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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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Medicare Fee Cuts Delayed Until March 31, 2010

Late Tuesday night, the President signed into law a bill that delays until March 31, 2010 the 21% Medicare fee cuts that were scheduled to take effect in 2010.  Further Congressional action will be necessary to stop the implemenation of these cuts for the remainder of the year.  Please contact your federal legislators in Washington today to urge them to take permanent action on this issue.

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Stimulus Bill Includes Important Changes to HIPAA Requirements


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Medicare Fee Changes Delayed


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House Passes Legislation to Delay Medicare Fee Cuts; Senate Must Act Before 21 Percent Reduction Can Be Averted

On Wednesday, Dec. 16, as part of the FY 2010 Defense appropriations bill, the House of Representatives passed legislation that would delay the 21 percent Medicare fee cuts until March 2010.  The Senate has yet to vote on this bill.  We urge members to contact your senators today, to ask them to stop the 21 percent Medicare fee cuts for 2010.  The Senate is expected to take a vote on this bill in the next few days, so your immediate action is needed.  Please visit the ACA Legislative Action Center  where you can create an e-mail message quickly and easily to send to your senators to tell them to block the implementation of these drastic fee cuts. A template e-mail is included at the Action Center.

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CMS Required Fraud and Abuse Training

Many providers are receiving notices that they must complete a Fraud, Waste and Abuse (FWA) training program from Medicare Advantage Plans.  In 2007, CMS regulations mandated that Medicare Advantage (MA) programs require MA providers to take a FWA training program once a year, beginning in 2009  However, in response to concerns from the provider community, CMS has recently proposed to revise this requirement.  In the Oct. 22 Federal Register Proposed Rule, CMS stated that individuals who were enrolled as Medicare providers should not be required to complete the FWA training because it was redundant to the Medicare requirements for enrollment.  This proposal has not become a final regulation, but will most likely become final next year.  At this point, MA providers are required to take the FWA training. Many individual MA plans are offering their own FWA training courses.  An example of an available training course can be accessed here.

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NYSIF Introduces State-of-Art Medical Bill Inquiry System

The New York State Insurance Fund today announced a state-of-the-art online medical bill inquiry service with the expansion of its electronic Explanation of Benefits (EOB) for doctors treating workers’ compensation injuries covered by NYSIF. In making the announcement, NYSIF Chief Deputy Executive Director Francine James said the upgrades are part of NYSIF’s electronic medical billing and inquiry system available to all medical providers treating NYSIF claimants. “We are pleased with the upgrades we’ve made to our electronic EOB system and we anticipate that medical providers will be, too,” Ms. James said. “This system is a real time saver for doctors, their billing staffs and for our own personnel – and by including more information on screen NYSIF is introducing a state-of-the-art system for workers’ compensation medical bill inquiries.” The new EOB service gives providers a more detailed explanation of medical bill payments made by NYSIF, alerts them to bills that have not been received, or reasons why a bill hasn’t been paid. NYSIF introduced its online EOB for workers’ compensation medical providers in 2007, an Oracle based system built in-house by NYSIF system developers. The Fund followed soon thereafter with giving providers the option to submit medical bills electronically to NYSIF. The EOB upgrades are based on the most frequently asked questions received from doctors’ billing offices. The system has been a value added service, saving time and money by providing convenience for medical administrative staffs transacting business with NYSIF. According to NYSIF medical claims team, some of the more common reasons for non-payment of workers’ compensation medical bills submitted to NYSIF include pending claim status, claim disallowance, claim settlement, invalid jurisdiction, lack of proper medical records, and duplicate billing of paid procedures. All of this information is now accessible to medical providers and their staffs 24/7/365 days a year, spelled out clearly in one location for all medical bills submitted on every claim. NYSIF’s expanded electronic EOB offers an express means by which to cut wait time on billing errors, avoid payment delays and eliminate the time and resources NYSIF and doctors’ staffs devote to billing questions. Medical bill inquiries made online at provide users with NYSIF’s claim number, the claimant’s name, date of injury, complete contact information for the NYSIF case manager and office assigned to the case, the NYSIF assigned bill number, bill date, date received and bill status for every claim on record. As an insurance carrier, NYSIF assigns its own claim number to workers’ compensation claims. The New York Workers’ Compensation Board assigns a different number to the claim. NYSIF lists both numbers in the summary to avoid potential confusion for administrative personnel not familiar with the state workers’ compensation system. The summary includes billing codes, total charges and amounts paid, along with a reason why only partial payment may have been made for certain billed procedures. A short narrative summarizes the check number, amount paid, date issued and mailing address on record. Users have the option to click on the check number to see a complete explanation of payments included in the check and to print the complete EOB. The service is free to any medical provider doing business with NYSIF. Medical providers may only access the EOB for the bills they submit. By leading to less time spent on billing questions, either on the phone or exchanging e-mail, NYSIF believes the new features will further increase productivity and efficiency for medical office personnel using the system and for NYSIF staff. NYSIF, a non-profit organization of the state of New York created as part of the Workers' Compensation Law of 1914, is New York’s largest workers’ compensation insurance carrier. By law, NYSIF is a competitive insurance carrier that sells workers' compensation and disability benefits insurance to any employer doing business in New York State. Approximately 185,000 employers hold NYSIF workers' compensation insurance policies, constituting about 41 percent of the market.

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The following is a summary of the key provisions relevant to chiropractic within the new Insurance Omnibus Law. Section 3, 19 & 32 Prohibits an insurer or HMO from implementing an adverse reimbursement change to a contract with a health care provider unless insurer or HMO gives health care professional 90 days written notice of the change and allows health care professional 30 days to terminate his/her contract with insurer or HMO. Effective date is January 1, 2010. Section 4 & 17 Insurers offering comprehensive policies establish grievance procedures and provide access to care consistent with insurance law. The effective date is January 1, 2011. Section 6 Requires insurers and HMOs to pay claims submitted electronically within 30 days and expands the provision of the PROMPT PAYMENT LAW to self-insured municipal cooperative health plans. This is effective January 1, 2010. Section 7 Prohibits insurers and HMOs from denying a claim on the basis that they are coordinating benefits – unless insurer or HMO has reasonable basis to believe enrollee has other insurance which is primary. Effective January 1, 2010. Section 8 If prompt payment violation is determined, an insurer or HMO shall not be subject to penalty if insurer or HMO has processed at least 98% of claims submitted within the calendar year. In the past, the insurer would pay claims to avoid penalties, but then implemented retrospective audits. This is effective January 1, 2010. Section 9 Health care claims must be submitted by health care professional within 120 days after date of service. Allows health care professionals to request reconsideration of a claim that is denied as untimely. If health care professional demonstrates untimely claim was a result of an unusual occurrence and health care professional has pattern of timely claim submission. HMO/insurer may reduce untimely claim by 25%. Effective April 1, 2010. Section 10 This portion contains most of the NYSCA drafted language on retrospective audits for the benefit of all title VIII health care professionals. Limits of look back period of time payers can go when making routine retrospective audits to 24 months. In addition, before payer can commence a recovery effort, payers must give providers written notice at least 30 days in advance of any recovery effort providing the practitioner with vital information concerning the claim and a reasonably specific explanation of any proposed adjustment as well as an opportunity to challenge the overpayment recovery effort. No time limit exists in situations where the payer holds a reasonable belief of fraud, intentional misconduct or abuse of billing. Effective January 1, 2010. Section 12, 13, 14 & 31 Inhibits insurers and HMOs from treating a hospital that participates within a network as a nonparticipating provider solely because the health care provider admitting or rendering services to the insured/enrollee is a nonparticipating provider. These sections also prohibit insurers and HMOs from treating a health care provider that participates within a network as a nonparticipating provider solely because services are rendered in a nonparticipating hospital. This is an important change, particularly for chiropractors and/or hospital based chiropractic practices. Effective date is January 1, 2010. Section 20 & 33 These provisions allow a newly licensed professional and providers relocating to NY to join the group practice of credentialed par providers participating in a HMO/MCO, a nonprofit indemnity or medical service plan to be provisionally credentialed by the health care plan until such time as the plan makes its final determination regarding the provider’s application. Effective date is October 1, 2009. Section 27 & 40 This requires an external appeal agent to notify a provider when appropriate of an external appeal determination. Effective date is January 1, 2010

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NYSCA Responds to the Medical Treatment Guidelines Proposed by the State of New York Department of Insurance to the Workers’ Compensation Board


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ACA Comments on First Draft of Health Care Reform Legislation

The American Chiropractic Association (ACA) obtained on June 5 a draft bill designed by Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Committee on Health, Education, Labor and Pensions (HELP). This opening salvo is the first of many pieces of health care reform legislation that will be debated in the coming months within the U.S. Senate and House of Representatives. The ACA Board of Governors discussed the draft June 6 during a previously scheduled meeting. The ACA government relations department is carefully reviewing the bill. According to ACA’s government relations staff, the bill, titled the “American Health Choices Act,” would direct individuals and businesses to obtain health care insurance. The draft contains language creating a federally-sponsored “public plan” that would compete with private insurers. The public plan aspect of the legislation is troublesome to Republicans, many of which have declared that a public plan would wipe out current private insurance; however, the public plan option recently gained approval by the Obama administration. Other major provisions in the draft bill include: -----Providers and hospitals that serve patients under the new public plan would be paid 10 percent above current Medicare rates. -----Premiums will cover most of the costs associated with the public plan. -----New insurance exchanges called “Gateways” would be created to enable individuals to shop for insurance, similar to how consumers shop for air fares on Internet travel sites. -----Federal subsidies for mid- to low-income families to purchase insurance. The bill does not include specific language regarding physician status or services that would be available under the public plan. Instead, a new “Medical Advisory Council” would decide a schedule of services considered “essential health care benefits.” Each year, the council would issue new recommendations, which would take effect automatically unless rejected by Congress. The HELP Committee is scheduled to address the bill the week of June 15. The other Senate committee of jurisdiction, Finance, is looking to address health care reform sometime later in June. The House of Representatives is planning to address health care reform throughout the summer and pass a bill before the August recess. ACA urges all doctors of chiropractic to continue to contact their legislators in Washington and demand that chiropractic interests are protected in any health care reform plan developed on Capitol Hill. Doctors of chiropractic and state associations are also strongly encouraged to enlist their patients and other chiropractic supporters in the ChiroVoice advocacy network. ACA will continue to issue updates on pertinent reform activities as they become available. Stay informed throughout the national health care reform debate via:

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