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Dynamic Chiropractic – February 15, 1991, Vol. 09, Issue 04

ACA Joint Legislative Column

By Kurt Hegetschweiler, DC
The following is the first of a monthly column designed to keep all doctors of chiropractic updated with the legislative activities of the American Chiropractic Association (ACA) in Washington, D.C.

In July of 1990, I was appointed chairman of the ACA Legislative Commission by ACA President Charles Downing, D.C. Since then the entire ACA Governmental Department has undergone a complete restructuring designed to insure the survival of the chiropractic profession into the year 2000 and beyond.

The first step toward that goal was the hiring of a legislative strategist, Dennis Shedd, now a federal judge. In just a few short months, a comprehensive legislative and administrative plan for the 1990s was designed under his direction. Before Mr. Shedd's departure, he assisted the ACA in finding and employing a new Governmental Relations Director, Mr. Richard Miller, and an additional legislative consultant, Mr. Mark Goodin. As the chairman of the Legislative Commission I can tell you that never before has the ACA had a more powerful and better-connected team in Washington, D.C.

The entire Governmental Relations staff, together with the ACA Legislative Commission are now ready and poised to tackle the challenges of the 1990s on behalf of our great profession and our patients.

The last quarter of 1990 was marked by very high legislative and administrative activity, resulting in one seemingly small, but nevertheless potentially far-reaching legislative victory.

On November 4th, 1990, President Bush, together with the 1991 United States Budget Committee signed the 1990 Omnibus Reconciliation Act, which included important legislation for the chiropractic profession and the chiropractic patient of Medicare age. This bill was specifically aimed at the problem of Medicare patients joining HMOs and, with the consequential loss of direct access to reimbursed chiropractic care. The work of the ACA with Senator George Mitchell (Democrat -- Maine) paid off. His bill requires the Secretary of Health and Human Services (HHS) to "study the availability of Medicare covered chiropractic services to HMO enrollees and the arrangements and types of practitioners involved in furnishing such services."

Remember, Congress only allowed HMOs to bid for Medicare contracts if they promised to offer the exact same coverage and access to treatment available to all Medicare recipients not enrolled in HMOs. The HHS secretary's first report is due in one year; we all know what it will show.

This victory, small as it seems, is the first ACA legislative success in 17 years. Ironically, it was 17 years ago that chiropractic first got into Medicare. Resolving this issue is very crucial and could have an affect on the design of other federal programs. Historically, many federal insurance programs have first looked to Medicare coverage before designing their own.

In addition, the ACA House of Delegates decided to allocate one million dollars to finance a law suit against the federal Health Care Financing Agency (HCFA) on the same HMO/Medicare issue. This law suit has since been filed and puts HCFA/HHS into a kind of double pinch, with chiropractic now definitely getting their attention.

More Medicare

In 1991 the ACA will reintroduce the Medicare Reform Bill which clarifies the definition of physician, adds reimbursement for examination and x-rays, and at the same time eliminates the ridiculous requirement of annual x-rays. This bill will again be introduced jointly with the International Chiropractors Association (ICA).

Yet More Medicare

The Medicare Fee Schedule is an issue of monumental importance to our profession. It deals with the type of fee schedule chiropractic services will be billed and reimbursed under in the future. Again, remember our future position with Medicare may well determine our position with other federal programs, including National Health Insurance, which are gradually making their way through the legislative process.

Many other issues will be aggressively dealt with by the ACA Governmental Relations Department in 1991 and beyond. These include: commissioning of DCs in the Armed Forces (will be introduced jointly with the ICA); ERISA; Federal Research Funding; Federal Worker's Compensation; National Health Insurance/Minimal Benefits; Civilian Health and Medical Program United Services (CHAMPUS); and the chiropractic postage stamp (for the 100th anniversary of chiropractic in 1995).

Further, the ACA together with Association of Chiropractic Colleges (ACC), will be lobbying Congress in an effort to preserve the Health Educational Assistance Loan (HEAL) program. In addition, the ACA and ACC will for the first time be pushing for chiropractic students' eligibility in the Health Professional Student Loan (HPSL) program.

Now let me briefly comment on one other issue: standards of care. Since this is mainly a legislative report, this issue at first sight doesn't really seem to belong here. On the contrary, the development of standards of care is extremely crucial to most of the issues I've discussed. These standards need to be developed soon, but without giving up the totally scientific process that is currently being used. The ACA House of Delegates agrees and has allocated $250,000 to the Rand study currently in progress. An additional $250,000 was pledged by the National Chiropractic Mutual Insurance Corporation (NCMIC) with all funds to be distributed by the Foundation for Chiropractic Education and Research (FCER), with involvement of the Consortium for Chiropractic Research, of which ACA is now a member.

Standards of care, when available, will be of great help to our cause in Washington, D.C. since I firmly believe that they will show chiropractic's cost-effectiveness and efficacy. This may be contrary to what the legislatures have been led to believe by the insurance lobby.

As you can see, the ACA Legislative Department has had a very busy year, the busiest in a long, long time. It intends to be even busier on behalf of this great profession in 1991. All this if continued at the current pace, and only then, will insure chiropractic's presence in the next century. The ACA welcomes your support and comments.

Kurt Hegetschweiler, D.C.
Chairman, ACA Legislative Commission
Rancho Palos Verdes, California


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