Superintendent of Insurance Alessandro A. Iuppa announced that CIGNA Healthcare of Maine, Inc., and CIGNA Behavioral Health (collectively "CIGNA") have been fined a total of $900,000 for multiple violations of Maine law. The fine, which was assessed as part of a consent decree with the companies, constitutes the largest fine ever levied by the Maine Bureau of Insurance. CIGNA Healthcare of Maine, Inc. holds a certificate of authority to operate in Maine as a health maintenance organization ("HMO"). CIGNA Behavioral Health holds a license as a medical utilization review service that reviews the necessity, use, or appropriateness of behavioral health care services, and as a third-party administrator. The companies were found to have violated Maine law for failing to pay claims on time, failing to pay interest due, failing to keep supporting claim documentation and failing to have adequate procedures for identifying and correcting errors in a timely manner. In addition to the fine, the companies must pay restitution of interest to affected claimants. Both entities must pay combined restitution to affected claimants for interest due for late paid claims of approximately $915, 000 for calendar years 2001 and 2002. For prior years the companies must provide additional unpaid interest for claims processed from September 18, 1999 (the date the present text of Maine's prompt pay law took effect) to January 1, 2001. The companies will have until the end of January 2004 to calculate the additional interest due. The aggregate amount for the four years will be the largest award of restitution ever obtained for claimants by the Maine Bureau of Insurance. In addition to the claims payment issue, the consent agreement resolves a number of other violations. These include: complaint handling, company grievance procedures, records retention, failure to actively market individual health plan coverage, and member notification concerning plan cancellation. One of the most startling findings to emerge from the examination was the fact that CIGNA's own grievance review process overturned initial claim denials, when appealed, a significant percent of the time. The consent agreement requires that the companies file a plan of corrective action for the Superintendent's review and approval that addresses each violation of law listed in the consent agreement. The action plan is due to the Superintendent by December 31, 2003. The Superintendent singled out the grievance process as one area where the Bureau sought reforms. The Bureau of Insurance is part of the Department of Professional and Financial Regulation, which encourages sound ethical business practices through high quality, impartial and efficient regulation of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations for the purpose of protecting the citizens of Maine. Consumers can reach the Bureau through its Web site at www.MaineInsuranceReg.org; by calling 800-300-5000 in-state; or by writing to Bureau of Insurance, 34 State House Station, Augusta, ME 04333. This information is reprinted with permission of the The Monument Newspaper Copyright 2003.

ARLINGTON, Va -- With just one week remaining before the beginning of the Iowa caucuses, the American Chiropractic Association (ACA) has secured official statements on chiropractic care from each of the six leading Democratic presidential candidates. ACA secured these statements through close cooperative efforts with the Iowa Chiropractic Society and politically active doctors of chiropractic across the country. "Though they may often disagree on other issues, the leading presidential candidates for the Democratic presidential nomination appear to completely agree on the value and benefits of chiropractic care," said ACA President Donald Krippendorf, DC. "The ACA is encouraged by this enthusiastic support and more determined than ever to ensure that it is maintained by our elected leaders long after Election Day." Governor Howard Dean, Congressman Dick Gephardt, Senator John Kerry, Senator John Edwards, General Wesley Clark and Senator Joe Lieberman round out the list of candidates who have submitted statements. To view these statements, visit: http://www.acatoday.com/government/other/candidates_endorse.shtml The ACA, the largest national organization representing doctors of chiropractic, has taken an active role in the months leading up to the January 19, 2004 Iowa precinct caucuses in evaluating the health care policy positions of each of the announced presidential contenders. This effort has included meetings with major candidates and senior campaign officials, and the use of ACA's specially designed issues questionnaire. "The candidates are recognizing the political clout of Iowa's chiropractic constituency," said F. Dow Bates, DC, ACA Iowa Delegate. "The numbers speak for themselves. Iowa is home to thousands of doctors of chiropractic and chiropractic assistants, tens of thousands of chiropractic patients and the largest chiropractic college in the world. The road to victory in the Iowa caucuses goes straight through the offices of the state's doctors of chiropractic." Providing additional outreach were Keith Overland, DC, ACA Connecticut delegate, who serves as a health care policy adviser to the Lieberman campaign, and Dan Redwood, DC, of Virginia, who helped secure General Clark's statement. Source: American Chiropractic Association

It is my understanding that CMS has revised the Medicare Fee Schedule for 2004 and extended the time providers have to decide whether enroll with CMS as a participating provider. Doctors have until February 17, 2004 to consider the new fee schedule before making their 2004 participation decision. The new fee schedule incorporates increases passed by Congress and signed by the President into law on December 8, 2003. Because the law was signed so late in the 2003 calendar year, CMS is back peddling trying to incorporate the changes brought on by the law with the current calendar year. As a result, CMS has extended the time providers have to consider the new fees and whether they want to remain a participating provider or not. As a result Medicare contracted carriers have released the following physician advisory at the behest of the CMS: 1. Providers should stop and contemplate the rate increases authorized by the Medicare Prescription Drug, Improvement, and Modernization Act before making their 2004 Medicare participation decision. If doctors decide to maintain the same participation status in 2004 that they currently have now, they do not need to take any further action. 2. After reviewing the new rates, members should understand the extended timeframes for making their decision and the rules involving their 2004 payments while their decision is being processed, especially if they decide to change their participating status. 3. If members decide to change their participation status, they should be sure to complete the participation agreement that everyone should have received from their respective carrier and submit it to that carrier as soon as possible. The 2004 participation enrollment period has been extended and carriers will accept the agreements postmarked as late as February 17, 2004. For the complete listing of the new Medicare fees, go to MEMBERS ONLY section under INS. & MANAGED CAREE and then select MEDICARE:

