AOMNC

Case Law - Florida Dept of Administrative Hearings #03-2964
On August 15th, 2003, Richard Allen Freiberg (pro se) challenged the Florida Board of Acupuncture/Dept of Health to follow the appropriate Laws (specific statutory authority) in their rule making. During 1998 under Florida Law Chapter 98-418 the Florida legislature rescinded the Board of Acupuncture's authority to approve 'continuing education' providers. Read Administrative Law Judge Robert E. Meale's decision.

Case Law - Florida Dept of Administrative Hearings #01-0025
Florida Medical Association (FMA) and Florida Academy of Physicians Assistants (FAPA) challenged the Florida Board of Acupuncture/Dept of Health to stop Florida Acupuncture Physicians from using and ordering laboratory and imaging tests. Administrative Law Judge E.J. Davis ruled...Petitioners, FMA & FAPA, are 'without standing' to challenge proposed rules 64B1-4.010 & 64B1-4.011 Florida Administrative Code, and the challenges are accordingly dismissed. This decision is of national importance.

Case Law - Florida Dept of Administration Hearings #00-4737
Florida Medical Association (FMA) and Florida Academy of Physicians Assistants (FAPA) challenged the Florida Board of Acupuncture/Dept of Health to end Florida Acupuncture Physicians long time use of the title "Acupuncture Physician". Administrative Law Judge E.J. Davis ruled...Petitioners, FMA & FAPA, are 'without standing' to challenge existing rule 64B1-3.001(6) Florida Administrative Code, and the challenges are accordingly dismissed. This decision is of national importance.

Testimony regarding the need for all 'qualified acupuncturists' in having the CHOICE of enough viable procedural codes matching one's state legal scope of practice while including real and realistic Relative Value Units attached to those codes, as seen in the ABC Code system. This would enable all those interested to capture the real cost benefits and the real outcome benefits of Acupuncture & Oriental medical modalities.

----------------------------------------------------------------------------------------------------

TWO LETTERS REGARDING THE FEDERAL ACUPUNCTURE BILL and THE PROS & CONS FOR THE PROFESSION

From: Harvey Kaltsas, AP, DOM, Dipl. Ac. (NCCAOM);
President Emeritus, AAOM, FSOMA;
Former Chair and Vice Chair, Florida Board of Acupuncture

Dear Colleague:

Remember the story of the Trojan Horse - a gift provided by the Greeks to the Trojans which ultimately led to the demise of Troy? Our beloved profession of Oriental medicine is now being offered a Trojan Horse. Beware.

There are some individuals within our profession who would prefer that licensed acupuncturists never become statutory providers covered within the Medicare system and hence within the system of American health care insurance in general. Over the past twenty years, these same individuals' viewpoints have been fully aired, and they have been rejected by the overwhelming majority of licensed acupuncturists.

Who does not now agree that the best future for our patients and ourselves lies in the full acceptance of acupuncture and Oriental medicine within the established American system of medical healthcare and medical insurance coverage?

Now - thanks to the Federal Acupuncture Coverage Act, HR 1477, sponsored by Congressman Maurice Hinchey (D - NY), and co-sponsored at the moment by 35 additional legislators - licensed acupuncturists are close to being added as statutory providers within the Medicare system and as providers within the Federal Employees Health Benefits Plans. It has been a long struggle to get this far, and victory is in sight.

However, just as wily Odysseus used subterfuge to defeat the Trojans, our opponents are trying to draw us into a trap. The Bush administration appears to be offering to help licensed acupuncturists become providers but only within the Federal Employees Health Benefits Plans (FEHBP) - if we will assist in gutting HR1477 by dropping language that would establish us as statutory Medicare providers. The Bush administration's argument might be as follows:

a) Millions of federal workers are covered under FEHBP, and as covered providers we would have plenty of work treating those patients.

b) Getting coverage under FEHBP would provide Secretary of Health and Human Services Tommy Thompson with both a reason and an opportunity to conduct a study on the cost-effectiveness of acupuncture.

c) Once such a study is completed, by executive fiat, Secretary Thompson could direct the Center for Medicare/Medicaid Services (CMS) to include acupuncture as a covered modality within the Medicare system. CMS does not need Congressional approval to include modalities within Medicare, and our profession might in this sense avoid a long and costly political battle by going this route.

As a loyal Republican, I wish that my experiences as Vice Chair of the Florida Board of Acupuncture under another Bush administration did not color my perspectives to distrust Secretary Thompson's proposals, but they do, and I must share them with you.

