ACA EVP Weekly Report

October 21, 2003

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: October 20, 2003

This week’s report includes the following items:

1. ACA’S REPLY BRIEF IN TRIGON CASE POSTED ON ACA WEB SITE 2. INCREDIBLE TWO WEEKS IN CHIROPRACTIC INSURANCE RELATIONS 3. ACA PARTICIPATES IN PANEL DISCUSSION SPONSORED BY THE NATIONAL BLUE CROSS BLUE SHIELD ASSOCIATION 4. ACA PRESENTS AT FARMERS INSURANCE ADJUSTERS MEETING 5. ACA PRESENTS TO NATIONAL ASSOCIATION OF INDEPENDENT INSURERS 6. ACA SEEKS INFORMATION ON BLUES PLANS RESISTANT TO PT COVERAGE FOR CHIROPRACTORS 7. CMS ISSUES GUIDANCE DOCUMENTS REGARDING HIPAA 8. ACA’S ANNUAL MEETING PROVIDES SUCCESSFUL FUNDRAISING 9. FORENSIC GROUP HELPS NCLAF 10. DEADLINE FOR DELEGATE ELECTIONS APPROACHING 11. CAN’T ACCESS THESE LINKS?

1. ACA’S REPLY BRIEF IN TRIGON CASE POSTED ON ACA WEB SITE

A copy of ACA’s response to Trigon’s appeal brief can be found on ACA’s Web site at:

<http://www.acatoday.com/pdf/FullReplyBrief.pdf>

There is a possibility now that oral arguments will go before the Appeals panel before Christmas. Look to this report for further details.

2. INCREDIBLE TWO WEEKS IN CHIROPRACTIC INSURANCE RELATIONS

I am sure you are tired of hearing me talk about how great things are with the profession as you struggle with reduced reimbursement and further restriction. But from the perspective of someone who has been involved with this profession for 30 years, the achievements we are enjoying today would have been unheard of even just ten years ago. Whether we’re talking about legislative victories, advancements in insurance relations and greater exposure from the media, we are making real progress. The examples below are evidence, and while none of these events will provide immediate reimbursement, they will bring about better understanding between the insurance industry and the chiropractic community. This, I believe, will result in policies that are developed based on fact, rather than on preconceived and discriminatory notions. That is why these meetings are so important and significant.

3. ACA PARTICIPATES IN PANEL DISCUSSION SPONSORED BY THE NATIONAL BLUE CROSS BLUE SHIELD ASSOCIATION

We begin on October 7 in Chicago, as ACA Chairman McClelland, DC, sat on a panel along with representatives of the American Medical Association and the American Hospital Association in a meeting sponsored by the national BlueCross BlueShield Association. The purpose of the meeting was to bring the payer and provider communities together to discuss the need to develop standardized benchmarks around quality performance and reporting. Dr. McClelland discussed the integration of our profession into the current health care system and highlighted ACA’s efforts toward developing best practices.

Participating on the panel and observing from the audience were a cross-section of the private and governmental insurance community. Included were representatives from AARP, General Electric, CMS, Institute of Medicine, Midwest Business Group on Health, National Breast Cancer Foundation, American Academy of Family Practice, American College of Cardiology, American Academy of Pediatrics, the Food and Drug Administration and numerous BlueCross BlueShield medical directors.

4. ACA PRESENTS AT FARMERS INSURANCE ADJUSTERS MEETING

This past week, ACA Governor Gentile, DC, attended and lectured at the annual meeting of the Tennessee Farmers Insurance Company, presenting on chiropractic claims and coverage. Each adjustor received a copy of ACA’s Claims Adjusters Orientation package on chiropractic.

Dr. Gentile had made a similar presentation at the ACA-sponsored Claims Solutions Work Group meeting. His invitation was a result of an insurance carrier hearing his presentation and recommending it to a Farmers Insurance representative. Farmers Insurance now plans to send a representative to our next Claims Solutions Work Group meeting in March 2004.

5. ACA PRESENTS TO NATIONAL ASSOCIATION OF INDEPENDENT INSURERS

I participated on a panel discussion last week with a state senator from Florida and the vice president of the Erie Insurance Group, on how the insurance and chiropractic communities are getting along. The meeting was sponsored by the National Association of Independent Insurers (NAII)-an organization of over 600 insurance carriers-at its annual legislative conference.

Each of us on the panel was given 20 minutes to make opening comments. I spoke about the positive things that had taken place with our two communities since 1999, when our Claims Solutions Work Groups began, including joint cooperation in developing a claims adjusters orientation kit. I also pointed out the problems that still exist, and challenged those in the audience to learn more about our profession and to act on fact rather than on preconceived notions. I urged them to work with our state associations and to accept their requests for dialogue. While my presentation was well received, the real stars were the other two panelists.

Wisniewski, Vice President of Erie Insurance, was one of the original participants of ACA’s Claims Solutions Work Group. He spoke about the tension that existed at the beginning of the meeting and how it changed as the two groups learned that they had more in common than in disagreement. He noted the success in putting together the claims adjuster orientation packet on chiropractic, and how he was in the process of teaching his claims managers about these important documents. He encouraged other insurance carriers to reach out to the chiropractic profession locally and to encourage their claims managers to be trained on the chiropractic orientation package.

was followed by State Senator Durrell Peaden of Florida. The Senator also spoke positively about his relations with the chiropractic community and in particular his relationship with Dr. Dennis , who serves with him in the State Senate. He indicated his strong support for a state-supported chiropractic institution, and that the outcome looks very positive. While these supportive remarks from a state legislator would be important to the audience, even more significant is that they were coming from someone who also happens to be a medical doctor.

You couldn’t buy these kinds of positive remarks that were heard by over 100 attorneys, medical doctors, claims managers and lobbyists.

6. ACA SEEKS INFORMATION ON BLUES PLANS RESISTANT TO PT COVERAGE FOR CHIROPRACTORS

Local BlueCross BlueShield plans that administer the Federal Employee Plan (FEP) were notified with a July 1 memorandum of the new Blues policy to reimburse doctors of chiropractic for physical therapy services. We have heard from providers in some states that the coverage has been implemented and that doctors are being paid. However, there are still states that have not yet implemented the coverage. If you continue to be denied for PT services by your local plans, the ACA wants to know about it.

For more information on the Federal Employee Plan’s physical therapy benefit-including a list of covered PT codes and dates of coverage-visit the ACA Web site at <http://www.acatoday.com/insurance/managed_care/dcs_benefit.shtml>.

7. CMS ISSUES GUIDANCE DOCUMENTS REGARDING HIPAA

CMS has issued guidance documents outlining its most recent revisions to its compliance policy. The documents provide contingency planning guidelines. CMS says it wants to ensure that the health care industry understands its enforcement as the industry moves toward compliance with HIPAA electronic transactions and code sets. To review the documents, visit: <http://www.cms.hhs.gov/hipaa/hipaa2/general/default.asp#contingency_guide>

8. ACA’S ANNUAL MEETING PROVIDES SUCCESSFUL FUNDRAISING

The HOD meeting was successful on many levels-not the least of which was fundraising. The ACA-PAC, through a successful auction and direct appeals, raised $20,000. And following Mcs’ presentation, Drs. Max Atnip and Spoto combined their efforts to raise $162, 841 in cash and pledges to the National Chiropractic Legal Action Fund (NCLAF). This effort made September a very successful month for NCLAF, receiving contributions in the amount of $170,007.69. More importantly, the number of doctors pledging monthly contributions to NCLAF increased by 41, bringing the new total to 946 doctors participating in “E-Z Pay.”