Continuing to build an infrastructure between the insurance industry and the chiropractic profession, the American Chiropractic Association (ACA) recently participated in the latest in a series of conferences with leaders of several major insurance groups. Known as the Claims Solutions Work Group (CSWG), the conference was held in Chicago, IL, and featured senior-level executives of the ACA, the National Association of Independent Insurers (NAII), Shelter Insurance, Farmers Insurance, Allstate, national and state BlueCross BlueShield, General Casualty Insurance, AAA, Erie Insurance Group, American Family Insurance and Metropolitan Life Insurance, among others. Hosted by NAII, the largest property/casualty insurance association, the meeting marked the sixth time ACA has participated in a CSWG conference since 1999. Expanding upon breakthroughs achieved from past CSWG meetings, the participants discussed chiropractic reimbursement issues, developed joint projects that will support a better relationship between insurers and doctors of chiropractic, and identified priorities for the coming year. Specific problematic billing codes were also discussed, including extra-spinal CMT, neuromuscular reeducation, testing and measurement codes, massage, hot packs, manual therapy (97140) and E/M codes with CMT. Many insurers agreed to review their practices and those of their business partners as they relate to these codes. ACA President Donald Krippendorf, DC, has noticed continued, dramatic improvement in the communication and cooperation between payers and doctors of chiropractic as a result of the CSWG conferences. "In four short years the participants of the Claims Solutions Work Group have constructed a bridge between insurers and chiropractors that did not previously exist. The ACA is proud to be a part of this most important program." According to Paula Pfankuch, a senior manager with BlueCross BlueShield of Illinois, the meeting "really turned out to be a great day." Pfankuch added that BlueCross BlueShield of Illinois is "on board" and plans to participate in the next Claims Solutions Work Group meeting in the Spring. The next in the series of CSWG conferences is scheduled for March 3, 2004, in conjunction with ACA's annual National Chiropractic Legislative Conference (NCLC) in Washington, DC. Source: American Chiropractic Association

The effect of acupuncture on pain perception is controversial. Because late amplitudes of somatosensory evoked potentials (SEPs) to noxious stimuli are thought to correlate with the subjective experience of pain intensity, we designed this study to detect changes of these SEPs before and after acupuncture in a double-blinded fashion. Sixteen volunteers were anesthetized by propofol and exposed to painful electric stimuli to the right forefinger. Then, blinded to the research team, the acupuncture group (n = 8) was treated with electric needle acupuncture over 15 min at analgesic points of the leg, whereas the sham group (n = 8) received no treatment. Thereafter, nociceptive stimulation was repeated. SEPs were recorded during each noxious stimulation from the vertex Cz, and latencies and amplitudes of the N150 and P260 components were analyzed by analysis of variance. P260 amplitudes decreased from 4.40 ± 2.76 µV (mean ± SD) before treatment to 1.67 ± 1.21 µV after treatment (P < 0.05), whereas amplitudes of the sham group remained unchanged (2.64 ± 0.94 µV before versus 2.54 ± 1.54 µV after treatment). In conclusion, this double-blinded study demonstrated that electric needle acupuncture, as compared with sham treatment, significantly decreased the magnitudes of late SEP amplitudes with electrical noxious stimulation in anesthetized subjects, suggesting a specific analgesic effect of acupuncture. IMPLICATIONS: This double-blinded study demonstrates that electric needle acupuncture, as compared with sham treatment, significantly decreases the magnitudes of late somatosensory evoked potential amplitudes with electrical noxious stimulation in anesthetized subjects, suggesting a specific analgesic effect of acupuncture.

Chiropractic care at the Dept. of Veterans Affairs could expand dramatically, if the final recommendations of the VA chiropractic advisory committee are followed. "Any provider of care in the VA would be able to refer a patient for chiropractic services," said Warren Jones, MD, a member of the advisory committee and immediate past president of the American Academy of Family Physicians. This would mean that nurse practitioners and rehabilitation therapists could be making referrals as well as orthopedic surgeons and primary care physicians.

Omega 3 fatty acids from fish and fish oils can protect against coronary heart disease. This article reviews the evidence regarding fish oils and coronary disease and outlines the mechanisms through which fish oils might confer cardiac benefits.