In 2000 the Florida Medical Association and others challenged the Florida Board of Acupuncture's authority to create administrative code rules that would determine and thereby clarify our scope of practice. Governor Jeb Bush's administration virtually did nothing to support the Board of Acupuncture in this legal battle. Fortunately the Florida acupuncture profession stepped forward and donated monies to pay for enormous legal bills for outside counsel that enabled the Board of Acupuncture to have it's day in court. The Board of Acupuncture and therefore the profession eventually won a very clear victory over the Florida Medical Association. The FMA was further chastised in the decision by Administrative Law Judge E.J. Davis regarding their behavior bordering on anti-trust activity.

It is my very strong personal belief that Governor Jeb Bush saw more political value in being aligned with MDs than with licensed acupuncturists, and that political calculation informed his decision-making.

I believe the same political calculation is at play in President George Bush's administration.

If Secretary Thompson wanted CMS to cover acupuncture, that order could be done today. He cannot truthfully say that he does not have the legal authority and political strength to do so.

But more importantly, if CMS were to cover the modality of acupuncture today, only statutory providers, already approved within the Medicare system, would be allowed to treat and collect fees for providing this soon to be approved service of acupuncture. At present those are primarily MDs and DOs. Secretary Thompson does not have legal authority, by executive fiat, to declare licensed acupuncturists to be statutory covered providers within the Medicare system. Only an 'Act of Congress' can enable licensed acupuncturists to become statutory providers within the Medicare system - which is exactly one of the primary goals which the Hinchey Federal Acupuncture Bill proposes!

Sadly, the actions of the Bush administration fly in the face of one of the most basic tenets of conservative Republicanism - that the federal government should step out of the way and let the free market decide the course of people's actions.

Our current Medicare & Federal Employee Healthcare Benefit system forces 48 million Americans to choose health care from amongst the most expensive providers - MDs and DOs - and from amongst modalities which we licensed acupuncturists know to be most often ineffective as well as exorbitantly expensive. Medicare consumers are therefore not allowed to opt for the lower cost healthcare practitioners - licensed acupuncturists - who are offering lower priced, cost-effective wholistic healthcare modalities.

In 1993 Senator Tom Harkin (D-Iowa) asked me to explain to the U.S. Senate Subcommittee on Healthcare Appropriations how the Chinese were able to spend only $72 per person per year on health care whereas in the USA we had to spend $3200 per person per year. I testified that the system of traditional Chinese medicine available to the Chinese people had kept health care costs down. I urged Congress to enact legislation to make the Chinese system of healthcare more widely available in America.

That Chinese system of wholistic healthcare has been actively and systematically opposed by the allopathic profession, their associates within the American insurance industry, the pharmaceutical industry, and their political allies for the past 30 years. Opposition comes not because acupuncture and traditional Chinese medicine are ineffective or costly, but precisely because they are cost-effective and have efficacious benefit-outcomes!

If healthcare were more effective and less expensive, medical consumers would not feel the terrifying necessity to buy expensive pharmaceuticals and to pay soaring medical insurance premiums. MDs would also make less money. During all the recent political debate over the high cost of prescription drugs, have you ever heard a politician raise the prospect of Chinese herbal therapy as a cost-effective alternative? Our profession has not been part of the debate because our existence challenges the status quo of vested interests in the medical community.

The Hinchey bill, as presently written, serves the long-term interests of the public and of our profession. Any implications or recommendations by the Bush administration that we gut the Hinchey bill do not. Be wary of Greeks bearing gifts.

Harvey Kaltsas, AP, DOM, Dipl. Ac. (NCCAOM);
President Emeritus, AAOM, FSOMA;
Former Chair and Vice Chair, Florida Board of Acupuncture

----------------------------------------------------------------------------------------------------

Until the Acupuncture/Oriental Medicine profession has a FORMAL and PERMANENT status within MEDICARE Law - as the STATUTORY PROVIDER of/for Acupuncture & Oriental medicine - ALL well-trained Licensed Acupuncturists will continue to be less than 'second class professional' healthcare providers with almost ZERO rights, even in the private sector, and more importantly WITH NO STATUS. This would continue the categorization of Licensed Acupuncturists as professionals WITHOUT A HOME. You will continue to receive (EOBs) Explanation of Benefits from the payers of this country (both from goverment and the private sector) stating that they deny your fees for service and will ONLY pay an MD, DO, or PT to administer acupuncture services. That is what they are already doing and to forgo inclusion of Licensed Acupuncturists as STATUTORY MEDICARE PROVIDERS will continue to insure this 'untouchable' position while other untrained and much lesser trained health care practitioners take-over the majority of acupuncture/oriental medicine in all arenas.