Some of the organizations that contributed during and after the annual meeting include the following:

Breakthrough Coaching: $9,850, brings total to $70,450

Michigan Chiropractic Fraternal Order: $5,000, brings total to $15,000 ACA Council on Diagnosis of Internal Disorders: $500 (first contribution) Virginia Chiropractic Association: $5,000, brings total to $11,500 SACA Palmer College (West): $1,000, brings total to $1,220 SACA--Palmer College: $400, brings total to $3,077.35 SACA New York Chiropractic College: $200, brings total to $809.37 SACA Life Chiropractic College West: $51.05 (first contribution) SACA Life Chiropractic College: $593.65, brings total to $653.65 SACA Cleveland College (KC): $500, brings total to $1,338 Rhode Island Chiropractic Society: $2,500, brings total to $9,500 NYCC Class of 1986: $2,000, (first contribution) Nebraska Chiropractic Physicians Assoc: $5,000, brings total to $60,001 Mississippi Chiropractic Association: $2,500, brings total to $7,500 Illinois Chiropractic Society: $500, brings total to $5,856 ACA Council on Chiro Physio Therapeutics/Rehab: $2,000, brings total to $3,000 Connecticut Chiropractic Network, Inc: $4,000, brings total to $9,000 Connecticut Chiropractic Association: $4,000, brings total to $11,000 Chiropractic Rehabilitation Association: $5,000 (first contribution) Association of Chiropractic Colleges: $10,000, brings total to $120,000 Arkansas Chiropractic Society: $1,350, brings total to $2,350 American Chiropractic Auxiliary: $100, brings total to $12,600 Master's Circle: $500, brings total to $10,500 Performance Health: $100, brings total to $1,300 SACA-Logan College: $300, brings total to $2,025 Arizona Assn of Chiropractic: $1,000, brings total to $3,500

Uncle 's Business Training: $1,000, brings total to $3,000

Other notable contributions include:

Dr. Ken Luedtke contributed $2000 in memory of Dr. Arnold Cianciulli. A contribution from the Arizona Association of Chiropractic was the result of donations by members attending their annual state convention. HESSCO contributed an adjusting table to this effort.

9. FORENSIC GROUP HELPS NCLAF

Members attending a conference sponsored by the ACA College of Forensic Sciences heard a presentation on the lawsuit and ACA activities by Dr. Warren Jahn. Through this event, ACA received ten contributions totaling $1150 and 3 monthly pledges of $100 each, as well as one new ACA “Governor’s Advisory Cabinet” member.

10. DEADLINE FOR DELEGATE ELECTIONS APPROACHING

Members seeking election as delegate or alternate delegate must signify their intent in writing via certified mail by December 16, 2003, to the Corporate Secretary of the American Chiropractic Association, 1701 Clarendon Blvd, Arlington VA 22209

Ballots will be sent January 15, 2004 to voting members of the states of Alabama, Arizona, California North, California South, Connecticut, District of Columbia, Georgia, Idaho, Illinois South, Indiana, Kansas, Louisiana, land, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New York Metro, North Carolina, Ohio, Rhode Island, South Dakota, Texas East, Vermont, Puerto Rico, Virgin Islands, Washington, Wisconsin and Wyoming.

Term of office is two years. For more details on the delegate elections, qualifications and procedures, consult the ACA Bylaws, Article VIII, Section C

Garrett Cuneo Corporate Secretary

11. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to dmillard@... <mailto:dmillard@...> with a subject of: "REMOVE - EVP Report."

October 29, 2003

ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: October 27, 2003

This week's report includes the following items:

1. JUDGE IN ACA LAWSUIT AGAINST HHS TAKES ACTION 2. MEDICARE BILL MAKES PROGRESS 3. ACA ANNOUNCES SPINAL HEALTH MONTH TO THE MASSES VIA AUDIO NEWS RELEASE 4. NEW MEDICARE MODIFIER REQUIREMENT EFFECTIVE SEPTEMBER 1, 2003 5. UNCLE PAUL'S CHIROPRACTIC BUSINESS: OUR LATEST CONTRIBUTOR 6. PARKER HELPFUL ONCE AGAIN IN FT. LAUDERDALE 7. MASTERS CIRCLE LENDS ITS SUPPORT FOR THE LAWSUIT 8. ACA LEADERSHIP ON THE ROAD 9. ACA’s 2004 CHIROPRACTIC CODING SOLUTIONS MANUAL - EVERY DOCTOR’S ESSENTIAL CODING RESOURCE 10. CAN’T ACCESS THESE LINKS?

1. JUDGE IN ACA LAWSUIT AGAINST HHS TAKES ACTION

On September 30, 2003, the judge handling ACA’s lawsuit against the Department of Health and Human Services (HHS) signed an order dismissing all of the American Physical Therapy Association’s (APTA) prior motions as moot. You will recall that earlier in this litigation the APTA tried to intervene in the case. They later filed motions to withdraw. None of this means anything, except that the judge may be finally focusing on our case, as he needs to consider the motions for summary judgment filled by both HHS and ACA. As you know, the HHS changed its policy that had allowed physical therapists to be reimbursed for the chiropractic benefit. However, their existing policy still allows reimbursement to medical doctors and osteopathic doctors for the chiropractic benefit. We believe, and the facts demonstrate, that it was the intent of Congress in approving the language "manual manipulation of the spine to correct subluxation" was to refer to doctors of chiropractic, and that only doctors of chiropractic should be reimbursed for the service.

2. MEDICARE BILL MAKES PROGRESS

Last January, congressional leaders set October 3, 2003, as their target adjournment date for the year. However, a full legislative agenda and several contentious debates - including one concerning competing proposals to provide a $4 billion modernization of the Medicare program - have kept Congress at work, likely into November. In fact, it may be Thanksgiving before senators and representatives are back in their districts for the year. Until then, the ACA Government Relations team will remain an active presence on Capitol Hill and continue to lead the fight for pro-chiropractic legislation, including the Medicare Chiropractic Full-Scope Demonstration Project. Last June, the Senate passed a Medicare modernization bill (S.1) containing this ACA-backed provision as a first-step toward providing fair treatment for DCs and chiropractic patients under the Medicare program. Senator Grassley (R-IA), the prime sponsor of the “chiropractic demo” and a leader of the ongoing Senate-House conference on Medicare, is working with other pro-chiropractic lawmakers to ensure that it is retained in the final Medicare package. To secure final passage of the demo, the ACA must defeat anti-chiropractic interests - including organized medicine, the powerful physical therapy lobby, CMS bureaucrats and even influential MDs serving in Congress, like Dr. Bill Frist, the Senate Majority Leader. All DCs are urged to contact their representatives in the U.S. House to express support for the Medicare Chiropractic Full-Scope Demonstration Project Section 440 of S.1 at this critical moment. For more information, please see the Legislative Alert Bulletin on the ACA Web site --

<http://www.acatoday.com/government/medicare/alert_050503.shtml>

3. ACA ANNOUNCES SPINAL HEALTH MONTH TO THE MASSES VIA AUDIO NEWS RELEASE

Earlier this month, ACA released a Spinal Health Month audio news release -- a one-minute audio package that includes newscast narration formatted to fit radio newscasts. The audio news release promotes Spinal Health Month and the benefits of chiropractic care. The piece also encourages listeners to visit ACA's Web site to find an ACA member doctor-like you-in their community. The audio news release has been delivered to radio stations across the country, providing them with a 60-second audio clip of ready-to-use programming. While the audio news release is guaranteed to have an audience of 1.1 million listeners in 35 of the nation's top 50 markets, the message is likely to be heard by roughly 4 to 5 million listeners. To hear ACA's Spinal Health Month audio news release, visit ACA's Web site at: <http://www.acatoday.com/media/releases/spinal_health_month_release.mp3>

Also, if you haven't yet seen ACA's backpack safety multimedia news release, be sure to visit: <http://www.prnewswire.com/mnr/aca/11280/>

4. NEW MEDICARE MODIFIER REQUIREMENT EFFECTIVE SEPTEMBER 1, 2003

As I reported previously, effective September 1, 2003, for dates of service July 1, 2003 and after, there is a new modifier required for most therapy services when billed to Medicare, in addition to the GY modifier.

There are two lists of codes that would affect chiropractors. The first list requires the use of the GP modifier on all claim submissions (there must also be a plan of care on file for these outpatient therapy services*). The second list requires the use of the GP modifier only under certain conditions.

PLEASE NOTE: Failure to include the GP code modifier for these services will result in the claim/service being returned as “unprocessable.”

