Records

Medicare requires that services provided to a patient are authenticated in the patient health record. Hand written or electronic signatures are acceptable. A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation. Signature must comply with the following:

Stamp signatures are not acceptable.
You must be familiar with your Local Coverage Determination (LCD) policy on authenticating records as these policies will take precedence over the guidelines below.
If, in the course of a patient health record review, a signature is found to be illegible, Medicare contractors will look for a signature log or attestation statement to determine the identity of the provider.
A signature log includes a list of the typed or printed name(s) of the author(s) of the associated initials or illegible signature(s).
The signature log can be included on the page where the initials or signature are present, or may be in a separate document.
Although a reviewer may encourage providers to list their credentials in the signature log, a claim should be not denied if the log is missing a provider’s credentials.
All signature logs should be considered regardless of the date the log was created.

Attesting to a Signature’s Validity

Providers can include an attestation statement in the documentation they submit. Only the author of the medical record can attest to the record in question.

Attestations will be accepted by reviewers regardless of the date of the attestation, except in those cases where the regulations or policy indicate that a signature must be in place prior to a given event or a given date. For example, if a policy states the physician must sign the plan of care before therapy begins, an attestation can be used to clarify the identity associated with an illegible signature but cannot be used to “backdate” the plan of care.

CMS recommends that, rather than backdating a patient health record, providers should use the signature authentication process explained below. In some situations, a provider may be contacted by a contractor and asked to submit an attestation statement or signature log. Providers will have 20 calendar days from the date of the contractor’s call, or the date that the request letter is received by the post office, to provide the information. To be valid for Medicare medical review purposes, the attestation statement must be signed and dated and contain sufficient information to identify the beneficiary. An example is included below:

“I, _____[print full name of the physician/practitioner]___, hereby attest that the medical record entry for _____[date of service]___ accurately reflects signatures/notations that I made in my capacity as _____[insert provider credentials, e.g., DC]___ when I treated/diagnosed the above listed Medicare beneficiary. I do hearby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”

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Medicare Audit Alert

The current requests for audits by Medicare are not an unusual review.  In New York, there is currently a special services pre payment audit request for 98941 services as of October, 2010 and for 98942 services as of November 2009. Also, Medicare does ongoing CERT reviews on Chiropractic claims in which they will review records for proper documentation to support the claim and diagnosis that has been billed.
With the prepayment audit review, they seem to be sending a request letter for each patient and they are only asking for 3 months of records. A special services CERT request letter is usually 3-4 pages long, and they may ask for multiple patients or multiple dates of service, listed in chart form and they usually request 6 months of previous records.
According to Dr. Ritch Miller, ACA Medicare Committee chairman, you should and must comply. If for some reason you speak with anyone from the carrier/contractor, log the persons name, ID #, station number or whatever and write word for word what you are told. Normally we recommend not speaking with the contractor. KEEP TRACK OF EVERYTHING, and make 2 copies of everything you send to them.
Doctors are encouraged to review the Local Coverage Determination (LCD) for Chiropractic Services (L27350). LCDs can be accessed from the Medical Policy Center on the web site; enter keyword L27350 in the Medical Policy Center search form field to access the Chiropractic Services policy. There is a detailed description on what you documentation should include for the initial visit and subsequent visits.
We also suggest before you start working on the audit, go to the ACA Medicare Webpage and read the links on audits/appeals. You and your staff should take the free 2 hour ACA Medicare documentation webinar. Then, we recommend that you read everything else on the webpage. You need to know everything you can about Medicare, now. So even if you think you know everything there is to know about Medicare, you need to read everything once again. In particular, some of the things (but not all) they are looking for include the diagnosis with a subluxation to correlate with the service code that is billed (98940, 98941, 98942). There should be a treatment plan for the condition. You should note the level of the subluxation adjusted. A PART exam should be done on the onset date of the condition treated with subsequent periodic re-exams and function assessments. Finally, every visit should be signed in full by the provider of the service.  If you have not signed your notes attaché an attestation page with the visits. This can be found at key word signature.
Other suggestions from Dr. Miller include the following. With regard to what documentation to send, we recommend you send everything in from the BOX 14 (CMS 1500) date on, even if it is a month or two longer than the 3 months, if that date is less than the 3 months then we suggest you send in 3 months documentation if the patient was treated at that time. Make sure you send all supporting documentation even if it is several years old, like the patients original intake forms if that has historical information on it, if this information is found in no other place in the records.
Many doctors’ first react with anger and frustration when they start to get these audits. That is not helpful and in past cases has made things a whole lot worse. Be as pleasant as you can be with anyone you speak with. 
Only send in patient records, do not send in any explanatory letters or anything that is not an "official" patient record, since it can be used against you and since it is not official it cannot be used in your favor.
If you get denied on any of the claim(s), you we recommend that you consider an appeal, if the documentation supports the service billed, even if you are asked to return only $20. It is a temptation to not go further, but that may be seen as admission of guilt and they more than likely will continue with future audits.
Hopefully this won't turn into the battle that many other states are going through across the country, but you must prepare for the worst and expect the best. There are doctors across the country, (and again hopefully you are not one of them), that have been carrying on this battle for over two years. So you must take this very, very seriously.
The ACA is working on this with CMS and hopefully we can turn this around. Unfortunately, with the executive branch and administration's increased and well publicized focus on fraud and abuse, don't plan on that.
If you have any questions, please first go to the ACA webpage and see if you can find the answer there. If not please contact Dr. Lupinacci or Dr. Penna. If you have any questions specific to this notice, please feel free to contact either of us also.
Dr. Louis Lupinacci, DC
NY Medicare Chiropractic CAC Rep
Dr. Mariangel Penna, DC
NY Alternate Medicare CAC Rep

