Fall is right around the corner, then the holidays, then the New Year and then the 2020 legislative session.  This means that we are working hard to lay the groundwork to move our legislative agenda in the 2020 session of the Washington State Legislature.

Our 2020 agenda as approved by the Washington State Chiropractic Association Board of Directors includes:

Legislation:

• Regulating Benefit Managers (ASHA, Tivity, eviCore, Optum)
• Prior authorization (clarifying “episode of care”)
• Medicaid inclusion of chiropractors

Policy:

• Monitoring the implementation of SB 5380, passed during the 2019 session, which addresses prescription opioid misuse via prevention, education and treatment. There is huge opportunity here as its clear legislative intent is that patients be directed toward trials of non-drug treatment prior to opioid prescriptions being administered.
• Tracking the details and service area requirements for a program in underserved communities that would make chiropractors eligible for student loan repayment.
• Monitoring the progress of Cascade Care, the state’s new public option health plan and the state’s new Universal Health Plan Work Group. Making every effort to maintain access to chiropractic services consistent with statutory protections, such as Every Category of Provider.  So much to keep track of!

Insurance:

• Continue to challenge unfair practices regarding chiropractic coverage and push for fair laws.

While many of us are still enjoying summer activities, the January 2020 legislative session will be here before we know it! I encourage all chiropractors to connect now with their state senators and representatives.  Those relationships will be important as we begin meeting with lawmakers to get support for our issues in 2020. Invite your legislators to coffee or lunch or take them on a tour of your office.  It’s all about educating them about what you do to provide health and wellness care in your community.

You can find the names and contact information of your legislators here: https://app.leg.wa.gov/districtfinder/.

We have numerous requests from legislators for campaign contributions.  To move our agenda successfully we must participate financially and at a grass roots level.  We can’t be successful without your contributions!

If you are a regular WSCT contributor, it is appreciated. If you haven’t donated, please do so now!  Click here to make either a one-time or recurring donation.  Or, if you prefer, fill out and return the enclosed contribution envelope. You can make a one-time contribution of $1,000, $500, $250, $100 or you can sign up for monthly credit card withdrawals.

Finally, here’s a reminder to place the WSCA’s Annual Fall Conference on your calendar.  It will be October 4-5 at Bellevue Marriott, and you can earn up to 25 CEs. Continuing education topics include:

• Today’s Chiropractor on the Witness Stand: Presenting and Defending Treatment of Acute and Chronic Injuries, with featured speakers Richard Adler, JD and Dan Murphy, DC, DABCO
• Current Evidence-Based Approach to Diagnosis, Triage, and Clinical Chiropractic Management of Common Lumbar Spine Conditions, with Anthony Lisi, DC
• Establishing Trust with Patients through Professional Marketingby Siouxsie Jennett

Learn more and register at www.chirohealth.org/wsca19. Hope to see you there!

— Dr. Dave Butters, President
Washington State Chiropractic Trust

We have urgent, unfinished business.

That’s my simple message as we prepare to advocate once again for chiropractic during the 2019 Washington State Legislature.

Yes, we achieved tremendous gains during the 2018 session, including fair pay regarding spinal manipulation (which becomes effective Jan. 1, 2019) and six visits without prior authorization for each new episode of care, new episode = 90 days with no treatment for same condition (in effect since June 6, 2018).

Now, in this critical mid-term election year we must support those state legislators who supported us. To complete our contribution objectives we need to raise an additional $30,000 between now and the general election. Our legislative strength and effectiveness depends on this!

You can learn more about the legislators we are supporting in this online WSCA Election Guide.

Our main priority for the 2019 legislative session, as outlined by the WSCA Board of Directors, is to emphasize drugless services to combat the opioid crisis: This proposed legislation is modeled after legislation that passed in West Virginia this year. This bill is intended to do three things:

1) Require health plans to increase their visit limits to 20 for drugless services such as chiropractic, acupuncture, physical therapy, massage therapy and occupational therapy.

2) Require the copay for these drugless services to be the same as Primary Care services.

3) Require patients who seek opioid services/prescriptions to first visit for a trial of care at least one of the named drugless providers prior to receiving an opioid prescription.

We have expended enormous political capital to achieve our latest legislative wins, and much will be expected of us. I can’t stress enough how important it is to donate to the Trust, to help elect those who support chiropractic. Your donations ensure that we have access to legislators who are in a position to help our profession and our patients.

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and makes a difference.  If you haven’t contributed, I urge you to do so today. Just click on the DONATE button.

Make a one-time contribution of $1,000, $500, $250, or $100, or sign up for monthly credit card withdrawals: $100, $50 or $25.