Those codes always requiring the GP modifier and appropriate plan of care include: 92506 92507 92508 92526 92597 92607 92608 92609 97001 97002 97003 97004 97012 97016 97018 97020 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97113 97116 97124 97139 97140 97150 97504 97520 97530 97532 97533 97535 97537 97542 97703 97750 97799 V5362 V5363 V5364 G0281 G0283 Physicians must also use the GP modifier with the codes below when the services are provided under a therapy plan of care:

29065 29075 29085 29086 29105 29125 29126 29130 29131 29200 29220 29240 29260 29280 29345 29355 29365 29405 29425 29445 29505 29515 29520 29530 29540 29550 29580 29590 64550 90901 90911 92610 92611 92612 92614 92616 95831 95832 95833 95834 95851 95852 96000 96001 96002 96003 96105 96110 96111 96115 97601 G0279 G0280 0020T 0029T *Therapy services, no matter who performs them, must meet the standards and conditions that apply to therapy services. For example, there must be an appropriate plan of care and documentation that supports medical necessity whenever therapy services are billed to Medicare

5. UNCLE PAUL'S CHIROPRACTIC BUSINESS: OUR LATEST CONTRIBUTOR

The latest contributor to come forward in support of the National Chiropractic Legal Action Fund is Uncle 's Chiropractic Business Training. At NCLC, they pledged $10,000, and recently at HOD in New Mexico increased the pledge to $35,000. Additionally, many of its affiliated offices have not only signed up as monthly contributors but also became members of the ACA.

Correction: Last week’s EVP report failed to report the contribution of the students from National University of Health Sciences. Dyer, President of the SACA chapter at National University of Health Sciences correctly pointed out that his chapter contributed $500 to the National Chiropractic Legal Action Fund at NCLC in March. This increases the total contribution made by the NUHS SACA chapter to $1,000.

I’d also like to note that in commenting last week on the contributions collected at a seminar sponsored by the ACA College of Forensic Sciences, I failed to mention the efforts of Dr. Leanne Cupon in this respect.

6. PARKER HELPFUL ONCE AGAIN IN FT. LAUDERDALE

Over the last couple of years, the Seminars have been a terrific source of funding for the National Chiropractic Legal Action Fund (NCLAF). Since January of 2002, we have raised over $700,000 through the efforts of Dr. Mancini and his staff. He has given us every opportunity to promote the NCLAF and has himself become a strong advocate whenever possible. This past week, Drs. J. Flynn, Don Krippendorf and I attended the Seminar in Ft. Lauderdale, FL, and we were once again well-supported. Dr. Flynn was given an opportunity to present at the Team Teacher luncheon; and addressed the crowd attending the Jack Canfield presentation, where over 600 doctors and CAs were present. Dr. Mancini weighed-in with his strong support, along with Dr. Larry Markson during the final event.

One other doctor deserving particular mention is Dr. Singer. On Thursday night of the program, he gave an impassioned plea for support for the NCLAF. He did a terrific job in tying the Wilk suit to the Trigon. It was outstanding.

Thanks also to Dr Tom Hyde, ACA Delegate, for spending time at our booth.

's big program will be in Las Vegas, and it’s going to be huge. The ACA Board of Governors will be holding its midwinter meeting at the same venue as the program. Once again, Dr. Mancini has promised us every opportunity to promote NCLAF at a program that reaches 10,000 doctors and CAs.

7. MASTERS CIRCLE LENDS ITS SUPPORT FOR THE LAWSUIT

Dr. Larry Markson and the Masters Circle have been strong supporters of the NCLAF. This past weekend at in Ft. Lauderdale he once again reminded doctors of the significance of these suits and the need for the profession to rally behind them. It is our understanding that the Masters Circle’s 3rd Annual Superconference being held at the Rio Hotel and Casino in Las Vegas November 6-9 will include a strong pitch for the NCLAF as well. The three day program includes many prominent speakers from the chiropractic profession, including: Dr. Wayne Dyer, Mr. Jack Canfield, Dr. Guy Riekeman, Dr. Pat Gentempo, Dr. Carol Ann Malizia, Dr. Bob Hoffman, Dennis Perman and others. It is our understanding that 2,000 doctors have already registered for the program. ACA leadership will be there to answer questions regarding the lawsuits. For further details, visit: www.themasterscircle.com <http://www.themasterscircle.com>

8. ACA LEADERSHIP ON THE ROAD

The last couple of weeks, we have had so much to report that I haven't mentioned the ongoing work of our leadership. Here is a summary:

Dr. Don Krippendorf, our new president, has hit the ground running. He attended the opening of the new Palmer College in Florida; attended and spoke at the ACA Georgia luncheon attended by over 70 doctors, and then attended the dinner honoring Dr. Shelby Elliott along with Drs. Brassard and Dr. . Dr. Krippendorf completed the month by traveling to Toronto, Canada to visit the facilities of two companies endorsed by the ACA and then attended the program in Ft. Lauderdale.

Immediate Past ACA President Dr. Daryl Wills recently traveled to Montreal to represent the ACA at the recent annual World Congress of Chiropractic Students (WCCS). This conference includes chiropractic students representing all the chiropractic colleges in the world. All the chiropractic organizations were present and each, including Dr. Wills, was given an opportunity to discuss the activities of their organization. Many SACA officers participated at this meeting, but special recognition should be given to Janelle Whitehead and Haas.

This same month, ACA Governor/Past Chairman , DC, and Dr. Vaughn, ACA Texas Delegate, accepted an invitation from the Kansas Chiropractic Association to attend annual convention of that organization. They were both given an opportunity to address the attendees, and at the evening banquet Dr. introduced Congressman Jerry Moran, a strong supporter of the profession.

Also this month saw ACA Governor (District 2) Dr. Zange attend the Fall convention of the Illinois Chiropractic Society in Decatur, Illinois. With the help of two Illinois ACA delegates, Dr. Strehl and Dr. Jim Rehberger, Dr. Zange handled the ACA booth and gave a presentation on ACA activities and the National Chiropractic Legal Action Fund to the association’s board of directors. The doctors were given an opportunity to present the Dr. Carl Cleveland-narrated “Simple Justice” video to the general membership and to discuss the National Chiropractic Legal Action Fund.

Finally this month , ACA Council Pres Manceaux spoke at Cleveland Chiro College for SACA Day and the Visiting Lecture Series. One of the largest attendances of students took place and a great deal of interest was generated for ACA student membership

9. ACA’s 2004 CHIROPRACTIC CODING SOLUTIONS MANUAL - EVERY DOCTOR’S ESSENTIAL CODING RESOURCE

ACA’s 2004 Chiropractic Coding Solutions Manual has been completely revised this year into an even more user-friendly, comprehensive, chiropractic-specific coding resource, starting with a new smaller 6 x 9 desktop reference size. If there was ever a year to purchase the ACA coding manual, 2004 is the year! New this year - color-coded sectioned tabs, a glossary of terms, an index for quick referencing, updated letters of appeal, and a new Federal Employee Plan (FEP) section. Included with your purchase is a free CD-ROM with customizable template letters and downloadable essential claim forms, such as the CMS-1500 form. You will also receive a free yearly subscription to the popular quarterly newsletter, the ACA Practice Advisory.

Price: ACA Member: $75.95; Non-member: $115.00. For more information, go to www.shopaca.com <http://www.shopaca.com> or call 800-368-3083. Please mention this email when ordering item CPT04.

10. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to dmillard@... <mailto:dmillard@...> with a subject of: "REMOVE - EVP Report."

November 4, 2003

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: November 3, 2003

This week’s issue includes the following items:

1. LEGAL UPDATE 2. ANTHEM TIGHTENS ITS GRIP ON HEALTH CARE 3. LEGISLATIVE UPDATE 4. ACA DISASTER RELIEF INITIATIVE MOVES FORWARD 5. HOW TO HELP VICTIMS OF CALIFORNIA WILDFIRES 6. STATE ASSOCIATION CONFERENCE CALL FOCUSED ON MEDICARE DOCUMENTATION AND APPEALS: LMRP THE FOCUS IN FUTURE CALLS 7. LONG RANGE PLAN AT A GLANCE 8. CAN’T ACCESS THESE LINKS?

