Dr. Dave Butters

These are uncertain times, but I’m certain of one thing: Despite COVID-19 challenges, chiropractors continue to provide the best possible care for their patients. That’s why I’m pleased to report that issues on our legislative agenda fared well during the Washington State Legislature’s 2021 session. (More on that below.)

It’s also clear that our Medicare patients need the important care we provide. I’m urging all chiropractors to contact their Congressional representatives to support H.R. 2654, introduced by the American Chiropractic Association. This federal legislation will allow Medicare patients greater access to our services by requiring Medicare cover the full scope of chiropractic services allowed by their state scope of practice.

For this bill to pass, every chiropractor needs to take immediate action. It’s a short, 3-step process and the ACA has made it very simple for you, your staff and your patients. Your action will only take a few minutes. You don’t even need a template, or to write a letter on letterhead.

  1. Visit  www.votervoice.net/ACA/campaigns and select which option you prefer (public, DC, or student DC), then
  2. Provide your email and mailing address, and
  3. Click submit

The system they are using will know who your Congressman or Congresswoman is by your address. Use your home address first, as that’s your voting address and it defines your constituency. If you are able to do a second address, do so with your business details. You can either write your own message or select the already written message for you.

Here’s the update on the recently concluded session of the state Legislature. Due to the pandemic, all legislative hearings took place via virtual platforms, and those were broadcast for everyone to watch. Our lobbyist, Lori Grassi, was tasked with monitoring all hearings of interest to our profession and following up with legislators via email when issues arose – no easy task. The following bills on our legislative agenda were approved and signed by the governor:

ESHB 1196-Audio only telemedicine

 The bill:

  • Requires reimbursement for audio-only telemedicine services.
  • Expands the definition of telemedicine for purposes of hospital privileging to include audio-only telemedicine services.
  • Requires the Insurance Commissioner and the Collaborative for the Advancement of Telemedicine to study and make recommendations regarding telemedicine

SSB 5169 Relating to provider reimbursement for personal protective equipment during the state of emergency related to COVID-19: 

For the duration of the federal public health state of emergency related to COVID-19, a state-regulated health benefit plan must reimburse a health care provider who bills for incurred PPE expenses as a separate expense — using the American Medical Association’s current procedural terminology code 99072 — or as subsequently amended, $6.57 for each individual patient encounter.

Related to this, we have also been tracking complaints about insurance carriers violating the statute requiring PPE reimbursement. Washington State Chiropractic Association Executive Director Jeff Curwen has prepared a video on how to file a complaint with the Office of the Insurance Commissioner in response to PPE reimbursement denials. You can watch that at http://bit.ly/WSCAvideo.

Another approved bill that doctors should be aware of is ESSB 5229 Concerning health equity continuing education for health care professionals. By Jan. 1, 2024, the boards and commissions regulating health care professions that are subject to continuing education requirements must adopt rules requiring licensees to complete health equity continuing education training at least once every four years. The minimum standards for continuing education programs must include instruction on skills to address the structural factors—such as bias, racism, poverty—that manifest as health inequities.

In addition to legislative work, our lobbyist has also been monitoring insurance issues raised by our members. The following are a status of those efforts:

Kaiser Permanente

We have been working with Kaiser Permanente (KP) on several key issues:

The new AT Modifier Policy effective Feb. 1, 2021: The WSCA raised concern over this policy change with Kaiser as being out of alignment with CMS guidelines on their use of the modifier. The KP policy, as it stands now, also doesn’t allow for treatment of chronic patient case presentation and assumes those patients that are not  “acute” are in  “maintenance care.” Other issues, such as shifting denials to provider responsibility, which is also counter to CMS guidelines, was conveyed by WSCA and acknowledged by KP. Our committee shared concerns and our supportive position on this matter with Kaiser in May, and they will review their policies and procedures and respond back to the WSCA. They did, however, positively acknowledge our concerns. As we receive updates, we will notify you through the WSCA electronic newsletters.

Physical Medicine and Rehabilitation: We have repeatedly raised the issue of KP not allowing a chiropractic patient to receive the same level of care as they would a physical therapist, with denials of some of the PM&R codes when performed by chiropractors. In early conversations we learned that the KP position was that, after some research, this appeared to be a carryover from a longstanding Group Health policy to deny some PMR codes in their HMO plans unless they were performed by their in-house PT. Our position is, and has been, that this is in violation of law. KP reports that they are reviewing their policy and will report back to the WSCA.

Our position with KP, as it is for all payers, it that payers need to comply with governing regulations. However, the primary position and messaging we take is to improve access to best patient care pathways, especially in spine and musculoskeletal patient presentations where chiropractic shows consistent evidence-based cost-effective high value. While we often need to point out payer policy problems, our primary concern remains centered on what is best for the patient. That high-road communication resonated well with KP, and we encourage membership to keep that as the most fundamental concern.

In an effort to work toward building a better relationship with Kaiser Permanente, they have agreed to have regular discussions with us throughout the next year to show good faith. The goal is to have payer policy match well with best patient care practices.

Violations of the PPE Reimbursement Statute
This issue is not specific to one carrier since complaints have been about most carriers. Remember that the statute only applies to state-regulated health plans and is not inclusive of personal injury, workers compensation benefits, self-insured and self-funded plans, or union negotiated health plans. This does make things a bit confusing, but you can identify the plan type by 1) calling the carrier and asking them what type of plan the patients is covered by; and 2) ask your patient to require a “Plan Summary Description” from their carrier (which they MUST produce to the patient, but not to you); and 3) file a complaint with the Office of the Insurance Commissioner.

Aetna Notices Regarding Use of E&M Visits and Modifiers
Recently, Aetna has sent notices to chiropractors requiring the use of modifiers for some services, specifically x-ray and evaluation and management services. If you are experiencing these issues, please file complaints at the Office of the Insurance Commissioner and site the fair pay statute RCW 48.43.190, and make comment that the limitation of allowing for an E&M may put the patient at risk and possibly violate your scope of practice requiring you perform a differential diagnosis.

Your financial support of the WSCT and membership is CRITICAL during these unprecedented times! You have and will continue to benefit from EVERYTHING that we do. If you have donated recently and/or are a regular contributor to the WSCT, it is appreciated, and it makes a difference. You can visit www.washingtonchirotrust.org and click on the DONATE button to make either a one-time or recurring donation.  Or you can mail a check to WSCT, PO Box 2163, Seattle, WA 98111

It’s also critical that you support the Washington State Chiropractic Association through your membership. Our accomplishments are due to the joint work of these two organizations. You can learn more about joining the WSCA at www.chirohealth.org/page/join_wsca.

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