Fwd: CSOMA: SB-899 Update

[Guest guest]

Note that the gist of this letter is that w/o research, we are

witnessing the beginning of the end of insurance coverage for

acupuncture. WC in CA is pretty much history and private insurers will

soon follow. So while some folks are claiming acceptance is on the

upswing and acupuncture research is unnecessary or will just hurt us in

some way. think again. tick-tock. Its EBM or its nothing at all.

 

 

 

CSOMA <office

August 7, 2004 10:15:39 PM PDT

 

CSOMA: SB-899 Update

 

 

August 6, 2004

 

SB 899: Workers' Compensation

Legislative Impact on Acupuncture and Oriental Medicine

 

Greetings CSOMA Members and Colleagues:

 

Despite the continuous efforts of CSOMA, CAOMA and The Foundation of

Acupuncture Research (FAR), the acupuncture community is facing major

hurdles in addressing the Workers' Compensation reform enacted by SB

899. In addressing the complexity of issues, we must not forget that

the acupuncture community has not been singled out from other care

providers under the Workers' Compensation System. To that extent all

providers are pretty much in the same boat. Where changes can be made

for the benefit of acupuncture, diligent attention is being given.

CSOMA and many other members of the acupuncture community have been

working with FAR to further acupuncture research and provide

documentation to enhance the role of acupuncture within the ACOEM

guidelines and help implement LC 5307.27, which will address,

“frequency, duration, intensity and appropriateness of all treatment

procedures.”

 

To update the efforts of FAR, on June 17 th FAR met with Dr. Ann

Sercy, Assistant to the Administrative Director of the Division of

Workers Compensation and Christine Baker, the Executive Director for

the Commission on Health and Safety, to discuss the ACOEM guidelines.

FAR was informed that the Department of Workers' Compensation had

contracted an independent research company, Rand, Inc. who is compiling

a survey and will recommend utilization guidelines for California

Worker's Compensation by October 1, 2004. Both Dr. Sercy and Christine

Baker encouraged FAR to contact Rand, Inc. with the offer to work

directly with Rand consultants. As of August 2nd, FAR submitted their

research guidelines to Rand, Inc. who are now in the process of review.

If you are interested in supporting FAR, please contact Richard

Esquivel at Richard.

 

Medical Provider Networks (MPN)

With the changes that have taken place within the Workers'

Compensation Law, it now states that unless you contract with a Medical

Provider Network (MPN) you will not be able to treat injured workers as

of January 1, 2005. If there are no acupuncturists contracted with the

network/insurance company, then you are allowed to go out-of-network. I

am sure that most, if not all, provider networks will have contracted

acupuncturists to work on injured workers to bypass that part of the

law. There has been some speculation that some networks will contract

acupuncture and chiropractic out to a network that specializes in those

professions. I myself received my first contract for a Workers'

Compensation Medical Provider Network (MPN) from Landmark in the mail

last week and in reading it over, wondered which other managed care

companies were going to join in the new law scheduled to go in effect

at the first of the year.

 

Landmark

Landmark's new contract states that fee reductions will be up to 20%.

According to Sandra Johnson, Landmark's Provider Relation's Director,

they will not know until guidelines governing MPN's are available in

November, how they will be able to administer the contracts. They are

trying to be proactive in getting everything in order to comply with

the new guidelines.

 

ASHP

I also spoke with Dr. Lloyd Friesen with American Specialty Health

Plans (ASHP) and he stated that, because of their ongoing relationship

with Kaiser, they have already signed an agreement with them. He

informed me that ASHP have no further plans to expand a Workers'

Compensation MPN and have not actively promoted for employers to join

with them. He also added that practitioners will receive 75% of the

Official Medical Fee Schedule (OMFS).

 

Acu Care

Ilan Migdali of Acu-Care stated that they are looking at contracts

with a maximum of a 10% reduction. Ilan Migdali, a seasoned

practitioner and longtime supporter of CSOMA and now FAR, wants his

program and contracts to benefit acupuncturists by respecting and

enhancing their existing practices.

 

One of the problems I see is once again we are going to see fee

reductions (up to 30% according to some sources, on top of the 5% we've

already taken) through these networks without the relief of mounds of

paperwork. From what I understand, you will still need authorization to

treat and the reporting requirements will remain the same. The

advantage of contracting with a Medical Provider Network is the

addition of injured workers to your practice but it will be up to you

whether the fee reductions will cover your office and per-patient

overhead. A remark I've heard from several acupuncturists with a cash

practice as well as those who don't practice in the workers'

compensation system is that none of this applies to them (well, who is

going to be marketing YOUR cash patients while the Workers'

Compensation System continues to degrade?)

 

Now is the time to get involved! Please help in whatever way you deem

possible-donate money to your association, donate time, and more

importantly, get your patients involved!

 

http://www.caaa.org

 

Note: Should you no longer choose to receive CSOMA News Alerts, please

notify us by return email. Your name will be removed from our files,

and we apologize for the inconvenience.

 

CSOMA

2710 X Street, Suite 2A

Sacramento, CA 95818

 

# # # #

 

 

 

 

Chinese Herbs

 

 

FAX: