Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Prior Authorization, Fair Pay in Washington State
Under the Prior Authorization bill, patients will be allowed up to six consecutive visits of chiropractic care in a new episode of care – defined as a new or recurrent condition for which the patient has not been treated for in the previous 90 days – without prior authorization. The Fair Pay bill, specific to spinal manipulation, will give insurers the option to:
- Match the pay of doctors of chiropractic up to what they pay other providers for spinal manipulation;
- Reduce the payment for other providers down to what they pay DCs for spinal manipulation; or
- Pay DCs the appropriate payment methodology identified by Centers for Medicare & Medicaid Services (CMS) using a Relative Value Unit (RVU) formula to set fair payments for all.
During the legislative session, the Washington State Chiropractic Association referenced Foundation for Chiropractic Progress (F4CP) evidence-based resources as WSCA members testified in the House Health Care Committee against health insurance representatives who openly communicated their bias against the chiropractic profession. This bill, in conjunction with a bill passed in 2008, makes it illegal for insurers to unfairly pay DCs less for all the services they deliver.
"The WSCA actively works to position doctors of chiropractic as first-line physicians for disease prevention and overall good health promotion," commented Lori Grassi, state lobbyist and executive director of the WSCA. "Having the ability to present the Foundation's material, including its chiropractic placements in America's Health Insurance Plans' (AHIP) SmartBriefNewsletters, was significant in the passage of the Prior Authorization and Fair Pay bills. Consumers will now have easier access to safe, effective and non-pharmacological care, and doctors of chiropractic will be situated on a more fair playing ground among other providers."
Kent S. Greenawalt, chairman of the F4CP, commended the hard work put forth by the WSCA and urged other states to take a stand: "Our greatest accomplishments are achieved when the chiropractic community joins forces and works together toward the advancement of the profession."
He continued: "The Foundation is a leading voice of the chiropractic profession and will continue to provide high-quality, evidence-based resources, including white papers, press releases, brochures, flyers, e-books, resource manuals and more to its state associations, corporate sponsors, colleges and over 20,000 doctor members to utilize at the ground level to further communicate the improved outcomes, cost-effectiveness and high patient satisfaction scores associated with the drug-free chiropractic approach."
Reduced Opioids, Increased Access in West Virginia
In West Virginia, Senate Bill 273, "Reducing Use of Certain Prescription Drugs," was recently signed into law. The purpose of the bill is to reduce the overuse of prescriptions of opioids and create a method to provide other treatment plans, rather than prescribing narcotic painkillers. Under the bill, health care practitioners treating a patient "for any of the myriad conditions that cause pain" will be required to refer the patient to alternative treatments before prescribing an opioid.
"Senate Bill 273 benefits the chiropractic profession in West Virginia and provides for doctors of chiropractic to treat pain while decreasing the amount of prescriptions in our state," said Chad Robinson, executive director of the West Virginia Chiropractic Society.
SB 273 will restrict initial opioid prescriptions for acute pain to four days for emergency rooms or urgent care centers; three days for dentists and optometrists; and seven days for other providers outside of ERs or urgent care centers. West Virginia's new law will also require insurance companies operating in the state to cover at least 20 visits to alternative therapy providers for treatment of pain. Patients will be able to seek treatment from alternative therapy providers without a doctor's referral.
Athletic Team Doctors in Oregon
Oregon recently passed a measure that includes DCs in the list of qualified health professionals who can assess a concussed student athlete and begin the release process to start return-to-play protocols.
Prior to the new measure, the Oregon Schools Activities Association's (OSAA) Sports Medicine Advisory Committee determined that DCs did not have the training to assess student athletes suspected of suffering a concussion. This triggered policy changes in some school districts to not allow chiropractic sports physicians from acting in the capacity of "team doctor," something many DCs had been doing for decades.
The Oregon Chiropractic Association, in conjunction with the Oregon Board of Chiropractic Examiners and the University of Western States, prompted a concussion subcommittee of the OSAA's Sports Medicine Advisory Committee to determine if DCs had adequate training.
The Oregon State Senate then passed Bill 1547, which adds chiropractic physicians, naturopathic physicians, physical therapists and occupational therapists to the list of qualified health professionals who can assess a concussed student athlete and provide a release to start the stepwise return-to-play protocols.
Oregon Health and Sciences University is producing a comprehensive online concussion return-to-play and learning course that all qualified health professionals must successfully complete. This evidence- and consensus-based course will be updated every four years in coordination with the International Consensus Meeting on Concussion in Sports. There will be no centralized registry of qualified health professionals; those who have successfully completed the course will self-identify with a certificate of completion.
"This much-needed bill helps to re-establish chiropractic sports physicians as qualified to be team doctors," said Dr. Vern Saboe, director of governmental affairs for the Oregon Chiropractic Association.
Steps in the Right Direction
The bills passed in Washington, West Virginia and Oregon are steps in the right direction to catch up to market need and the reality that doctors of chiropractic are first-line providers for pain management and general health and wellness.
Dr. Sherry McAllister is a graduate of Palmer Chiropractic College West; practices in San Jose, Calif.; and is currently the executive vice president of the Foundation for Chiropractic Progress (F4CP). Visit www.f4cp.com to learn more.