Life’s lost its accreditation in June 2002 and has since suffered a huge decease in enrollment. Life got their accreditation back, but due to bad public relations their image was hurt and enrollment has remained low. With so few students, the university can no longer pay back its debts, totaling $30.7 million. The SPSU foundation plans to take on Life’s debt, buying the campus for a fraction of it’s appraised worth. The foundation plans to take on Life’s $30.7 million debt, which comes out to be a $2.7 million annual payment. This is a great deal since the campus was appraised for $52 million. The foundation intends to pay the debt with bonds, which they will subsequently pay off with monies from rent to be paid by Life University, SPSU, and possibly the Georgia Public Library Service. Life will rent back 50% to 60% of the campus (four or five buildings). SPSU will also pay the rent for the portions of campus they use. Since SPSU’s budget is already tight, Dr. Rossbacher is trying to get the Board of Regents (BoR) to take over SPSU’s rental costs. On November 18, the BoR approved the foundations proposal to begin planning for the purchase of the land. Early next semester, when planning is finished, Dr. Rossbacher will give the formal proposal requesting that the BoR take on SPSU’s rental costs. Unfortunately, even if the BoR does approve the proposal, they cannot legally guarantee that the money will be available every year. Dr. Rossbacher commented that the BoR does not make rash investments so if they approve the money, she asserted that they will most likely make the money available every year. Along with the acquisition of the campus, the foundation will also buy the apartments located on Life’s campus. The foundation plans to finance these apartments in the same way as the University Courtyard on SPSU’s campus – the foundation will sell bonds to pay for the apartments up front and use rent for the apartments to pay off the bonds. Unlike the University Courtyard, Life’s apartments are going to be used for married couples that attend SPSU, Life, and possibly Kennesaw State University. The apartments will add 128 units with some apartments having 1, 2 or 3 bedrooms. The merging of the SPSU and Life’s campuses will add a lot of space to SPSU. SPSU is 226 acres now and the addition of the Life campus will add another 89 acres, plus a few more with the apartments. There would be an additional 12 buildings with a total of 433,000 square feet of space. One of the buildings SPSU will be getting is the “Tree House,” which was built before the 1900’s and was the house of the old caretaker of Marietta’s water supply. This building has a big commercial kitchen, a dining room, and many meeting rooms. Dr. Rossbacher hopes that it can be used as a fundraising tool and for campus events since the student center has become very popular and SPSU organizations and faculty sometimes cannot get space for events. The 1415 building on the far end of Life campus would be used for classrooms if the Georgia Public Library Service doesn’t rent it. Most of the other space on campus is good for seminars rather than classrooms, except for in the gymnasium. The gym has classroom space along with basketball courts and athletic facilities. Another addition is going to be a well-manicured soccer stadium and two rugby fields. The foundation, in addition to the purchase of Life’s campus, plans to give SPSU $5 million to renovate both campuses. Two plans for this money are to convert the old gym on SPSU’s campus into studio space and tear down the I-building. The two campuses will also be connected with a road. The road that runs in front of the utilities buildings, which almost connects the campuses, most likely will be extended to unite SPSU and Life. Another place for suitable for a road has not been identified. Walkways, foot bridges, and maybe bike paths will be put in. Further, the fence that now separates the campuses will be taken down. Right now, Life is under Southern Association of Colleges and Schools (SACS) accreditation review. On December 6-9, Life is sending a delegate to represent them at the annual meeting of the SACS board in Nashville, TN, where the board will reveal its decision on Life’s accreditation. Dr. Rossbacher is confident that even if Life is unable to rent the property from the foundation, SPSU will figure out a way to keep the campus. Rossbacher stated that there are other parties that are interested in renting parts of the campus and added that the foundation has been looking at Life campus for a long time, which she emphasized makes her confident that they would look at all situations seriously in hopes of acquiring the property. Life University will be added to SPSU by July 2004 if everything goes as planned. The BoR must approve the proposal for final planning and financing of the acquisition. This means that by fall semester next year, Life will likely be part of the campus. Life’s lost its accreditation in June 2002 and has since suffered a huge decease in enrollment. Life got their accreditation back, but due to bad public relations their image was hurt and enrollment has remained low. With so few students, the university can no longer pay back its debts, totaling $30.7 million. The SPSU foundation plans to take on Life’s debt, buying the campus for a fraction of it’s appraised worth. The foundation plans to take on Life’s $30.7 million debt, which comes out to be a $2.7 million annual payment. This is a great deal since the campus was appraised for $52 million. The foundation intends to pay the debt with bonds, which they will subsequently pay off with monies from rent to be paid by Life University, SPSU, and possibly the Georgia Public Library Service. Life will rent back 50% to 60% of the campus (four or five buildings). SPSU will also pay the rent for the portions of campus they use. Since SPSU’s budget is already tight, Dr. Rossbacher is trying to get the Board of Regents (BoR) to take over SPSU’s rental costs. On November 18, the BoR approved the foundations proposal to begin planning for the purchase of the land. Early next semester, when planning is finished, Dr. Rossbacher will give the formal proposal requesting that the BoR take on SPSU’s rental costs. Unfortunately, even if the BoR does approve the proposal, they cannot legally guarantee that the money will be available every year. Dr. Rossbacher commented that the BoR does not make rash investments so if they approve the money, she asserted that they will most likely make the money available every year. Along with the acquisition of the campus, the foundation will also buy the apartments located on Life’s campus. The foundation plans to finance these apartments in the same way as the University Courtyard on SPSU’s campus – the foundation will sell bonds to pay for the apartments up front and use rent for the apartments to pay off the bonds. Unlike the University Courtyard, Life’s apartments are going to be used for married couples that attend SPSU, Life, and possibly Kennesaw State University. The apartments will add 128 units with some apartments having 1, 2 or 3 bedrooms. The merging of the SPSU and Life’s campuses will add a lot of space to SPSU. SPSU is 226 acres now and the addition of the Life campus will add another 89 acres, plus a few more with the apartments. There would be an additional 12 buildings with a total of 433,000 square feet of space. One of the buildings SPSU will be getting is the “Tree House,” which was built before the 1900’s and was the house of the old caretaker of Marietta’s water supply. This building has a big commercial kitchen, a dining room, and many meeting rooms. Dr. Rossbacher hopes that it can be used as a fundraising tool and for campus events since the student center has become very popular and SPSU organizations and faculty sometimes cannot get space for events. The 1415 building on the far end of Life campus would be used for classrooms if the Georgia Public Library Service doesn’t rent it. Most of the other space on campus is good for seminars rather than classrooms, except for in the gymnasium. The gym has classroom space along with basketball courts and athletic facilities. Another addition is going to be a well-manicured soccer stadium and two rugby fields. The foundation, in addition to the purchase of Life’s campus, plans to give SPSU $5 million to renovate both campuses. Two plans for this money are to convert the old gym on SPSU’s campus into studio space and tear down the I-building. The two campuses will also be connected with a road. The road that runs in front of the utilities buildings, which almost connects the campuses, most likely will be extended to unite SPSU and Life. Another place for suitable for a road has not been identified. Walkways, foot bridges, and maybe bike paths will be put in. Further, the fence that now separates the campuses will be taken down. Right now, Life is under Southern Association of Colleges and Schools (SACS) accreditation review. On December 6-9, Life is sending a delegate to represent them at the annual meeting of the SACS board in Nashville, TN, where the board will reveal its decision on Life’s accreditation. Dr. Rossbacher is confident that even if Life is unable to rent the property from the foundation, SPSU will figure out a way to keep the campus. Rossbacher stated that there are other parties that are interested in renting parts of the campus and added that the foundation has been looking at Life campus for a long time, which she emphasized makes her confident that they would look at all situations seriously in hopes of acquiring the property. Life University will be added to SPSU by July 2004 if everything goes as planned. The BoR must approve the proposal for final planning and financing of the acquisition. This means that by fall semester next year, Life will likely be part of the campus.