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Workers’ Compensation Program

WC changes are here as of Dec 1, 2010. Learn how to treat your patients and get paid under the new system.

Chiropractic Services have been Unbundled!

Learn how to correctly bill modalities and avoid costly mistakes.

The forms, the treatment, get the information you need now by clicking on the link below!

Workers’ Compensation Program

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House Passes One-Month Extension Patch

The House of Representatives has passed legislation temporarily stoping the 23% cut in physician payments under Medicare scheduled to take effect on Dec. 1. The same measure has already passed the Senate.

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Major Change in the Manner Medical Care is Provided to Injured Workers


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NYSCA Responds to The New York State Workers Compensation Board’s “Proposed Medical Treatment Guidelines”


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NYSCA Prepares Its Comments in Response to NYS WCB Proposed Medical Treatment Guidelines

On June 30, 2010 the New York State Workers Compensation Board published its “Proposed Medical Treatment Guidelines.”  A public comment period of 45 days commenced at that time and will end on August 16, 2010.  The NYSCA Workers Compensation Task Force has spent considerable time and energy reviewing the “Proposed Medical Treatment Guidelines,” researching supporting documentation and crafting a response to the Workers Compensation Board.  We anticipate that the final NYSCA response will be delivered to the Workers Compensation Board prior to the appointed deadline. 

In an effort to remind the members of the NYSCA as well as the entire chiropractic profession, patients and general public of the organization’s position regarding the proposed guidelines, the following story has been republished for review.  It is the feeling of the NYSCA leadership that the documentation sent to the Workers Compensation Board should be available to the public for review. 
The NYSCA will publish its current comments and recommendations to the NYS WCB shortly after they have been submitted to the board sometime on or about August 16, 2010.  Please check this website for the updates.

The chiropractic profession, patients and the general public are invited to review NYSCA’s original position paper regarding the Medical Treatment Guidelines:

In March of 2007 Governor Eliot Spitzer issued a directive regarding Workers Compensation reform to State Insurance Department Chairman Eric Dinallo. Mr. Dinallo was instructed to form a task force with the expressed mission of updating the guidelines used by the New York State Workers’ Compensation System. In the directive, the governor stated that Chairman Dinallo was to create a task force comprised of representatives from industry, organized labor, and both houses of the state legislature. There were no representatives from any provider groups, including chiropractic, directly appointed to the task force.

A subsequent news release from the NYS Insurance Department Chairman revealed the task force had selected participants who were “highly credentialed physicians and other professionals to serve as essential advisors in the creation of the guidelines which” reportedly, “express the consensus of the expert professionals.” The task force was given the mission to review the current NYS Workers’ Compensation guidelines and compare them to current evidence-based guidelines as well as guidelines used in other states. In December 2007 the task force delivered their recommendations to Governor Spitzer and Chairman of the New York State Workers’ Compensation Board, Zachary Weiss. The New York State Workers’ Compensation Board has subsequently been instructed to develop regulations to implement the recommendations of the task force.

Although these guidelines were reputedly “designed to deliver quality, lower-cost care for injured workers”, the NYSCA believes the real agenda is cost containment at the expense of the injured workers. According to Eric Dinallo, Superintendent of the New York State Insurance Department at the time, “the proposed medical treatment guidelines for treating workers injured on the job will benefit those workers while helping to hold down the cost of workers’ compensation insurance for all New Yorkers. Unfortunately, these guidelines do not meet either of these goals.