Of late we are hearing statements from within our profession and by those who seem to be acting on behalf of the federal governement....all of which appears to be promising to our profession the inclusion and thereby reimbursement when treating ONLY Federal Employees. On the surface this might appear a great advancement but be very careful of a very small part of the-loaf. Be cautious as to WHY certain individuals and/or special interest groups MAY NOT or DO NOT want the well-trained Licensed Acupuncturists to be STATUTORY MEDICARE PROVIDERS. That is assuming they will ever speak out on this issue. They might advise you that 'you don't want' Medicare coverage - for all sorts of rediculous reasons including to instill the fear that you won't make any money treating Medicare recipients. Keep in mind that there are 39 Million MEDICARE RECIPIENTS and only 9 Million Federal Employees and some 300 million US citizens.

Are you willing to trade the whole universe of numbers (300 million +/-) for a small portion of maybe 9 million Federal Employees who may never come for acupuncture treatments? Be careful of jumping for the 'carrot on the end of the stick' that is being held out in front of you as there is a lot less potential then you think at the end of that stick. Ask yourself WHY these political factions don't want the well-trained Licensed Acupuncturists to be THE - STATUTORY MEDICARE PROVIDER of/for Acupuncture/Oriental Medicine.

ANYONE who is truly supportive of Licensed Acupuncturists from within the profession or from outside the profession would normally and should STRONGLY support HR1477 with it's inclusion of Licensed Acupuncturists as the STATUTORY MEDICARE PROVIDERS of Acupuncture. Otherwise the profession needs to be aware of the possibility of other unspoken agendas.

Keep in mind the probability that if Licensed Acupuncturists ONLY receive reimbursements under Federal Employee Health Benefit programs and DO NOT become OFFICIAL STATUTORY MEDICARE PROVIDERS.....it is a very likely probability that MDs, DOs and PTs will 'TAKE OVER' all of MEDICARE BILLING for acupuncture. There are 39 million Medicare Recipients and ONLY 9 million Federal Employees. Also, as goes MEDICARE so goes all other insurance payers. Do you wish to TRADE OFF the potential of a small percentage of 9 million Federal Employees for the REST of the country (some 300 million citizens)?

#1 It is about Licensed Acupuncturists becoming STATUTORY MEDICARE reimburseable PROVIDERS and;

#2 It is about the approval by the US Congress authorizing payment for the administration of acupuncture services to 39 million MEDICARE RECIPIENTS.

It is extremely IMPORTANT to take into your consideration what such political positions might be attempting to prevent. As STATUTORY MEDICARE PROVIDERS, Licensed Acupuncturists WILL BE REIMBURSED for many services they provide in the majority of states where their scopes of practices (State Law) are beyond simply administering 'acupuncture needles' AND Licensed Acupuncturists as STATUTORY MEDICARE PROVIDERS will be the PRIMARY providers of these services thereby setting the educational standards. The US Congress may NOT reimburse others unless they meet the professions minimum educational standards.

If these organizations statements are true, then consider that the federal government should have been able at any time to reimburse Licensed Acupuncturists. If that is true, then why now - all of a sudden - are they purportedly promising this solution when all they ever had to do was cease the apparent discriminatory reimbursement policies by their Third Party Administrators? Additionally, their Third Party Administrators have the FREE WILL to do what THEY desire and this small offering may not be legally binding on their TPAs. One result of this kind of proposition is to wind up PROHIBITING Licensed Acupuncturists from EVER becoming STATUTORY MEDICARE PROVIDERS by default. If they claim that this is not true, then let the profession SEE these individuals from within the profession and from without, TOTALLY SUPPORT - by their affirmative actions - the passage of the 2003 Hinchey Federal Acupuncture Bill. Let us ALL see the Department of Health & Human Services fully and openly support HR1477 (2003 Hinchey Federal Acupuncture Bill).

We all need to remember that even 'Licensed Social Case Workers' and 'Midwives' are STATUTORY MEDICARE PROVIDERS. Ask youselves, WHY Licensed Acupuncturists have never been added as STATUTORY MEDICARE PROVIDERS and WHY there is any objection to doing so?

If other political positions are truly supportive of ALL of the right issues in the best interests for well-trained Licensed Acupuncturists, to take their place as STATUTORY MEDICARE PROVIDERS, then AOMNC applauds them and if NOT, then AOMNC objects to these attempts to undermine our great profession.

AOMNC continues - with your support as members - to lobby the US Congress to approve the inclusion of Licensed Acupuncturists as STATUTORY MEDICARE PROVIDERS along with Congressional APPROVAL for ACUPUNCTURE services for 39 million Medicare Recipients and 9 million Federal Employees in FEHB programs.