1. LEGAL UPDATE

The appeals court in ACA’s lawsuit against Trigon Blue Cross Blue Shield has copies of our 14,000-word appeals brief, Trigon's 14,000-word response and our 7,000-word reply (a word limit is enforced). It’s now up to the courts to take the next action. We do anticipate that they will schedule oral arguments and we are expecting them before Christmas in Richmond, Virginia. Guess where I will be when they are scheduled?

The three panel judges will be announced one day before the oral arguments are presented. This gives our attorneys 24 hours to research cases involving these judges and ,where possible, citing their opinions in the oral arguments.

We are hoping that a decision will come down within 90 days following the oral arguments, but it could be much longer. The 4th circuit court has a reputation for quick turnaround on decisions, but this isn't any normal case. As you will note from the Anthem story below, the significance of this decision continues to grow.

2. ANTHEM TIGHTENS ITS GRIP ON HEALTH CARE

Anthem, which recently purchased Trigon Blue Cross Blue Shield, expanded its grip over health care by purchasing Wellpoint Networks, Inc. This will make ANTHEM the largest health insurance company in the United States, with 26 million enrollees and operating Blues plans in 13 states.

3. LEGISLATIVE UPDATE

Medicare: The conference committee continues to deliberate in its attempt to reconcile the Senate and House versions of the Medicare drug bill. While our provision has not yet been considered, our doctors in Connecticut have followed up with Congresswoman , who remains supportive.

AHP: There will be no action taken in the Senate this year on the legislation supported by the business community that would preempt state insurance equality laws. The bill did pass the House and will certainly be a battleground next year in the Senate. As you may be aware, we are in a coalition with the national Blues and the National Governors Conference in attempting to defeat this measure.

Veterans Affairs: The House and Senate conference committee is trying to reconcile differences on a VA bill that includes, in the House version, a chiropractic provision permitting the immediate hiring of chiropractic doctors in the VA system. The Pennsylvania doctors have been contacting the office of Senator Arlen Specter -- a key member of the conference committee -- regarding the measure.

DOD: The House and Senate conferees of the Defense Authorization Bill are also meeting. Part of their job is to reconcile the House language that includes an acceleration on implementing the chiropractic provision in the DOD by one year and increasing the annual appropriations for the chiropractic project by $6 million, bringing the total to $18 million. The Senate version doesn't have these provisions but includes strong report language that addresses many of the problems we are having with the DOD and strengthens the hand of the DOD chiropractic Advisory Committee in dealing with a bureaucracy in some of the branches that have been dragging their heals.

DOD Expansion: Congressman Lane and Congressman Ed Schrock are circulating a letter to members of the House requesting that they become cosponsors of legislation to expand chiropractic benefit under DOD TRICARE plan to include family members of servicemen, retirees and survivors. You should have received an email alert on this last week.

For further details regarding this legislation, please contact ACA’s Government Relations office at 800-986-4636.

4. ACA DISASTER RELIEF INITIATIVE MOVES FORWARD

As our nation witnessed the horrific tragedies that took place in New York, Pennsylvania and Washington, DC, just two short years ago, many in the chiropractic profession heeded the call to serve. And while the chiropractic profession demonstrated its mettle through this unforgettable experience, it was not the first time doctors of chiropractic had banded to help their country and their community. In cases of natural disasters, terrorism or other tragedies, our profession has stepped up to the plate time and time again.

The difficulty, however, is that not every doctor of chiropractic who offers to serve is granted easy access to a disaster site. The lack of a "passport," such as an ID card connecting a doctor of chiropractic with an official oversight organization, often acts as a roadblock to access. Recognizing this impediment to serving, the ACA's House of Delegates passed an historic resolution in March, 2003, that aims to integrate doctors of chiropractic more freely into the disaster relief community. At ACA's recent annual meeting in Albuquerque, NM, ACA's Arkansas delegate Konarski-Hart, DC, reported on the progress of the initiative and distributed a related video, media kit, pamphlet and CD-ROM. For copies of these materials, or to discuss ACA's disaster relief initiative, please contact Bernat at ACA headquarters at

pbernat@... <mailto:pbernat@...>

5. HOW TO HELP VICTIMS OF CALIFORNIA WILDFIRES

Southern California has been ravaged by wildfires. The sheer immensity of the destruction is overwhelming: 750,000 acres blackened (about the size of Rhode Island), 3,400 homes destroyed and 20 killed. California Chiropractic Association (CCA) member doctors of chiropractic, their staff and patients have been displace by the fires, and some are sure to loose their homes and businesses. Members of the California Chiropractic Association have been extending helping hands -- literally and figuratively. Many, many doctors of chiropractic have closed their practices and traveled to the fire scenes to render adjustments to hundreds of brave firefighters. The CCA San Valley District has established a collection effort to assist victims of the wildfires. Money, clothing, nonperishable foods, baby supplies are being collected for distribution by relief agencies. If you would like to contribute, please send checks made payable to "CCA Fire Assistance Fund" to 638 West Duarte Road, Suite 11, Arcadia, CA 91007.

Clothing, foods, diapers, etc. can also be sent to the same address.

6. STATE ASSOCIATION CONFERENCE CALL FOCUSES ON MEDICARE DOCUMENTATION AND APPEALS: LMRP THE FOCUS OF FUTURE CALLS

The monthly call of the ACA EVP Advisory Committee, held on October 14th, was one of the best attended calls yet. The following states were represented: Pennsylvania, Iowa, North Dakota, South Dakota, Arizona, Alabama, Ohio, Kentucky, Georgia, North Carolina, Colorado, Nebraska, Alaska and Missouri. The call was led by Ms. McClelland, ACA Medicare consultant, with input from Dr. Ritch . The focus was Medicare Documentation and Appeals.

The next call is scheduled for November 11th at 1:00 Eastern. For the next three months we will be inviting CAC representatives from various states to share their experiences and hopefully help establish a more unified position in dealing with local medical review politics that influence the implementation of Medicare in the area. The November call will include states covered by the following carriers: Noridian Mutual Insurance Company, Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Arkansas.

7. LONG RANGE PLAN AT A GLANCE

If you don't know where you are going, any road will get you there. Without a long-range plan, an organization would be in a constant state of re-action. ACA has spent a lot of time putting together a plan and its implementation is tied to the performance plans of ACA staff, including mine. Spend some time reviewing our plan, and please let me know what you think:

The entire long-range plan can be found here: <http://www.acatoday.com/about/vision.shtml>

The executive summary can be found here: <http://www.acatoday.com/about/executive_summary.shtml>

8. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to dmillard@... <mailto:dmillard@...> with a subject of: "REMOVE - EVP Report."

December 5, 2003

ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo

Re: ACA EVP Weekly Report

Date: December 1, 2003

This week’s report includes the following items:

ACA RANKS HIGH AMONG WASHINGTON’S ELITE LOBBYING GROUPS DYNAMIC CHIROPRACTIC PUBLISHER TAKES UNPRECEDENTED ACTION ON LAWSUITS NCLAF MONTHLY CONTRIBUTORS CROSS 1000 MARK; NAMES PUBLISHED IN DYNAMIC CHIROPRACTIC DEADLINE FOR DELEGATE ELECTIONS APPROACHING CAN’T ACCESS THESE LINKS?

1. ACA RANKS HIGH AMONG WASHINGTON’S ELITE LOBBYING GROUPS

The Wednesday, November 26th issue of the Washington Times included an Op-Ed article by Heaney, a research fellow in the Centennial Center of the American Political Science Association, on the most effective lobbying groups involved with the Medicare bill just passed by Congress. ACA was listed among Heaney’s “top 25 most effective grassroots lobbying organizations for health care.” In his article, Heaney explains that, “These organizations are highly successful in building connections between their members and Congress on a wide geographic basis."

The chart lists ACA as the 19th-ranked organization, with the American Medical Association and

AARP listed as 2 and 3, respectively. The U.S. Chamber of Commerce is listed at #21, with the

American Physical Therapy Association listed as #24. The osteopaths are not listed at all, and, of course, there is no listing of any other chiropractic organization.