President Bush on Monday signed into law the most far-reaching changes in Medicare in nearly four decades.(H.R.1 an act to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the Medicare program and to strengthen and improve the Medicare program, and for other purposes) most sweeping changes to Medicare since its creation in 1965. Included in this sweeping legislation in Sec 651 is a provision for DEMONSTRATION OF COVERAGE OF CHIROPRACTIC SERVICES UNDER MEDICARE. To read Sec. 651 view page 436 of the link below.

Letters to the Editor Crain’s New York Business 711 Third Ave. New York, NY 10017-4036 Re: Samantha Marshall: More chiropractic visits put strain on employers File: P - 1 Dear Editor; The article by Samantha Marshall, “More chiropractic visits put strain on employers,” carried in the November 10, 2003 issue of Crain’s New York Business, is factually wrong and is more worthy of the kind of tabloid journalism one might expect to find at grocery market checkout counters. Mashall squarely puts the onus for any pending increases in Workers’ Compensation premiums on increased utilization of chiropractic care. Although as an absolute number, chiropractic utilization may have increased over the last few years, in terms of cost, the total amount spent on chiropractic is still a mere fraction of a percent of the $4.27 billion employers paid in workers' compensation premiums of under the Workers’ Compensation system. If there is any increase in Workers’ Compensation premiums, it likely parallels the escalating costs of health care in general, none of which have been attributed to chiropractic care. As studies conducted by forecasting firms, Hewitt Associaties1, Kaiser Family Foundation2, the California Healthcare Foundation3, Price Waterhouse Coopers4 and others illustrate over the last four or five years, health care costs have spiraled upward reaching the double digit stratospheres reminiscent of the early 1990s. However, forecasters place the blame for most of the increases squarely on rising cost of hospitalization and drugs,5 not chiropractic. Ms. Marshall’s statement that, “Costs have begun to rise recently in New York, where blanket coverage of chiropractic care is relatively new” is factually wrong. While chiropractic care has been covered service under the Workers’ Compensation system since 1975, the coverage Marshall refers to is not “blanket” or “new.” In fact, in New York, chiropractors are probably the lowest paid of all providers in the entire Workers’ Compensation Reimbursement system. In contrast to other providers, under the Workers’ Compensation fee schedule, chiropractic rates are capped at a reimbursement level equivalent to fifty percent (50%) of ninety-five percent (95%), or roughly 47.5% overall of the rate paid to a general practitioner, and significantly lower than the rate paid to medical specialists, a situation that has prevailed in New York since 1975. In addition, pursuant to the Workers’ Compensation fee schedule chiropractors are not reimbursed at all for many treatments and procedures they are entitled to perform by law. In addition, any cases controverted by insurers and employers are sent to a Workers’ Compensation Practice Panel for adjudication, as they are for other classes of provider. Ms. Marshall’s contention that “a bill introduced into the Assembly this summer, which has a good chance of passing in the next legislative session, would allow chiropractors to expand their fee schedules,” misses the mark. Bills have been introduced for several years that have had as their intent making the reimbursement of chiropractors equitable with other providers in the Workers’ Compensation system. This is a question of equity and fairness, and given the fact that the Legislature has thus far been unmoved, Ms. Marshall’s intimation that this bill “has a good chance of passing in the next legislative session” and “would allow chiropractors to expand their fee schedules” smacks of an appeal to emotional sensationalism, and is not genuine, professional, journalistic reporting. Ms. Marshall also has her facts wrong concerning the impact of the 1997 chiropractic Insurance Equality Law (effective 1998). Marshall states that, “The 1997 Chiropractic Care Act mandated that injured workers eligible for workers' compensation could receive almost unlimited chiropractic care.” (underlining added). Had Ms. Marshall actually bothered to take the time to read the Insurance Equality Statute she would have discovered that the Insurance Equality Law was an equity statute designed to give patients the same access to and equivalent coverage for chiropractic care in health insurance plans as they would receive for medical care provided to physicians. The 1997 Insurance Equality Law had nothing to do with and had no impact whatsoever on Workers’ Compensation Law, Workers’ Comp carriers or plans or employers. To suggest that the 1997 Insurance Equality Law allowed “the New York workers' compensation system [to] create the perfect climate for excessive use of chiropractic services,” is patently false. It calls into question Ms. Marshall’s ability to be fair, objective and balanced in her reporting. Likewise, Marshall incorrectly states that “chiropractors successfully sued several major insurers two years ago for more equitable coverage.” Had Ms. Marshall actually done any sort of investigation she would have learned that the courts had dismissed the suit holding that chiropractors had “no private right of action” to assume the responsibility for enforcing a law that was completely within the ambit of the State Insurance Department. Finally, Marshall and Crain’s reference to Dr. Daniel Quatro, President of the New York State Chiropractic Association as “Mr. Quatro” is an insult. The Federal government and State governments nationwide extend the courtesy of referring to doctors of chiropractic as “Dr.” in recognition of their extensive educational attainment, which studies show, is on par with other health care providers, including physicians.6 This disrespect is antediluvian and reflects, perhaps, part of the “lingering effects” a federal court found when it held organized medicine guilty in 1987 of a “long-term,7 systematic,8 successful,9 and unlawful”10 attempt to “contain and eliminate”11 the “chiropractic profession”12 by any means, legal and unlawful. In 1987, the Federal Court concluded a permanent injunction against organized medicine was necessary because “[t]here are lingering effects of the conspiracy”; because organized medicine “never acknowledged the lawlessness of its past conduct . . . ”13; and because the 'lingering effects' [of organized medicine’s campaign] still threatened plaintiffs with current injury.”14 Unwittingly perhaps, Crain’s contributes to that legacy. Crain’s does its readers a disservice by communicating information in this article that is just plain factually wrong. This type of shoddy reporting leaves the impression that Crain’s plays fast and lose with the facts and that its attitude is decidedly cavalier, perhaps intentionally so. Crain’s would do well to make sure that its reporters and writers have a firm grasp of the facts before putting any article to press. If this sort of shoddy reporting and editing one can expect from Crain’s, it certainly does not reflect well upon Crain’s, its reporters, editors or its other publications. Sincerely, Karl C. Kranz, DC, Esq. Executive Director New York State Chiropractic Association 1. Hewitt Associates. “Health Care Costs Continue Double-Digit Pace, But May Start Moderating in 2004,” Lincolnshire, IL, October 13, 2003. 2. Kaiser Family Foundation and Health Reserach and Educational Trust. Employer Health Benefits, 2003 Summary of Findings, September 2003. 3. California Healthcare Foundation. Trends & Analysis: Insurance Markets – Health Benefit Costs: Employers Share the Pain, July 2003. 4. Price Waterhouse Coopers. The Factors Fueling Rising Health Care Costs. April 2002. 5. Ibid. 6. Cherkin DC, Mootz RD. Chiropractic in the United States: Training, Practice, and Research. Agency for Health Care Policy and Research (AHCPR), Department of Health and Human Services (DHHS), Publication No. 98-N002, December 1997. Grant number HS07915 AHCPR. 7. Wilk v. AMA, 671 F.Supp. 1465, 1488 (Dist. Ct. N.D. Ill. 1987) 8. Id. 9. Id. 10. Wilk v. AMA, 895 F.2d 352, 357 (7th Cir. 1990) 11. Wilk v. AMA, 671 F.Supp. 1465, 1473 (N.D. Ill. 1987) 12. Wilk v. AMA,895 F.2d 352 (7th Cir. 1990), cert denied, 496 U.S. 927, 110 S.Ct. 2621 (1990). 13. Wilk v. AMA, 671 F.Supp. 1465, 1488 (Dist. Ct. N.D. Ill. 1987). 14. Wilk v. AMA, 895 F.2d 352, 357 (7th Cir. 1990))