— By Dr. Dave Butters, President
Washington State Chiropractic Trust

Governor Jay Inslee has signed into law the Chiropractic Fair Pay Bill ESB 5518, the Prior Authorization Bill ESSB 6157 and HB 2313 which gives the Chiropractic Quality Assurance Commission greater authority and independence in its budget and operational activities. Thanks to the skillful hard work and dedication of our lobbyist, Lori Grassi, the unwavering commitment and testimony of Dr. Austin McMillan, and others who took time from their practices and families to attend Legislative Day – including additional trips to Olympia to work this legislation through the process – we were able to prevail over 12 highly paid health insurance company lobbyists.

The Fair Pay Bill ESB 5518 ensures that chiropractors are paid no less than 90% of what osteopaths and naturopaths are paid for spinal manipulation services. Currently, they are paid up to 2 times, or 100% more, for the same services. A 10% variation in reimbursement between the chiropractic and osteopathic codes is due to the Resource Based Relative Value Scale (RBRVS) methodology. This methodology, which is used by Medicare, establishes fair fees for services and procedures on an annual basis and allows the 10% variation in pay for the difference in the facility overhead and malpractice insurance costs between the provider types. This calculation is known as the Relative Value Unit, or RVU. The initial Fair Pay Bill, passed by the WSCA nearly 10 years ago required that insurers pay chiropractors the same for Evaluation and Management and Physical Medicine/Rehabilitation services as paid to other medical providers. Following its passage, reimbursement to chiropractors for these services increased by up to 100% (doubled). When we passed the initial Fair Pay Bill we were not able to include spinal manipulation because the chiropractic and osteopathic spinal manipulation codes are different, even though the first three codes of both are substantially similar in their service descriptions. In the case of E&M and Rehab, all providers use the exact same codes.

After many years of persistence in educating legislators and building relationships (grass roots politics) we finally got a strong majority to see the disparity and unfairness in our reimbursement for spinal manipulation. In addition, we were able to prove that we have not had a fee increase for our core service (spinal manipulation) in 15 years and that our provider contracts are take-it-or-leave-it: there is no opportunity for negotiation! ESSB 5518 takes effect January 1, 2019.

The obvious question: How will the insurers respond to the Fair Pay Bill come January 1, 2019? We don’t know! They could reduce the osteopaths and naturopaths to what they pay us, they could increase us to what they pay them, they could move us both towards the middle (all within the 10% variation) or they could use the RBRVS formula which factors in the variation and is federally recognized by CMS/Medicare. Legislators were moved by the disparity in pay and no cost of living increase in 15 years. I would suggest there was legislative intent behind the passage of ESSB 5518 and I would hope the insurers respond in good faith. We’ll just have to see!

The Prior Authorization Bill ESSB 6157 allows for up to 6 consecutive visits within an episode of care before prior authorization can be required. If the patient has not received treatment for the same or similar condition for a period of 90 days or longer it is, by definition, a new episode of care. Initially we had legislative support for 12 visits prior to requiring authorization for additional care but to move the bill out of the Senate and keep it alive we ultimately had to accept 6 visits. Those 12 health insurance lobbyists fought us aggressively every inch of the way. This legislation improves on our current situation but is still not a resolution that satisfies most of us. It’s an incremental process that never ends, I’ve come to learn and accept that challenge over 44 years of practice and political/legislative involvement nearly that long. ESSB 6157 takes effect June 6, 2018 (this year).

HB 2313 is the bill that allows our regulatory commission, the Chiropractic Quality Assurance Commission, to manage our licensing funds efficiently and independent of the Department of Health. It also allows the Commission to manage its staff and be more responsive to the needs of the public and the profession.

These are historic achievements for the Washington State Chiropractic Association, the Washington State Chiropractic Trust and chiropractic as a whole. To our knowledge, no other state in the USA has passed Fair Pay or Prior Authorization legislation of this nature. However, it’s important to remember that it takes persistence over years to educate 98 House members and 49 Senators.

As you can imagine, we have expended enormous political capital and much will be expected of us. The midterm elections are this November. It’s critical that we be there for those that were there for us. The Goal: re-elect our supporters – those willing to fight for your issues.

We need individual chiropractors to host meetings with other chiropractors from their area, inviting their legislators to attend. Lori Grassi is willing to help you set that up, and invite the legislators. Contact Lori at 206-878-6055 or by email lgrassi@chirohealth.org.

I am calling on you again to donate to the Trust, to help elect those who support chiropractic.

If you have contributed recently and/or are a regular contributor to the WSCT, it is appreciated and makes a difference.

If you haven’t contributed, I urge you to do so today.

You can make a one-time or recurring donation online here. Or, if you prefer, you can mail a check to P.O. Box 2163,
Seattle, WA 98111

Make a one-time contribution: $1000, $500, $250, $100 or sign up for monthly credit card withdrawals: $100, $50, $25.

 — By Dr. Dave Butters, President

Washington State Chiropractic Trust