According to the article, the “rankings are based on anonymous interviews with 77 health care staff in the personal offices of members of Congress. Interviews were conducted by the author between April and July 2003."

The ranking of ACA ahead of the American Physical Therapy Association (APTA) and others is all the more significant when you consider the substantial edge in resources held by these groups. Take APTA as an example. According to the 2002 Association Yellow Book, the APTA has an annual budget of $25 million and 168 employees. The ACA has an annual budget of $6.5 million and 40 full-time employees. Can you imagine what we could accomplish with APTA’s budget?

Heaney also prepared an article on the Medicare bill that ran in the Sunday, November 30, edition of the Washington Post, in which he explains, “Chiropractors, who are usually at a disadvantage in political contests against physicians, won a rare victory with this legislation, which creates a new chiropractic demonstration project and increases reimbursement for chiropractic services.”

To see these and other examples of ACA’s media coverage on the Medicare issue, including the Washington Times chart of the top 25 most effective grassroots lobbying organizations for health care, please visit: http://www.acatoday.com/government/medicare/aca_lobbying_efforts.shtml

2. DYNAMIC CHIROPRACTIC PUBLISHER TAKES UNPRECEDENTED ACTION ON LAWSUITS

If you turn to page 2 of the November 30/December 1 issue of Dynamic Chiropractic expecting to find the “Report of My Findings” column by Don , you’ll be surprised to find instead an article by Mcs preceded by the following statement from Don :

Publisher's note: “This marks the first time someone outside our organization has written an article for my ‘Report of My Findings’ column. I feel the work attorney Mcs is once again doing for our profession is so important that readers need to hear about it directly from him.”

While this statement in itself is significant, the article written by Mr. Mcs regarding the lawsuits is equally important, as it brings into perspective the errors of the judge in the Trigon suit and why our appeal should be successful. The article also introduces a five-page summary of the key portions of the appellate brief that factually traces to the Trigon case the continuation of the conspiracy against this profession that was first identified in the Wilk suit.

There are a total of nine pages in Dynamic Chiropractic regarding the lawsuits. Thanks to Don for recognizing the importance of these lawsuits.

To read Mr. Mcs’ article, please visit: http://www.chiroweb.com/archives/21/25/07.html. For the rest of Dynamic Chiropractic’s coverage of the lawsuits in this edition of Dynamic Chiropractic, visit: http://www.chiroweb.com/archives/21/25/11.html

3. NCLAF MONTHLY CONTRIBUTORS CROSS 1000 MARK; NAMES PUBLISHED IN DYNAMIC CHIROPRACTIC

With the recent success at the Masters Circle program, we now have 1066 doctors who are monthly contributors to the lawsuits against HHS and Trigon. Look to the November 30, December 1 issue of Dynamic Chiropractic. The National Chiropractic Legal Action Committee has taken out a two-page advertisement listing the names of the doctors, students and

CAs who were monthly contributors as of November 10th.

Other contributions of note these past two weeks include:

NBCE: $75,000, bringing total to $275,000

SACA Palmer College: $100, bringing total to $3,177.35

Breakthrough Coaching: $9,850, bringing total to $99,200

Allied Health of Wisconsin: $50, brings total to $33,375

The Masters Circle: $500 (via EZ Pay), bringing total to $11,000

Performance Health (Biofreeze): $100 (via EZ Pay), bringing total to $1,400

Missouri State Chiropractic Association--District 1: $100 (via EZ Pay), bringing total to $6,800

Missouri State Chiropractic Association: $100 (via EZ Pay), bringing total to $2,000

Ohio State Chiropractic Association $5500—brings total to $52,130.30

Uncle ’s Chiro Business Training $1000—brings total to $4.000

4.. DEADLINE FOR DELEGATE ELECTIONS APPROACHING

Members seeking election as delegate or alternate delegate must signify their intent in writing via certified mail by December 15, 2003, to the Corporate Secretary of the American Chiropractic Association, 1701 Clarendon Blvd, Arlington VA 22209

Ballots will be sent January 15, 2004 to voting members of the states of Alabama, Arizona, California North, California South, Connecticut, District of Columbia, Georgia, Idaho, Illinois South, Indiana, Kansas, Louisiana, land, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New York Metro, North Carolina, Ohio, Rhode Island, South Dakota, Texas East, Vermont, Puerto Rico, Virgin Islands, Washington, Wisconsin and Wyoming.

Term of office is two years. For more details on the delegate elections, qualifications and procedures, consult the ACA Bylaws, Article VIII, Section C.

Garrett Cuneo

Corporate Secretary

5.. CAN’T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

If you do not wish to receive further e-mail promotions, Click Here to be removed. DO NOT REPLY to this message. The e-mail address in which you are subscribed is rcross@.... Copyright 2002. All rights reserved.

December 10, 2003

ACA EVP Weekly Report

Memorandum

ACA Members, ACA House of Delegates, Board of Governors and Other Interested Parties

From: Cuneo

Re: ACA Weekly Activity Report

Date: December 8, 2003

This weeks report includes the following items:

CLAIMS SOLUTIONS WORKGROUP IN CHICAGO NAII ASKS ACA TO CONDUCT TRAINING PROGRAM FOR CLAIMS ADJUSTERS LEGISLATIVE UPDATE DOD UPDATE VA UPDATE FCER DESERVES YOUR SUPPORT ACA's 2004 CHIROPRACTIC CODING SOLUTIONS MANUAL PARKER LAS VEGAS WILL BE THE PLACE TO BE IN JANUARY CAN’T ACCESS THESE LINKS?

1. CLAIMS SOLUTIONS WORKGROUP IN CHICAGO

For the sixth time in a short four-year period, officials from national insurance companies and ACA leadership met to study ways to improve billing and reimbursement issues involving chiropractic claims. On November 20, 2003, the National Association of Independent Insurers hosted this important meeting in Chicago at their headquarters. 13 insurers, some sending multiple representatives, met with ACA President Krippendorf and other ACA board members and delegates, including Dr. Gentile (Chairman of ACA's Insurance and Managed Care Committee), Dr. Spoto (ACA’s Pennsylvania delegate) and Dr. Jim Rehberger (ACA’s Illinois delegate), as well as Pat , ACA’s vice president for professional development and research, to explore better ways to cre! ate alliances and speed the claim handling process.

Many of the group's concerns have been addressed in the previous 5 meetings, such as improvements in clinical documentation, anti-fraud initiatives, and attention to best practices. Sights are now being set on new priorities. A session was held to address 7 particular, often-mishandled codes. Correct reimbursement policy was also discussed, and ACA requested that insurers correct medical review software vendor edits as well. Insurers are solely responsible for the business partners they hire, and if the coding edits they purchase are flawed it reflects back on the insurer and can represent unfair claim handling--a serious regulatory infraction. The codes discussed were Extra-Spinal CMT, Neuromuscular ucation, Testi! ng and Measurement codes, Massage, Hot Packs, Manual Therapy (97140) and E/M codes with CMT. Insurers agreed to reassess their practices and those of their business partners.

Companies attending the meeting included:

NAII, Allstate, American Family Insurance, AAA, Blue Cross Blue Shield Illinois, National BCBS Association, State Farm, Shelter, General Casualty, Erie, Metropolitan (Met Life) and Farmers. This is a mix of health, workers compensation and auto insurers.

The next meeting of the group is scheduled for March in conjunction with ACA’s National Chiropractic Legislative Conference (NCLC).

2. NAII ASKS ACA TO CONDUCT TRAINING PROGRAM FOR CLAIMS ADJUSTERS

The National Association of Independent Insurers (NAII), which includes over 700 insurance companies, has requested that ACA participate in a video teleconferencing program with its claims adjusters to provide training on chiropractic. It is anticipated that the chiropractic training manual for adjusters, which was a joint effort of the ACA and the insurance community including NAII, will be the text utilized during this program.