A new study debunking the long- held belief by many that firm mattresses are beneficial for low-back pain should prompt some consumers to re-think their choices in mattresses, according to the American Chiropractic Association (ACA). A study published in the November 15 issue of The Lancet found that people who slept on mattresses of medium firmness were twice as likely to report improvement in low-back pain symptoms than those who slept on firm mattresses. Doctors of chiropractic have long counseled patients that "comfortably supportive" mattresses are superior to very firm "table board" mattresses, said George McClelland, DC, chairman of the board of the American Chiropractic Association. "A medium-firm mattress will more readily adapt to the natural curvatures in a person's spine," he explained. Dr. McClelland and the ACA recommend the following tips for choosing mattresses: If you're not in the market for a new mattress, and your current mattress is too firm, you can soften it up by putting a 1- to 2-inch-thick padding on top of it -- usually available at mattress and bedding stores. A mattress should provide uniform support from head to toe. If there are gaps between your body and your mattress (such as at the waist), you're not getting the full support that you need. Every few months, turn your mattress clockwise, or upside down, so that body indentations are kept to a minimum. It's also good to rotate the mattress frame every so often to reduce wear and tear. If you're waking up uncomfortable, it might be time for a new mattress. There is no standard life span for a mattress; it all depends on the kind of usage it gets. Be aware that changes in your life can signal the need for a new mattress. For example, if you've lost or gained a lot of weight, if a medical condition has changed the way you sleep, or even if you have changed partners, it could mean that it's time to find a new mattress that will accommodate those changes and help you sleep more soundly. When you're purchasing a mattress, don't be embarrassed to actually lie down on it at the store to check its fit and comfort. Don't just sit on it to test it.

