Issue 1 - January 2003

Legal Issues

• New law acknowledges DCs, gives students loan option
• Funds supporting lawsuit spurt in November
• HIPAA regulations become effective in April – Are you ready?
• Where can you get help for HIPAA?

New law acknowledges DCs, gives students loan option

A new law signed recently by President Bush finally gives chiropractic the status of primary health care provider – a designation other health care professionals have had for some time.

The Health Care Safety Net Improvements Act includes doctors of chiropractic as primary health care providers. Through the National Health Service Corps Program, funded by the Health Care Safety Net, students of chiropractic are now eligible for a federal student-loan program, if they agree to provide primary health care in underserved areas. The program is being launched for a three-year pilot period.

An important implication of this program is that “the status will help the ACA obtain primary care status [for doctors of chiropractic] in other federal programs, as well as in private sector insurance plans,” said James D. Edward, D.C., chairman of the American Chiropractic Association.

Edwards explained that dentists, podiatrists, physical therapists and nurse practitioners have been allowed to serve in the NHSC – but not chiropractors. “Despite the fact that doctors of chiropractic have an advanced degree and are licensed in all 50 states, they have been excluded from [the NHSC],” he said.

The NHSC is a federally funded program aimed at improving healthcare delivery. Students who receive loans under the program are obligated to establish and maintain their practices in geographic areas designated as medically underserved by the federal government. “This provision … will have a positive impact on the availability of health care by encouraging doctors of chiropractic to establish and maintain practices in rural and medically underserved areas,” said Edwards.

Two years in the making

The ACA and the Association of Chiropractic Colleges actively worked for two years for the passage of this legislation. The details of the program are being worked out, said David S. O’Bryon, executive director of the ACC. “Essentially, students who apply for and receive loans from the NHSC will have some of the loan forgiven when they work in medically underserved areas,” he said. Individuals who are interested should contact their colleges for more information.

The ACA and ACC worked together for this legislation. The International Chiropractors Association did not participate in the legislative effort for this program, Ron Hendrickson, executive director, told CE. “But the ICA is glad to see the program. We wish it weren’t a pilot program.” Hendrickson said that pilot programs in the government sometimes delay implementation of a full-scale program. Nevertheless, Hendrickson agrees that “a real service will be done to the people in those underserved regions.”

“After the demonstrations period is over,” explained Edwards, “the Secretary of Health and Human Services, working with the ACA and ACC, will submit a report to Congress on the results of the demonstration project. . . Congress will then consider whether to make chiropractic a permanent part of the NHSC. [If it is], it will be the first time a federal program has designated doctors of chiropractic as primary care providers.”

Funds supporting lawsuit spurt in November

The Trigon lawsuit is tremendously costly, James Edwards, chairman of the American Chiropractic Association, recently told Chiropractic Economics. The ACA, along with the Virginia Chiropractic Association, five chiropractors and 18 chiropractic patients, are engaged in a lawsuit against Trigon Blue Cross Blue Shield and the national Blue Cross Blue Shield Association, to end reimbursement discrimination. The lawsuit, which began several years ago, alleges that insurance companies limit reimbursement or pay chiropractors less for identical services offered by other providers.

A second lawsuit supported by ACA through the National Chiropractic Legal Action Fund, is against the Centers for Medicare and Medicaid Services (formerly HCFA). This lawsuit, which began in 1998, seeks to protect the chiropractic profession’s right to detect and correct subluxations and maintain the exclusivity that chiropractors enjoy over other healthcare professionals.

Legal fund is growing

The National Chiropractic Legal Action Fund, established to pay for the lawsuits, received a total of $231,083 in November, including contributions from 1,007 ACA members and 231 nonmembers. During November, the fund received donations from the Florida Chiropractic Association (which has contributed a total of $20,000), several districts of the Georgia Chiropractic Association, Central Jersey Chiropractic Society and the Missouri State Chiropractic Society.

According to Garrett F. Cuneo, ACA executive vice president, the Maine Chiropractic Association showed special support for the lawsuits: It offered a matching challenge – up to $5,000 -- to its members. Members responded with contributions of $6,100 and ACA received $11,100 for the legal action fund. “All of this from a state that only has 190 licensed doctors of chiropractic,” says Cuneo.

Foot Levelers, Inc. remains a strong financial supporter of the lawsuit, with contributions totaling more than $28,000. The company has been contributing a portion of proceeds from its seminars, both to the legal fund, as well as to chiropractic academia.

