LEGISLATIVE

Since 1964, ICS has been serving as the only organization advocating for DCs in Iowa. We take great pride and care in assisting members and building alliances and coalitions with other providers, payers, businesses, government, and communities to improve healthcare outcomes through chiropractic care. ICS has a proud history of successfully pursuing changes at the Iowa legislature to advance access to chiropractic care. The collective voice of our membership has been effective.

Actively address issues that are extremely viable to pass. These are bills or rules that DCs cannot ignore because there is a high likelihood of passing, they may likely have a high impact on our profession, and the timing is immediate.

Seek opportunities to advance the profession through bills or rules that have a path for including DCs.

Monitor bills that have the ability to impact the profession but are not likely to pass. Though the likelihood of them passing may be low, ICS needs to always be prepared that circumstances change and DCs may need to respond.

ICS has provided our doctors tools, training and talking points so you are prepared to talk with your state legislators and congressmen and continue to build your relationships!

Actively Address Now – Act TODAY!

State Updates

Medicaid

ITC is conducting probe audits and comprehensive audits for chiropractic specialty. A few providers have shared they have credentialing concerns with Amerigroup. The ICS is actively working to iron out the issue.

Note, the Iowa Department of Human Services (DHS) is seeking to expand the managed care market. They have added Molina Healthcare as an MCO.

The ICS will keep you updated as things progress on this front.

2023 State Legislative Session Recap

The first session of the 90^th General Assembly adjourned Thursday, May 4^th. The Governor announced her priorities the first week of session during the Condition of the State address. Those priorities included school choice, tort reform, government reorganization and property tax relief. All priorities were accomplished.

The Iowa Chiropractic Society had no legislation they needed to defend or get passed. That left plenty of time for chiropractors to get to know their legislators. With the state legislature having almost one of every three legislators new and redistricting, the chances of you having a new legislator were pretty good. Lawmakers want to know their constituents personally. They do not want the only time they meet someone is when they need something. For that reason, we need chiropractors to be assertive and introduce themselves. Big changes can only happen with grassroots of an organization our size.

I challenge you to meet up with your legislators three times per year. Once at capitol day during the legislative session, once in the summer, and the third time during your legislative social in September. I know there was no legislation that needed your attention this year, but there will come a time when we need your help with your lawmaker. Please do your part by creating and/or building that relationship. 

Breakdown of legislation impacting the ICS

SF 514 - Re-organization legislation. This bill will merge departments in Iowa and should streamline government and reduce waste. We will see how this affects chiropractic. (Signed by Governor 4-4-23)

SF 87 - Mandatory cardiac evaluations for all athletic physicals. (Did not pass funnel)

HF 161 - Tort Reform (Medical malpractice). Limits non-economic damages to providers to $1 million or hospitals to $2 million for lawsuits stemming from medical malpractice. This should help surgeons with their malpractice to keep it from skyrocketing as much as it has in recent years. It will probably not affect chiropractors' insurance rates due to the lack on malpractice claims. (Signed by Governor 2-16-23)

Your participation in grassroots makes a difference!

• Talk with your legislators (it’s their job and they love to do it).
• Donate to their local fundraisers.
• Attend Capitol Day.
• Attend your legislative socials.
• Give to the PAC!

Federal Legislation

Medicare - The Highlights

On April 19,2021 the U.S. House of Representatives reintroduced HR 2654 - Chiropractic Medicare Coverage Act

On April 27, 2021 ACA signed a joint letter to U.S. Senate Chair, Senate Majority Leader, and Republican leaders in congress urging congressional leader to include additional funds for the Medicare Physician Fee Schedule in forthcoming legislation.

• Coalition letter.Infrastructure.Final.4-27-21.pdf (acatoday.org)

To impact of COVID-19 on Medicare and MACs', there are no CERT review available at this point.

WPS GHA CAC Meeting is scheduled on June 18, 2021, which Dr. Sheybani will be attending.

Medicare Fee Cuts: What’s Next?

On April 14, 2021, President Biden signed into law H.R. 1868, delaying the 2% sequestration cut scheduled for April 1^st through the end of the year. Unfortunately, the version of the bill signed by Biden did not address another potential cut coming down the road – sequestration cuts necessitated by the latest coronavirus relief bill, the American Rescue Plan. The House originally dealt with this issue in H.R. 1868, but the Senate stripped that language out of the version of the bill they passed.

It is unclear if this automatic 4% cut, required by law to offset costs associated with the COVID relief bill, would take place beginning October 1^st, with the beginning of the new fiscal year, or January 1^st. Either way, the fight to minimize cuts to the Medicare Physician Fee Schedule will continue throughout 2021. Congress still must act to prevent the 4% sequestration cut.