When appealing a claim denial from an ERISA health plan, it is important to determine the extent of the plan's chiropractic benefits as well as who made the decision to deny the claim and why, said Karen L. Handorf, deputy associate solicitor in the Plan Benefit Security Division of the U.S. Department of Labor (DOL). All of this information is available to patients, and doctors acting as patient representatives, under new DOL regulations. Employers with ERISA health plans are also obligated under the new rules to follow specific steps in the appeals process. Handorf, whose DOL division is responsible for providing litigation and advisory legal services under ERISA, participated in an Oct. 24 teleconference on new ERISA-related court rulings and Labor Department regulations hosted by ACA for chiropractic attorneys and state association representatives. She told the group that, at present, individual doctors and their patients are better off going through a plan's appeal procedure to obtain benefits rather than filing a lawsuit. If you have to file a lawsuit in federal court, the plan's decision is usually reviewed under an "arbitrary and capricious" standard; you are limited to the evidence that was presented to the plan administrator, and you will not be able to obtain anything more than the benefits that were promised. States can regulate insured plans through their state insurance laws, and the courts are interpreting ERISA preemption language to allow for more expansive regulation of insured plans by the states. ERISA, the Employee Retirement Income Security Act, was passed in 1974 and intended to encourage large multi-state employers to provide pension, health care and other compensation to their employees by shielding them from various state laws governing pension and insurance laws and instead requiring compliance with one set of federal laws. The law, however, also made it difficult for individuals to get relief for denied claims or botched treatment. About 80 percent of workers not covered by a government-based health plan receive their health care through an ERISA-protected plan. In response, the DOL this year issued new claim appeal procedures effective for all health benefit plans subject to ERISA regulations. It includes a specific time frame for filing an appeal, spells out the rights of the plan participants and responsibilities of the plans, and requires the plan to indicate why and on what basis a claim was denied. Handorf told participants that the first course of action should be to obtain the health plan's "SPD" or summary plan description, which describes-in plain, understandable terms-what a beneficiary is entitled to and what his or her rights are under the plan. From this, doctors and patients can determine if the denial is based on limitations allowed in the SPD. "It all comes down to how a plan is written..." says Handorf. "I would think that most plans that provide chiropractic benefits would be pretty specific about it." If a claim is denied for reasons of medical necessity, doctors and patients have the right to know the identity of the reviewer (who should have appropriate training and experience in the specific health care field involved) and the reasons for the denial. Once this information is known, doctors should submit any additional evidence supporting their treatment decisions to the health plan to be included in the official administrative record. Attention to such details of the appeals process is essential; otherwise, evidence may not be admissible further down the line.

New studies showing the staggering costs of headaches, back pain and other musculoskeletal conditions on the country's economy and the skyrocketing effect prescription drugs have on insurance premiums should convince the nation's employers and insurers to more fully integrate chiropractic care into employee health plans, according to the American Chiropractic Association (ACA). A November 12 study in the Journal of the American Medical Association found that headaches and back pain are leading reasons for lost productivity and absenteeism in the workforce -- costing more than $61 billion each year. And the 2003 Annual Employer Health Benefits Survey, conducted by the Kaiser Family Foundation and Health Research and Educational Trust, found that higher prescription drug costs are a major factor contributing to increases in health insurance premiums. "Over the years, studies have shown that chiropractic care is effective at treating headaches and back pain and can get workers back on the job more quickly than traditional forms of care," said ACA President Donald J. Krippendorf, DC. "At the same time, chiropractic also helps workers avoid expensive prescription drugs -- making it a perfect fit for employers looking to control health care costs." Back pain and headaches, in particular, are two conditions that doctors of chiropractic have successfully treated for decades -- and several studies have demonstrated chiropractic's effectiveness. Most recently, a study published in the July 15, 2003 issue of the medical journal Spine found that manual manipulation -- the primary form of treatment performed by doctors of chiropractic -- provides better short-term relief of chronic back pain than medication. In 2001, researchers at Duke University found cervical -- or neck -- manipulation appropriate for both tension type headache and cervicogenic headache and noted that "cervical spinal manipulation has a very low risk of serious complications" which may be "one of its appeals over drug treatment." Just a sampling of other studies include: A 1997 study published in Spine found "strong evidence that manipulation is more effective than a placebo treatment for chronic low-back pain or than usual care by the general practitioner, bed rest, analgesics and massage." A 1996 study published in the journal Medical Care found that first contact chiropractic care for common low back conditions costs substantially less than traditional medical treatment and "deserves careful consideration" by managed care executives concerned with controlling health care spending. In 1994, the U.S. Agency for Health Care Policy and Research found that "spinal manipulation is effective in reducing pain and perhaps speeding recovery" within the first month of acute low-back pain symptoms. A 1993 study conducted in Canada and funded by the Ontario Ministry of Health found that "the overwhelming body of evidence" shows that chiropractic management of low-back pain is more cost-effective than medical management, and that "many medical therapies are of questionable validity or are clearly inadequate." For more information on chiropractic care and research on its effectiveness, visit ACA's Web site at www.acatoday.com. The ACA, based in Arlington, VA, is the largest chiropractic organization in the country. The ACA promotes the highest standards of ethics and patient care, contributing to the health and well being of millions of chiropractic patients.

Attached is a copy of a Congressional "Dear Colleague" letter from Rep. Ed Schrock (R-VA) and Rep. Lane Evans (D-IL) being circulated in today's afternoon mail on Capitol Hill. It asks Members of the U.S. House of Representatives to join as original co-sponsors of an ACA-backed legislative proposal to extend chiropractic health parity to U.S. military retirees, dependents and survivors through the TRICARE program. In recent years, Congress has passed, and the President has signed into law, legislation establishing a permanent chiropractic care benefit for both active duty military personnel and veterans. The Schrock-Evans Chiropractic Parity in TRICARE Bill represents the next step toward ensuring that all of America’s current and former military service personnel, and their families, have access to the chiropractic services they need and deserve. ACA and the Association of Chiropractic Colleges have been involved in discussions concerning this issue since earlier this year and have committed to working closely with Reps. Schrock and Evans to build strong support for the legislation among pro-chiropractic Members of Congress. Accordingly, ACA urges all concerned DCs, CAs, chiropractic students and patients and friends of the chiropractic profession to immediately contact their representatives in the U.S. House to request that they join as original co-sponsors of the soon-to-be-introduced Schrock-Evans Chiropractic Parity in TRICARE Bill. As a chiropractic supporter, it is essential that you take immediate action on this matter by calling your Congressman or Congresswoman at his/her local office or through the U.S. Capitol switchboard at (202) 225-3121. Please urge co-sponsorship of the Schrock-Evans Chiropractic Parity in TRICARE Bill.