The ACA welcomes contributions to offset the growing cost of the lawsuits. Contributions can be sent to the National Chiropractic Legal Action Fund, P.O. Box 75359, Baltimore, MD 21275-5359.

Sources: American Chiropractic Association, 800-986-4636; Foot Levelers, www.footlevelers.com, 800-553-4860.

HIPAA regulations become effective in April – Are you ready?

The clock is ticking. Before you know it, April 14, 2003 – the date by which you must comply with the privacy provisions of HIPAA (Health Insurance Portability and Accountability Act of 1996) – will be upon us. If you fail to comply with HIPAA regulations, you could be fined $25,000 or more – and as much as $250,000 for blatant violations. Unlike many federal regulations that apply only to employers who have more than 50 employees or who conduct interstate business, HIPAA is not triggered by the size of an organization – but by transaction methods.

Does HIPAA Apply to You?

According to www.dc-HIPAA.com/8, a HIPAA Web site for doctors of chiropractic developed by NCMIC Chiropractic Solutions, Brown Rudnick eSolutions, LLC, and Global eHealth Solutions, HIPAA regulations will apply to you:

1. If your practice electronically submits any patient information when:
• checking patient insurance eligibility;
• processing patient claims;
• checking on the status of claim payments; or
• verifying referral authorizations.
Communication via e-mail with HMOs, Medicaid, Medicare or any health-care payors regarding the above activities may result in your being subject to HIPAA requirements if any patient information is disclosed.

2. If you use a billing service (or a billing service’s software to electronically submit claims), your practice must also be HIPAA-compliant by April 14.

Even if your practice handles all patient information on a 100-percent paper basis, using a billing service will likely trigger the requirement of HIPAA compliance for your practice. That’s because billing services generally handle patient information electronically, especially if they’re filing for Medicare, Medicaid or other insurance benefits. And if your billing service handles any patient information electronically, your practice will be required to implement HIPAA mandates.

If you need to comply, what’s you next step?

According to www.dc-HIPAA.com/8, by April 14 most chiropractic practices must:

1. Develop state-specific policies and procedures addressing HIPAA requirements.
2. Train current and all future employees on those HIPAA-compliant policies and procedures.
3. Appoint a privacy officer to oversee the practice’s compliance.
4. Develop a Notice of Privacy Practices for distribution to all patients.
5. Enter into “HIPAA-compliant agreements” with all business associates having access to patient information.

Enforcement of HIPAA mandates most likely will be monitored through government auditing.

Sources: DC-HIPAA, www.dc-HIPAA.com/8, was created in partnership with NCMIC Chiropractic Solutions, Brown Rudnick eSolutions, LLC (a subsidiary of Brown Rudnick Berlack Israels, LLP, a leading international law firm with an established expertise in HIPAA compliance), and Global eHealth Solutions (the producer of HIPAA eCollege, a web-based HIPAA training tool; U.S. Department of Health and Human Services, http://www.hhs.gov/ocr/hipaa/.

Where can you get help for HIPAA?

Government regulations are often not easy to understand or implement. This is the case of the privacy regulations under HIPAA. You can visit http://www.healthfinder.gov/ as a starting point to track down all of the information you need to bring your office into compliance. Or, you can visit these sites:

• Life Chiropractic College West. According to Dr. Gerard Clum, president of Life West, the college developed a seminar and a CD to help chiropractors navigate through compliance issues.

The CD contains templates, forms, schedules, FAQs and a PowerPoint presentation addressing HIPAA requirements. Cost is $50. Dr. Clum is also conducting seminars at various locations throughout the country. The cost varies with the co-sponsoring organization, but is generally less than $100 and includes the CD. See www.lifewest.edu for more information.

• DC-HIPAA. NCMIC, along with Brown Rudnick eSolutions, is offering an online training and compliance package designed specifically for chiropractors. It includes unlimited training for one year; easy-to-use assessment tools; customizable patient privacy forms; customizable compliance manual materials; training and materials reflecting pre-emptive regulations for your state; training certificates; and regular HIPAA updates to help you stay in compliance. Cost of the program is $495 for NCMICmalpractice policyholders or $745 for other chiropractors. Go to www.DC-HIPAA.com/8.for more information.

• Other sources. Search the Web for HIPAA training materials and/or consulting services. To find them, type in “HIPAA training” in your favorite search engine, such as Google.com.