3. LEGISLATIVE UPDATE

I hope you don't mind if I gloat a little bit. Being declared among the 25 most effective lobbying organizations on health matters on Capitol Hill, ahead of the physical therapists (APTA) and the U.S. Chamber of Commerce, and having our demonstration project show up in articles in the Washington Post and the Washington Times all in one week, is pretty heady stuff. Our lobbyists have already noticed a significant change in attitude by many hill staffers who are impressed by strong grassroots/lobbying organizations. Thanks to our lobbyists, our aggressive PAC and close cooperation from our members, including students, and state associations for making this happen.

This has been a successful legislative year for a number of reasons:

The President signed the Medicare bill on Monday, and I am happy to report that Jon Hymes (ACA vice president for government relations), Kim Krocker (ACA PAC Manager) and I attended the ceremony. More on that in a later report. As you know, the demonstration project is part of the Medicare package. It not only pilots full scope of practice under Medicare Part B, but also will eliminate the physician gatekeeper requirement that exists in Medicare Part C managed care plan. Dynamic Chiropractic is running a great article on the legislation, including a timeline that outlines our ten-plus year struggle to make this happen. To view the! article and timeline, visit: http://www.chiroweb.com/dynamic/temp/medicare.html

4. DOD UPDATE

The Department of Defense (DOD) authorization bill recently signed by President Bush includes a chiropractic provision that not only accelerates the full implementation of the chiropractic benefit by one year, but also increases its annual funding. The bill also has strong report language that lets DOD know that Congress isn't happy about the uneven implementation of the benefit in the armed services and urges the department to make better use of the chiropractic advisory committee. As of January 04 there will be 37 sites throughout the country that provide chiropractic care. There is a potential for there to be several hundred. There is a lot of room for improvement, and Congress realized that the medical bureaucrats would have to be dragged kicking and screamin! g to implement the provision.

Schrock/ Proposal: Legislation from Congressman Ed Schrock and Congressman Lane is being circulated that would assure that current and former military services personnel and their families have the chiropractic benefit. While most of our attention has been on other areas, in a short period of time we have been able to get 27 members of Congress to sign on as cosponsors. This legislation will undoubtedly be one of our priorities for next year. We urge you to contact your member of Congress to sign on to this bill. This will not be easy, as DOD will probably oppose the legislation because of cost. For more information, visit: http://www.acatoday.com/government/dod/schrock.shtml

5. VA UPDATE

The recommendations of the Chiropractic Advisory Committee of the Veterans Administration have been submitted to Secretary of Veterans Affairs Principi. We are continuing our discussion with him, but recognize that substantial opposition exists within the VA bureaucracy and organized medicine. None of this is surprising to any of us. Like the DOD, the implementation of the chiropractic benefit will require additional congressional pressure and pressure from veterans organizations. We will be organizing a campaign to be initiated at the beginning of the year and will urge your participation.

We were successful in including a provision in the Department of Veterans Affairs Long-Term Care and Personnel Authorities Enhancement Act of 2003 (S. 1156), that amends title 38 of the U.S. Code to provide the U.S. Department of Veterans Affairs with direct and immediate authority to hire and employ doctors of chiropractic to care for veterans in the VA health system.

6. FCER DESERVES YOUR SUPPORT

The Foundation for Chiropractic Education and Research (FCER) is celebrating 60 years, and we say "Thank you!" to all of you who are or have been friends of the foundation through being a member, making a donation, or purchasing a product. Sixty Dollars for Sixty Years -- In honor of the event, we are suggesting that doctors make a $60 tax-deductible* donation to FCER, less than the cost of going to dinner and the movies. Please see http://www.fcer.org/Donate60.htm for more information on FCER’s "Sixty Dollars for Sixty Years" campaign. All who donate will receive a FREE static cling window sticker for your office th! at shows your support for chiropractic research.

*Please check with your tax advisor. FCER maintains a 501© (3) status as an independent foundation dedicated to education and research.

7. ACA's 2004 CHIROPRACTIC CODING SOLUTIONS MANUAL

ACA's 2004 Chiropractic Coding Solutions Manual has been completely revised this year into an even more user-friendly, comprehensive, chiropractic-specific coding resource, starting with a new smaller 6 x 9 desktop reference size. If there was ever a year to purchase the ACA coding manual, 2004 is the year! New this year – color-coded sectioned tabs, a glossary of terms, a new clinical example section, an index for quick referencing, and updated letters of appeal. Included with your purchase--a free CD-ROM with customizable template letters and essential claim forms, such as the CMS-1500 form. You will also receive a free yearly subscription to the popular quarterly newsletter, the ACA Practice Advisory.

Price: ACA Member: $75.95; Non-member: $115.00. For more information, go to www.shopaca.com or call 800-368-3083. Please mention this email when ordering item CPT04.

*Books will be available January 2004.

8. PARKER LAS VEGAS WILL BE THE PLACE TO BE IN JANUARY

The ACA Board of Governors will hold its mid-winter meeting at the Las Vegas Hilton Hotel during the week of the Seminar next month. While at , ACA will take the opportunity provided by Dr. Fabrizio Mancini to raise awareness of our two lawsuits. Last January we raised over $500,000, and this year is giving us opportunities to increase on this total. We will be operating three booths and participating in some of the major events planned for the weekend. Plan to join us at to help in raising funds and also to attend an excellent program focused on your patients. In one weekend, your patients can learn from the best of the best and gain insight on wh! at it takes to be healthy both mentally and physically. Nowhere else will they have the opportunity to hear from so many best-selling authors on the basics of nutrition, exercise, stress management and how to be successful both personally and professionally.

Throughout the weekend you and your patients will be captivated by dazzling celebrity guests who support chiropractic, as well as hear from Olympic and professional athletes who rely on their health for their livelihood. Tell your patients about Las Vegas and help them take control of their lives and get healthy and well! If you have not registered yourself and your staff, be sure to register today! For more information call 1-888-727-5338 or visit us online at www.Seminars.com

9. CAN’T ACCESS THESE LINKS?Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@.... If you do not wish to receive further e-mail promotions, Click Here to be removed. DO NOT REPLY to this message. The e-mail address in which you are subscribed is rcross@.... Copyright 2002. All rights reserved.

May 12, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, ACA Board of Governors, House of Delegates and Other Interested PartiesFrom: Garrett CuneoRe: ACA EVP Weekly Report

Date: May 11, 2004

We realize that some of you may not have been receiving my report for the last few weeks. This is mainly due to spamming issues and has been resolved. I have posted this years' reports on our web site - please visit http://www.acatoday.com/membersonly/publications/evp_report/ to view them. Remember, you will need your username and password.

This week's report includes the following items:

1. APPEALS COURT DISAPPOINTS, BUT WE ARENâ€™T DONE YET 2. ANTHEM PAYS ITS OWN 3. 2004 ACF/AUXILIARY SCHOLARSHIP AWARD DEADLINE: JUNE 15th 4. CODING ISSUE BRIEFS AVAILABLE TO ACA MEMBERS 5. INFO ON E-MAIL STORAGE: A MESSAGE FROM OUR IN-HOUSE TECH GUY 6. SUCCESS IN MISSISSIPPI 7. CAM PRESENTATION 8. ACA SCORES ANOTHER SUCCESS ON CODING: IMPORTANCE OF CLINICAL DOCUMENTATION REAFFIRMED 9. LEADERSHIP ON THE ROAD 10. CANâ€™T ACCESS THESE LINKS?

1. APPEALS COURT DISAPPOINTS, BUT WE ARENâ€™T DONE YET

Iâ€™m sure youâ€™ve heard by now that the 4th Circuit Court of Appeals has come down with its ruling, rejecting our appeal in the Trigon lawsuit. The ACA will petition for a rehearing and appeal to the full panel of judges in the 4th Circuit.

One of the most significant parts of our case was our contention that a conspiracy existed between Trigon Blue Cross Blue Shield and the medical specialty societies in Virginia to assure that patients with musculoskeletal conditions were diverted to medical doctors instead of doctors of chiropractic, a clear violation of antitrust laws. Part of our evidence was the existence of a committee established by Trigon to review the AHCPR guidelines and recommend appropriate protocols for referring patients to chiropractic doctors. The committee was appointed from representatives submitted by medical specialty associations from throughout the state of Virginia, but no doctors of chiropractic were appointed to the committee. The committee had policymaking authority, with a vote taken of their actions and minutes recorded. Instead of publishing the positive results of spinal manipulation that had been the highlight of the AHCPR report! , they took a narrow view of the value of spinal manipulation, making it the secondary choice of treatment and creating a higher threshold for referring patients to chiropractic.