The U.S. Patent and Trademark office has awarded Dr. Joan Fallon patent # 6,632,429 entitled Methods for Treating Pervasive Developmental Disorders. The patent covers the use of digestive and pancreatic enzymes as a treatment for children with ADD, ADHD and Autism. The patent, which will remain in effect until 2019, represents a breakthrough for children with pervasive developmental disorders including ADD, ADHD and Autism. Autism is characterized by profound delays in communication and social interaction and is thought to affect over 1.5 million individuals in the U.S. ADD and ADHD have a prevalence of between 5 and 10% in the population. It is estimated that upwards of 10% of the population is medicated for some type of attention disorder. Dr. Fallon's invention employs the use of digestive and pancreatic enzymes for children with these conditions based upon the presence of a low level of chymotrypsin in the stool. Chymotrypsin is an enzyme secreted by the pancreas in an inactive form which becomes active in the presence of protein in the small intestines as well as a favorable pH. Without sufficient protein digestion, the formation of amino acids, the building blocks of new proteins, cannot occur. The lack of protein synthesis can underlie a significant neurological deficit in the child. Fallon's patent demonstrates that the administration of digestive and pancreatic enzymes produce profound changes in the autistic symptomotology including increases in social interactions, eye contact and speech and reductions in repetitive actions and hyperactivity. It further demonstrates changes in bowel habits including an increase in bowel control and formed movements. In the child with ADD and ADHD, the therapy significantly reduces the levels of medication the child is taking and, in many cases, the child no longer needs the medication, based upon observed increases in attention. "The patent recognizes a deficiency in the children with ADD, ADHD and Autism, and offers a biological solution. Digestive and pancreatic enzymes have been used safely and effectively for children and adults with cystic fibrosis for many years," said Dr. Fallon, inventor and patent holder. "I intend to continue to refine the use of digestive and pancreatic enzymes for these and other indications. This form of treatment opens new avenues for children and adults with these debilitating conditions. Contact: Dr. Joan Fallon 914-779-9300

Ear problems can be excruciatingly painful, especially in children. With 10 million new cases every year, ear infections are the most common illness affecting babies and young children and the number one reason for visits to the pediatrician -- accounting for more than 35 percent of all pediatric visits. Before yet another round of "maybe-they'll-work-and-maybe-they-won't" antibiotics or the drastic step of surgery, more parents are considering chiropractic to help children with chronic ear infections, according to the American Chiropractic Association (ACA). See www.acatoday.com . Dr. Joan Fallon, a doctor of chiropractic who practices in Yonkers, New York, has published research showing that, after receiving a series of chiropractic adjustments, nearly 80 percent of the children treated were free of ear infections for at least the six-month period following their initial visits (a period that also included maintenance treatments every four to six weeks). "Chiropractic mobilizes drainage of the ear in children, and if they can continue to drain without a buildup of fluid and subsequent infection, they build up their own antibodies and recover more quickly," explains Dr. Fallon. She'd like to see her pilot study used as a basis for larger-scale trials of chiropractic as a therapeutic modality for ear infections. When treating children with ear infections, Dr. Fallon focuses on the back of the skull and the first vertebra in the neck. After an adjustment to these areas, which helps the fluid in the ears to drain -- and depending on how chronic the problem is and where they are in their cycle of antibiotics -- children can generally fight the infection off themselves. That means, for the average child, between six and eight treatments. If a child's case is acute, Dr. Fallon will check the ear every day, measuring the ear and tracking the movement of the eardrum to make sure that it's draining. "I'll do adjustments every day or every other day for a couple of days if they're acute, and then decrease frequency over time." Dr. Fallon, whose research garnered her the acclaim of childrearing magazines like Parenting and Baby Talk, often sees great success when she treats a child for an ear infection. "Once they fight it themselves, kids tend to do very well and stay away from ear infections completely. Unless there are environmental factors like smoking in the house, an abnormally shaped Eustachian tube, or something like that, they do very well," she says. "I have two large pediatric groups that refer to me on a regular basis. In the winter, when ear infections are most prevalent, I see five or six new children each week from each group," says Dr. Fallon. "It's safe and effective and something that parents should try, certainly before inserting tubes in their children's ears."