Additionally, in 2022 the chiropractic profession could be looking at not only an overall reduction in the Medicare conversion factor, but also possible reductions to the relative value units (RVUs) for spinal manipulation that were expected to take pace beginning January 1, 2021. Luckily, these cuts, which could have reduced fees for CMT services by approximately 10 percent, did not take place, but they could be back on the table in 2022.

In late April, the ACA, as part of a coalition of provider organizations, sent a letter to Congress advocating for the inclusion of additional funds for the Medicare Physician Fee Schedule in any forthcoming legislation addressing the nation’s infrastructure needs. These funds would “ensure continued beneficiary access to vital health care services by providing additional financial stability for the nation’s health care system and health care workforce.” Approximately $3 billion would mitigate expected reductions to the conversion factor but would not address the other potential threats to chiropractic fees in the Medicare program. Further grassroots action may need to be undertaken on this issue, so stay tuned.

Update on H.R. 2654, the Chiropractic Medicare Coverage Modernization Act (Prepared on 5/21)

On Monday, April 19th, the Chiropractic Coverage Modernization Act (H.R. 2654) was re-introduced in the U.S. House of Representatives. The bill would allow chiropractors in Medicare to practice to their state’s full chiropractic scope of practice, enabling chiropractic patients to safely access medically necessary conservative, drug- and surgery-free care. Being able to provide Medicare beneficiaries with access to the full complement of the chiropractic profession’s broad-based, non-drug services would improve outcomes and patient satisfaction.

In most states, this would include such services as manual manipulation of the spine and extremities, E/M services, diagnostic imaging, and utilization of other non-drug pain management approaches that have become an important strategy in national efforts to stem the epidemic of prescription opioid overuse and abuse would be covered.

The critical first step in making this bill a reality is securing co-sponsors for this important bill. Last Congress, 90 Members of Congress from both sides of the aisle co-sponsored the bill. With the beginning of the new Congress in January, we started from scratch.

There is little doubt that if H.R. 2654 is passed, it would be the most important patient-centered federal chiropractic victory since the profession was first included in Medicare in 1972. Given the enormous influence that Medicare has on both Medicaid and private health insurance, passage of the Chiropractic Medicare Coverage Modernization Act could revolutionize chiropractic’s standing in America’s health care systems.

The current Medicare law is unfair to chiropractic patients and the profession. It also drives the skyrocketing costs of the Medicare system – a system that we as federal taxpayers are funding – by pushing patients into higher risk, higher-cost medical alternatives and away from the use of safe, efficacious, and cost-effective chiropractic care.

Stay in touch with the ICS for future updates!

Seek Opportunities!

ICS will continue to seek opportunities that:

1. Expand DC involvement in opioid prevention strategies.
   Background: DCs play a critical role in patient pain management. Chiropractic care relies on non-surgery, non-pharmacologic therapy, preventing opioid abuse and addiction. ICS will continue to seek opportunities to participate in opioid prevention strategies across the state.
2. Expand Iowa code to allow DCs to do physicals at pre-school level.
   Background: Currently, DCs may conduct physicals for students K-12. ICS will continue to seek opportunities so specifically include this provision to include pre-school in Iowa code.
3. Ensure DCs remain in all of the PCP talks for upcoming bills.
   Background: In 2017, DCs were designated as a primary care provider (PCP) in the Iowa Health and Wellness Plan. ICS will continue to ensure DCs are at the table as it relates to PCPs discussions in the state.
4. Remove x-ray requirement for Medicaid and push for more services covered.
   Background: Currently, DCs are required to conduct x-rays before they provide care. In many cases, this is not necessary and a waste of state dollars. ICS will continue to seek opportunities to remove this requirement for DCs and expand service coverage in Medicaid.
5. Advance open access provider panels for all state employees.
   Background: The ICPC network is primarily a closed network with limited provider participation. Any new providers who are able to join receive minimal reimbursement with expansion of the provider network. This network reduces patient access to care, provider participation, and reimbursement.
6. Limit the chiropractic adjustment to the chiropractic profession and do not let other professions "rename" the use of the adjustment to utilize in their technique.
   Background: Other professions will attempt to provide services specific to the chiropractic profession such as a chiropractic adjustment, thrust manipulation and acupuncture which is outside of their scope of practice. ICS will continue to monitor any attempt by other professions to infringe on chiropractors’ scope of practice.
   

Monitor Bills

ICS will continue to monitor the bills.  ICS will provide email legislative updates during the 2023 session. Watch for weekly emails.

Federal: Nothing at this time.

State: Nothing at this time.

For questions related to advocacy, please contact the ICS Lobbyist Matt Fitzgerald any time with your questions and legislative concerns.

PAC Donation Levels

Supporter

$101 - $249

Friend

$100 or less 

PLEASE NOTE: PAC donations must be made from personal accounts.

Friend: $100 or less