Two separate entities must be involved in order to have a conspiracy. It was clear that by appointing competitors of the chiropractic profession to determine the protocols for referrals, the results would be unfavorable to chiropractors and to their patients. But despite the clear intent of the committee and its purpose, the courts considered the committee to be a part of Trigon, rather than a separate entity. The court found that Trigonâ€™s actions were more akin to a hospitalâ€™s credentialing process. But we believe that comparing the type of coverage payment and referral policymaking decisions of Trigon and the selected medical societies to a hospital credential review process is comparing apples and oranges. Just imagine reviewing medical doctors without getting input from medical doctors. In our case, Trigon had no business whatsoever in distorting already researched and published federal guidelines. ! It decided to â€œprescribeâ€ contraindicated medical care for back pain patients. This action favored its non-employee medical doctors who voted on the false â€œprescriptionsâ€ for the benefit of their appointing medical trade association.

The ACA has 14 days to petition the panel for a rehearing and simultaneously to petition the entire 4th Circuit Court of Appeals. All of this is a precursor to petitioning the U.S. Supreme Court for a hearing. None of this will be easy. There is no guarantee along the way that our petitions will be heard. But we have no choice; if the antitrust laws have any meaning at all, we have to pursue this to the end. Our patients deserve better and our doctors do as well. Look to this report for further details.

2. ANTHEM PAYS ITS OWN

If there is any doubt that our cause in the Trigon suit is just, consider the following. On or about April 7, 2004, it was reported that the top executive of Anthem, Inc., was set to receive a $42.5 million stock and cash incentive package as a reward for the health insurerâ€™s rapid growth over the past three years. That is double the amount that all 961 of the chiropractors in Virginia received from Anthem (formerly Trigon) for the year 2001. The average payment to chiropractors per patient went from $357 in 1997 to $277 in 2001. Anthemâ€™s actions indicate that its top priorities are now profits and executive payouts rather than the reimbursement of costs for necessary and effective health care.

3. 2004 ACF/AUXILIARY SCHOLARSHIP AWARD DEADLINE: JUNE 15TH

Applicants for the 2004 ACF/ACA Auxiliary Scholarship Awards have exactly one month left to get their applications to ACA headquarters in Arlington, VA. The deadline is June 15, 2004. Please help us spread the word about this opportunity for students! Each year, the scholarship program confers awards to about 14-17 students. The amounts of the scholarships may vary from year to year, as determined by the ACF and ACAuxiliary Boards. Each applicant must be a Student ACA (SACA) member in good standing at an accredited chiropractic college in the United States. Applications will be reviewed and rated by each member of the ACF Scholarship Committee, and the winners will be announced at the ACA House of Delegates meeting in St. sburg, FL, Sep 2-4. More information, including the scholarship application packet, is available at http://www.acatoday.com/about/saca/scholarship.shtml.

4. CODING ISSUE BRIEFS AVAILABLE TO ACA MEMBERS

Because the coding and reimbursement landscape is ever-changing, we constantly strive to update the coding information we provide to our members. For example, there are numerous coding clarifications and Q & As available on ACAâ€™s Web site at this location: http://www.acatoday.com/insurance/coding/.

Contained in the above link are invaluable bits of information for any chiropractic office. This information is a specific member benefit, with the information written by members of ACA's Coding and Reimbursement Committee, two members of which sit on AMA coding panels. The site is updated regularly, so be sure to look at it from time to time so that you can keep on top of the most timely chiropractic coding information.

5. INFO ON E-MAIL STORAGE: A MESSAGE FROM OUR IN-HOUSE TECH GUY

One common reason for electronic mail not reaching its intended recipient is the recipients' email store being at or near capacity. Simply deleting emails from your inbox does not completely erase the message...it is still stored in your "Deleted Items" folder. Also, unless settings are changed, any message sent is stored in a "Sent Items" folder. So, when you want to clean your email store, be sure to clean out your Sent Items, Inbox, and Deleted Items to free up as much storage as possible. If you have a question for our in-house nerd, let me know and I will try to get an answer from him.

6. SUCCESS IN MISSISSIPPI

Dr. Al Norville, ACAâ€™s Mississippi delegate, reported that the Mississippi legislature passed -- and the governor signed -- legislation authorizing the use of the term Chiropractic Physicians for doctors of chiropractic, despite opposition from the state medical association. This makes Mississippi the 31st state to authorize DCs to use this designation.

7. CAM PRESENTATION

The National Center for Complementary and Alternative Medicine recently held public hearings in both Bethesda, land, and in Seattle, Washington, to update their Long Range Strategic Plan with input from the community. ACAâ€™s land delegate, Dr. Bill Lauretti, represented ACA at the Bethesda hearing, while Dr. Lori Bielinski, executive director for the Washington State Chiropractic Association, represented her group at the Seattle program.

ACA and chiropractic faculty researchers worked with Lori in developing the research portion of her testimony. And while the CAM institute focused solely on research of the spine, Dr. Bielinski explained to the institute, "When considering research on chiropractic services, the WSCA board of directors would like for you to consider that chiropractic is a profession, not a procedure -- chiropractors do more than spinal manipulation. Other aspects of the clinical such as the belief system, interpersonal relationship, and the therapeutic value of touch are important to investigate as well as the biomechanical and neurophysiological effects of manipulation. To that end, the chiropractic profession's research capacity needs to be enhanced by awarding grants for training in research methods; and by awarding grants for developmental research efforts in addition to those research opportunities focusing just on conditions related to the sp! ine.â€

8. ACA SCORES ANOTHER SUCCESS ON CODING: IMPORTANCE OF CLINICAL DOCUMENTATION REAFFIRMED

Based on a recent complaint from an Illinois member, ACA reconfirmed correct coding policy with Aetna on reimbursement for E/M services with CMT. While the treating DC forgot to use modifier -25, the situation offered ACA a chance to touch base with Aetna officials to determine that coding policy was indeed intact. Aetna assures us the denial was a result of the lacking modifier and there has been no change in coding policy to deny E/M services. Clinical documentation needs to be available to support the E/M as an independent procedure. Please refer to ACAâ€™s Web site for the definition:http://www.acatoday.com/insurance/coding/coding_clarifications.shtml.

9. LEADERSHIP ON THE ROAD

ACA Governor Glenn Manceaux, DC, represented ACA at the meeting of the Federation of Chiropractic Licensing Boards, where he was given an opportunity to present an update on the lawsuits, including the decision by the appellate court. He, along with Immediate Past President Dr. Daryl Wills, received support from many of the attendees to continue the suit.

Dr. Don Handley, ACAâ€™s West Texas delegate, reported success after his attendance at the annual meeting of the Texas Council of Chiropractic Orthopedists. He was given an opportunity to update the group on our lawsuits and was presented a check for $5,000 for the National Chiropractic Legal Action Fund. This brings the councilâ€™s total contributions to $10,000

Dr. Handley also presented the â€œSimple Justice 2â€ video and a PowerPoint presentation on ACAâ€™s Long Range Plan to the doctors attending the meeting of the Texas Chiropractic Association District 10 meeting on March 25th. Numerous delegates like Dr. Handley have been contacting the local/regional societies in their states requesting opportunities to present updates on ACA activities. If you are an officer of a state association, please provide your ACA delegate with an opportunity to present.

Dr. Dow Bates, ACAâ€™s Iowa delegate and his wife, Del, were presented with the Presidential Award by Iowa Chiropractic Society president Dr. Ken Storjohann for their contributions to the chiropractic profession -- in particular for their efforts in promoting the profession in the political process. Senator Chuck Grassley was present for the presentation.

Dr. Daryl Wills attended the "Bring Your Dreams to Life" seminar at Life University, where he was given an opportunity to address the attendees on the subject of "Being a Committed Chiropractor." While there, Dr. Wills discussed the importance of ACAâ€™s lawsuits as well as ACA membership, and showed the gathering the â€œSimple Justice 2â€ video.