Superintendent of Insurance Gregory V. Serio, along with New York City Police Commissioner Raymond W. Kelly and Brooklyn District Attorney Charles J. Hynes announced on Sunday the arrest of 51 individuals as part of the takedown of a no-fault insurance fraud ring in New York City. The arrests are the first phase of "Operation Gateway," an investigation into a criminal organization that is taking advantage of New York’s no-fault laws by falsifying auto accidents. It is estimated that fraudulent no-fault insurance claims amount to tens of millions of dollars a year in New York State, and hundreds of millions of dollars nationwide. Based on the evidence in this case, the loss is in the tens of millions of dollars. "The elaborate scheme and sophistication of the criminals involved in the case dismantled today proves that criminals are aware of how to circumvent the current no-fault law and make a great deal of money by doing so," said Superintendent of Insurance Gregory V. Serio "The Governor, the Insurance Department and law enforcement agencies, like the New York Police Department and Brooklyn District Attorney’s office, are doing everything within the power of the current law to take these criminals off the street, but until there is legislative action we will continue to see criminals like these who steal tens of millions of dollars from the auto insurance system and cause auto insurance rates to increase for honest New York drivers." A typical no-fault auto insurance scam begins with "runners," or recruiters who arrange to send individuals supposedly injured in an accident to clinics for treatment. The runners obtain phony accident reports and recruit ‘victims’ to send to medical clinics, which are paid off to provide medical tests. Lawyers are also involved who file insurance claims, up to $50,00 per victim which is the maximum amount allowed under New York’s no-fault laws. The organization’s top leaders keep most of the money and paid off those involved. In this case, runners were paid up to $2,500 for every victim they could link to a fictitious accident. The Department participated in the weekend takedown where NYPD detectives posed as insurance company representatives, called them at home to inform them they had been awarded an insurance claim of up to $11,000 and to pick it up in person in Queens. When they arrived to pick up their claim money, they were arrested and charged with fraud. The Department was initially contacted by the New York City Police Department to assist in the investigation in December 2002 after the NYPD received a tip regarding a suspected fraud ring in New York City. Also assisting in the investigation were Liberty Mutual Insurance Company, Kemper Insurance Company, MetLife Insurance Company, Allstate Insurance Company, Progressive Insurance Company, Clarendon Insurance Company, Continental Insurance Company, The Robert Plan, Eagle Insurance Company, GEICO Insurance Company, The Hartford Insurance Company, State Farm Insurance Company, Lancer Insurance Company, the Motor Vehicle Accident Indemnification Corporation, Nationwide Insurance Company, New York Central Mutual Fire Insurance Company, Statewide Insurance Company and Travelers Insurance Company. New York is aggressive in its fight against insurance fraud. To report suspected incidents of insurance fraud call 1-888-FRAUD-NY (1-888-372-8369). It should be noted that an arrest is merely an accusation and that a defendant is presumed innocent until proven guilty.

At its annual meeting, the ACA House of Delegates passed the following resolution endorsing the Association of Chiropractic College's clarification of the ACC paradigm related to diagnosis as follows: "A diagnosis is an expert opinion identifying the nature and cause of a patient's concern or complaint, and/or abnormal finding(s). It is essential to the ongoing process of reasoning used by the doctor of chiropractic in cooperation with the patient to direct, manage, and optimize the patient's health and well-being. "The process of arriving at a diagnosis by a doctor of chiropractic includes: obtaining pertinent patient history; conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and/or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation. "The Association of Chiropractic Colleges continues to foster a unique, distinct chiropractic profession that generates, develops, and utilizes the highest level of evidence possible in the provision of effective, prudent, and cost-conscious patient evaluation and care." (Note: This does not replace the current definition of diagnosis as found in the ACA Master Plan and other policy statements of the ACA. Motion Carried.)

The Centers for Medicare & Medicaid Services (CMS) announced today that it will implement a contingency plan to accept noncompliant electronic transactions after the October 16, 2003 compliance deadline. This plan will ensure continued processing of claims from thousands of providers who will not be able to meet the deadline and otherwise would have had their Medicare claims rejected. 'Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance while not disrupting providers' cash flow and operations, so that beneficiaries can continue to get the health care services they need,' said CMS Administrator Tom Scully. CMS made the decision to implement its contingency plan after reviewing statistics showing unacceptably low numbers of compliant claims being submitted. 'Medicare is able to process HIPAA-compliant transactions,' said Tom Grissom, director of CMS' Center for Medicare Management, 'but we need to work with our trading partners to increase the percentage of claims in production.' The contingency plan permits CMS to continue to accept and process claims in the electronic formats now in use, giving providers additional time to complete the testing process. CMS will regularly reassess the readiness of its trading partners to determine how long the contingency plan will remain in effect. The authority to implement a contingency plan was provided by guidance issued by HHS on July 24. CMS recognized that transactions often require the participation of two covered entities and that non-compliance by one covered entity may put the second covered entity in a difficult position. The guidance stated that covered entities that make a good faith effort to comply with HIPAA transactions and code set standards may implement contingencies to maintain operations and cash flow. CMS announced its contingency plan on September 11, but at that time had not made a decision on whether the plan would be implemented. Today's announcement means the CMS plan will be implemented on October 16, 2003. 'We encourage other plans to assess the readiness of their trading partners and implement contingency plans if appropriate,' Grissom said.

The NYSCA officers and downstate board members met with Oxford representative Drs. James Dillard and Bartley Bryt and Triad officers, Drs. Agostino Villani and Santo Sampini during the NYSCA convention in Rye Brook, NY on September 19, 2003. The purpose of the meeting was to discuss NYSCA member issues with Triad handling of care plans over the past nine months. Much of member complaints focused on onerous paper work (first visit submission of care plans with 30 day extensions); down coding; lack of supportive care approval (even though Triad reports approval of this type of care); difficulty in treating the chronic pain patient and the lack of clinical information on care plans on which treatment authorizations are based. An additional issue that was addressed and immediately clarified was the PCP referral. It was explained that once the patient has obtained the PCP referral, providing they remain in the same plan, the patient does not need a new referral after the initial even with lapses or discharge from care. As far as the remaining issues are concerned, Triad reports changes to the forms to be implemented in the new year. They recommend visiting their website to view the provider manual for proper filing of forms as well as being able to download care plans to be filled out on your desktop. Your NYSCA leaders plan to continue discussions with Oxford to assist them in understanding chiropractic in the managed care environment. We will keep communications open with Triad as long as our members have issues. Your responsibility is to communicate your problems with us. We are particularly interested in supportive care denials. NYSCA - working for you - with you.