Q: My practice is located in a mid-sized community and is doing well. I would like to give back to my community but, at the same time, I need my income to pay for overhead, marketing and salaries. Any thoughts?
A: President Trump has announced that the opioid epidemic is a national public health emergency. He has directed all executive agencies to use every appropriate emergency authority to fight the opioid crisis. The declaration of a public health emergency means that federal agencies can, among other things, shift some federal grants toward addressing this crisis.
Secretary Tom Price, MD, head of Health and Human Services, has announced that his department will provide $485 million in grants to help states and territories combat opioid addiction. The funding, which is the first of two rounds provided for in the 21st Century Cures Act (Cures Act), will be delivered through the State Targeted Response to the Opioid Crisis Grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Funding will be issued to all states, the District of Columbia, four U.S. territories, and the associated states of Palau and Micronesia. The funding will support a comprehensive array of prevention, treatment and recovery services depending on the needs of recipients.
Funds were awarded based on rates of overdose deaths and unmet need for opioid addiction treatment in the various states and territories. Florida, for example, has been allocated $27 million; New York will be receiving $25 million.
A brief glimpse at the internet lists thousands of state and private grants available for opiate treatment programs. So how does this framework impact you?
Work through a nonprofit
You can give back to your community by forming a charitable corporation—also known as a nonprofit—that provides services to those suffering from pain before they are prescribed opiates if that pain is not alleviated. If the nonprofit is organized as an integrated practice, the MD can prescribe medication that can work in conjunction with chiropractic services to treat opioid addiction, and the chiropractor can provide physical treatments to deal with pain.
As a nonprofit, you may be able to run free public service announcements on local radio and television stations, because they are required to operate in the public interest and can do so by giving free air time to nonprofits. In many cases, the station might even help you to produce these announcements at no cost.
A nonprofit is not the same as a regular corporation. The main difference is that a nonprofit has no shareholders. You cannot claim any of the nonprofit’s surplus gains, if any (although you and your staff are entitled to receive a reasonable salary for the services that you provide to the nonprofit).
Unlike a regular corporation, the main goal of which is to make money for its shareholders, the goal of a nonprofit is its mission; in this case, the alleviation of pain and opioid addiction through manual manipulation and other non-opiate modalities.
The nonprofit’s purpose is to serve its stakeholders. These are the people who access the nonprofit’s services, e.g., patients, donors who help fund the nonprofit’s operations, and the community who has to live with the scourge of drug addiction, all of whom have a substantial interest in seeing this blight resolved.
A nonprofit’s major advantage is that it can apply for both federal and private grants to fund the services it provides to the community. (It’s a rare thing for a regular corporation to be given money to run its business.) Start applying for grants as soon as possible, as obtaining a grant can be a lengthy and time-consuming process. If you don’t have the time to do it, there are professional grant writers who can assist you.
To start a nonprofit, you need to form a new charitable corporation and obtain 501(c)(3) tax exempt status. Although forming the corporation is not a lengthy process, it may take a while to obtain the tax exempt status. Once the nonprofit is formed and tax exempt, it will be, in most cases, exempt from paying federal and state income tax, and local county, real and personal property taxes.
A good faith effort
Managing a nonprofit requires that you discharge your duties to the organization in accordance with a good faith belief that your activities serve its best interests. You must avoid conflicts of interest in any transaction with the nonprofit as you are not permitted to personally benefit financially from the relationship.
The nonprofit should have a strong conflict-of-interest policy in place to help prevent inadvertent self-dealing. Such a policy, much like a compliance program, will help protect the interests of the nonprofit when it enters into transactions that could potentially benefit an officer or director. It may also protect officers and directors from personal liability for decisions in transactions in which they have an interest.
There are other facets to the creation and running of a nonprofit too lengthy to be discussed here, but the takeaway is that by treating opiate addicts through a nonprofit you will be interacting with all members of your community; those who are directly affected and those who are trying to help alleviate the suffering of this insidious condition.
[Note: Depending on your state law and scope of practice, it may be prudent to work with patients at-risk for addiction, or who are in recovery, rather than treat those undergoing active rehab—eds.]
Deborah Green, Esq., practices law in New York and Florida and has been a practicing attorney since 1977. If you have any questions concerning this article or other legal health care issues, she can be contacted at deborahgreen@thegreenlawfirm.net.