It is opinion of the NYSCA that since the chiropractic profession was not represented on this panel,the treatment modality that we offer was not thoroughly or properly evaluated. The guidelines are intended to “provide a consistent quality standard for the medical care of injured workers” and are reportedly “evidenced-based and reflect the sound clinical judgment of the physicians.” In theory, the guidelines “translate the medical literature into a usable and practical tool that assists busy medical providers in the provision of appropriate health care.” The question is: do the proposed guidelines achieve these goals?

Some of the deficiencies in the Medical Treatment Guidelines as proposed are detailed below.

1. The guidelines are supposed to “provide a consistent quality standard for the medical care of injured workers” and are reportedly “evidenced-based and reflect the sound clinical judgment of the physicians.” These guidelines do not follow the standards of guideline development, nor do they provide documentation of where their recommendations were obtained.

2. The Workers’ Compensation system must clearly address the needs of the injured worker. Policymakers should shift the focus from the bottom line to treatment value and quality of health outcomes. These guidelines do not consider the cost shifting that occurs when patients seek more conservative care as opposed to costly medical/surgical and pharmaceutical care. They also do not have a plan in place to perform vocational rehabilitation so for those more injured patients; the State is looking at shifting the costs to the private insurance sector.

3. A 2004 Rand study of the ACOEM guidelines, which are the basis of this proposal states that it “found the ACOEM guidelines to be of uneven quality.” While surgical topics were relatively well addressed, panelists were uncertain whether content was valid for physical modalities or other common and costly therapies.

4. The RAND study also stated that it “heard” numerous “anecdotes in which payors had used topical gaps in the ACOEM guidelines to deny care that might otherwise have been considered appropriate and necessary.”

5. A Workers Compensation Research Institute (WCRI) survey of injured workers in California, where comparable guidelines have been in effect for more than 4 years, revealed that there was a very low patient satisfaction rate with treatment and unfavorable clinical outcomes. In other words, the more severely injured workers felt that they were not receiving the best care for their injuries.

Be assured that the New York State Chiropractic Association considers this a high priority issue for the profession and we will do all that we can in order to protect the patients we serve.

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NACA Applauds Non-Discrimination in Health Care Reform

The National Association of Chiropractic Attorneys (NACA) today announced that it has issued a proclamation recognizing “the historic and profoundly positive legal ramifications for the chiropractic profession and the patient community it serves in Section 2706, ‘Non-Discrimination in Health Care,’ recently enacted as part of the federal ‘Patient Protection and Affordable Care Act.’”

The provider non-discrimination provision reads in part: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

The provision has long been championed by the American Chiropractic Association (ACA) and members of the Chiropractic Summit. It was achieved primarily due to collaboration with Sen. Tom Harkin (D-Iowa) and help from other key players such as Sen. Chris Dodd (D-Conn.). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision. ACA will continue to fight for proper implementation during the regulatory process.

“It is important to recognize this provision as a historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans,” said NACA Vice President Mike Schroeder. “While there is still much work to be done in the regulatory process, we are encouraged by the fact that Congress has finally acted to end provider discrimination based on one’s license.”

It is also important to note that Section 2706, and its assurance of non-discrimination in terms of participation and coverage, effectively requires that doctors of chiropractic be allowed to provide any “essential benefit” that is within their scope of practice. This will prove to be a particularly significant victory as the essential benefits package under the health care reform law is defined over the next couple of years.

“As significant as Section 2706 is to the chiropractic profession, it is possible to lose ground during the regulatory drafting process,” said NACA President Paul Lambert. “NACA strongly encourages all segments of the chiropractic profession to support ACA in its efforts to ensure that the regulations enacted under Section 2706 properly reflect the patient protections intended in the statute."

To support the work being done to ensure the proper implementation of the provider non-discrimination provision, visit the CHAMP Web site at, and encourage chiropractic patients to join ChiroVoice at In addition, state chiropractic associations can also adopt resolutions recognizing the importance of Section 2706.

NACA is the only organization in the United States and Canada dedicated to legal professionals representing regional, state, local and national chiropractic associations, chiropractic colleges and state chiropractic licensing boards. The purpose of NACA is to network and provide legal education on chiropractic issues to better represent chiropractic associations, licensing boards and colleges and to advocate on a national and local level for issues benefiting chiropractic physicians and their patients. NACA provides resource information to address national and local issues faced by organizations representing or regulating chiropractic.

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Board Publishes Proposed Regulations Adopting Medical Treatment Guidelines


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Medicare Fee Cuts Delayed Until December

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.”  This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010.  The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems.  Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates.  CMS expects to begin processing claims at the new rates no later than July 1, 2010.  Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.  Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount.  Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.  Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment.  Submitted charges on claims cannot be altered without a request from the physician/provider.  Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

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Medicare Fee Schedule


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Doctors of Chiropractic and Patients Included in UnitedHealth Group Settlement

More Than $350 Million Available to Affected Parties

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Congress Considers Pushing Back Medicare Fee Cuts, Again

After returning from its spring recess on Monday, the Senate quickly turned its attention to the Medicare fee schedule cuts.  In mid-March, the House passed a bill to delay the fee cuts until May 1.  The Senate has been debating that bill this week. On Wednesday, an amendment to the bill was presented that would delay the cuts until May 30.  The extension to the end of May would give Congress additional time to develop a longer-term solution to the proposed cuts.   If the delay until May 30 passes the Senate, the bill would have to return to the House for consideration. The House is already taking measures to swiftly pass the bill if it returns to its chamber.  House officials have indicated they could pass the bill by the end of the week. ACA will send out a notice to all members as soon as any final action is taken.

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Change Is Here! National Government Services New P.O. Boxes Effective April 1, 2010


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President Obama signs healthcare legislation into law; provisions benefit chiropractic

On Tuesday, March 23, 2010, President Obama made history when he signed national healthcare reform legislation into law. Over the past year, Palmer College of Chiropractic has closely watched the healthcare reform debate and subsequent actions taken by Congress. Palmer administrators, faculty, staff, students and alumni have been working behind the scenes with government officials, other chiropractic organizations and at the grass-roots level for more than a year to facilitate chiropractic’s inclusion in healthcare reform legislation, and with the signing of this new law, these joint efforts have resulted in several provisions that are positive for chiropractic.

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House Passes Health Care Reform Bill

Historic Pro-Chiropractic Provisions Will Become Law

(Arlington, Va.) -- The U.S. House of Representatives passed HR 3590, the Senate-passed version of national health care reform legislation, tonight. The final vote took place after a nearly 13 month battle, culminating in a contentious struggle to garner votes from undecided members of the Democratic majority in Congress.

This means that the provisions contained in HR 3590 now only await President Obama’s signature to be enacted into law. These provisions include an important provider non-discrimination provision long championed by the American Chiropractic Association (ACA). Incorporation of this provider non-discrimination provision, also known as the “Harkin Amendment,” was achieved primarily due to the efforts of Sen. Tom Harkin (D-Iowa), with help from other key players such as Sen. Chris Dodd (D-Connecticut). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision.

“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against Doctors of Chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider's license is inappropriate and now must stop,” said ACA president, Dr. Rick McMichael. “While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one's license, and they have said that such discrimination must stop.”

The provider non-discrimination provision (Section 2706) to be enacted into law reads in part: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

Regarding this provision, John Falardeau, ACA’s Vice President of Government Relations said, “The Harkin non-discrimination language will be applicable to all health benefit plans both insured and self-insured. National health care reform is designed to eventually cover 30 million currently uninsured Americans. The non-discrimination language will, over time, apply to those individuals as well. However, that number of covered individuals pales in comparison to the 55 percent of workers who are currently covered by self-insured plans that will be affected by the Harkin non-discrimination language. The potential impact in this regard cannot be overstated.”

Additionally, the legislation passed by the House includes two other provisions that impact the chiropractic profession. Doctors of chiropractic are specifically included as potential members of interdisciplinary community health teams. These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care. Community health teams are integrated teams of providers that include primary care providers, specialists, other clinicians, licensed integrative health professionals and community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included in these patient-centered, holistic teams. Dr. McMichael noted, “This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the health care team.”

Furthermore, the legislation establishes a National Health Care Workforce Commission to examine current and projected needs in the health care workforce. The commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and includes them in the definition of health professionals. In addition, chiropractic colleges are included among the health professional training schools to be studied. The National Health Care Workforce Commission is tasked with providing comprehensive, unbiased information to Congress and the Obama Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health care workforce programs, another very important inclusion.

Assuming final modifications to the bill are ultimately agreed to by the Senate; ACA will then publish a detailed analysis of the entire legislation, including a timeline for when certain provisions become effective. Additionally, ACA will maintain an active watch over the implementation of the legislation over the next several years and will offer its views regarding proposed regulations that will likely be developed in order to fully implement the new law. ACA will also respond to any future legislation such as “technical corrections” and other modifications that might be considered. Dr. McMichael noted, “Our partners on the Chiropractic Summit were important team members in securing these critical inclusions for the benefit of our profession and our doctors. We thank all team members for their good collaborative work on this major effort and future efforts to come.”

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