Dr. Jacklitch, ACAâ€™s North Dakota delegate, reported that he and ACA Governor Blair Bauer, DC, attended the 92nd annual convention of the North Dakota Chiropractic Association and were given numerous opportunities to discuss ACA activities. At the business meeting, Dr. Jacklitch provided an update on our lawsuits and numerous other ACA initiatives. The North Dakota Chiropractic Association then presented ACA with a check for $7,500 bringing the associationâ€™s total contributions to $57,505. The association also contributed $1,000 for an important chiropractic value statement ACA is preparing that will compare the economics of the chiropractic model of care to the medical model. On a side note, Dr. Jacklitch reported that two weeks prior to the North Dakota convention, he and a number of other doctors had a private breakfast meeting with U.S. Senator Kent Conrad, who was attending the State Democratic Convention.

Dr. Bob Mastronardi attended an educational seminar of the Chiropractic Society of Rhode Island, where he was given an opportunity to provide an update on ACAâ€™s lawsuits and to show the doctors in the attendance the â€œSimple Justice 2â€ video.

10. CANâ€™T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

May 19, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, ACA Board of Governors, House of Delegates and Other Interested PartiesFrom: Garrett CuneoRe: ACA EVP Weekly ReportDate: May 17, 2004

This week's report includes the following items:

1. 2004 MEMBERSHIP CAMPAIGN OFF TO A GREAT START 2. ACA NEW JERSEY DELEGATE TESTIFIES BEFORE NEW JERSEY LEGISLATURE3. A WIN FOR FLORIDA PROVIDERS4. MEMBERS: SUBMIT NOMINATIONS FOR ACA AWARDS5. ACA CODING SEMINARS ARE PARTICULARLY VALUABLE FOR STATE ASSOCIATIONS6. IS YOUR CONGRESSMAN/WOMAN ON THIS LIST? HE OR SHE SHOULD BE!7. CAN'T ACCESS THESE LINKS?

1. 2004 MEMBERSHIP CAMPAIGN OFF TO A GREAT START

You'll be glad to know that ACA is building its membership and becoming an even stronger voice for the chiropractic profession. That's why ACA launched a major membership growth campaign in March. As a result, we have already added close to 200 new members to our ranks. Please join us in welcoming these new members to ACA membership. To see a list of new members and their sponsors, visit: http://www.acatoday.com/membership/new_members.shtml. We can't do it without YOU! Please help us spread the word about what you, the members of ACA, are doing for the profession. Encourage a non-member to join in with you. Membership applications are available at: http://www.acatoday.com/membership/application.shtml. ACA leadership and concerned member advocates can participate in the membership campaign by logging in to the leadership campaign section: http://www.acatoday.com/membersonly/leadership/. In addition to the resources available on our Web site, we are always available to provide any assistance you need. Please contact the membership department at (800) 986-4636 for more information. Thank you for your continued support.

Remember, the best advocate for membership is you. Help spread the word. If you think it would be helpful to send this report to a non-member you know, please send me the email address and I will include it on the distribution list.

2. ACA NEW JERSEY DELEGATE TESTIFIES BEFORE JERSEY LEGISLATURE

Dr. Stiso, ACA's New Jersey delegate, joined the leadership of the newly formed Association of New Jersey Chiropractors (ANJC) to testify before the insurance committee of the New Jersey Assembly in favor of A2359, a bill that would require chiropractic physicians, podiatric physicians, allopathic physicians, and osteopathic physicians be reimbursed at the same rate under various health and accident plans. The ACA office and legal staff worked with Dr. Stiso in developing his testimony. Naturally, the New Jersey business and industry lobby opposed the bill. Nonetheless, the bill passed out of committee with only one dissenting vote. Joining Dr. Stiso was Dr. Steve e, ANJC legislative chairman; Dr. Spadafino, ANJC president, Dr. ph Garolis, ANJC communications chairman; and Dr. Cirino, Jr., ANJC Board Member. The ANJC was recently formed out of a merger of five or six competing organizatio! ns in the state. Imagine what you can accomplish when everyone flies under a single flag. Congrats, New Jersey doctors.

3. A WIN FOR FLORIDA PROVIDERS

Thanks to a few tenacious ACA members and a dialogue established with American Chiropractic Network executives, the ACA brought to the attention of United Health Care (UHC) an issue in which provider claims were inappropriately audited, resulting in numerous provider refund requests. Florida providers began to receive dunning notices earlier this year with UHC requesting refunds where providers performed chiropractic manipulative therapy (CMT) and Evaluation/Management (E/M) services on the same date of service. Thanks to our efforts, UHC set the wheels in motion to facilitate ACN working with UHC's audit division - Ingenix - to implement changes to their CPT coding edits. I will update you in a future report once these changes are finalized.

4. MEMBERS: SUBMIT NOMINATIONS FOR ACA AWARDS

ACA's Chiropractor of the Year, Humanitarian of the Year, Delegate of the Year, Alternate Delegate of the Year, Flynn-Lynch Award, and Academic and Research awards will be presented at ACA's 2004 House of Delegates meeting in St. sburg, FL.

Nominations -- which must include the name of the nominee and a brief essay on why he or she should be considered for the specific award -- must be sent to the ACA by July 19, 2004. Nominations for the Chiropractor of the Year and Humanitarian of the Year awards will be forwarded to the Awards Committee for selection. Delegate of the Year and Alternate Delegate of the Year, as well as the Flynn-Lynch Sr. Memorial Award will be submitted to the Delegate of the Year Committee for selection. Researcher of the Year and Academic of the Year awards will be selected by the Research and Academic Awards Committee.

Send nominations to the ACA Corporate Secretary, 1701 Clarendon Blvd., Arlington, VA 22209. (For more information on ACA awards, go to the bylaws section of the ACA Web site: http://www.acatoday.com/membersonly/frameset.cfm?FIND=2003_bylaws.pdf and scroll to Article V, sections F, G and H.)

5. ACA CODING SEMINARS ARE PARTICULARLY VALUABLE FOR STATE ASSOCIATIONS

Don't wait to sign your state association up for ACA's new coding seminar: Navigate the Insurance & Coding Process -- dates are going fast! Several states have registered for this new educational program, including Georgia, Nebraska and Michigan! Now available for your state association through the ACA, Navigate the Insurance and Coding Process provides chiropractic professionals with the tools needed to negotiate successfully with insurers and steer clear of costly coding errors, while protecting your practice from claim delays, billing review and fraud investigations. Participants will master coding clarification for evaluation and management (E & M), chiropractic manipulative treatment (CMT), manual therapy, massage, CPT modifiers, and other chiropractic related services such as writing a diagnosis, x-rays, and hot/cold packs.

Generate Revenue For Your State Association and Chiropractic College: This seminar can be customized for a full or half-day formats at the suggested seminar rates while at the same time, generate significant revenue. Once your organization sets your date, ACA secures the speaker, and provides presentation materials suitable for duplication and marketing.

Navigate the Insurance & Coding Process is a must for DCs, billing/coding professionals, students, and practice managers! For more information contact: Janet Ridgely, ACA Director of Education and Meetings at 1-800-986-INFO (4636), x216 or via email at jridgely@....

6. IS YOUR CONGRESSMAN/WOMAN ON THIS LIST? HE OR SHE SHOULD BE!

This year, the ACA and the Association of Chiropractic Colleges (ACC) have been leading the effort to pass HR 3476 -- bi-partisan legislation introduced by Congressmen Ed Schrock (R-VA) and Lane (D-IL) -- to extend the existing chiropractic care benefit for active-duty military personnel to America's military retirees, dependents and survivors through the TRICARE program. As a result of lobbying efforts associated with NCLC, which included DCs and students holding meetings in the offices of every Senator and Congressman and Congresswoman, and follow-up efforts by ACA members from coast-to-coast, there are now 60 co-sponsors of HR 3476. That's a good start, but with a total of 435 Members of the House of Representatives it is clear we need more co-sponsors.

Is your Congressman or Congresswoman a co-sponsor? For a complete listing of all 60 current co-sponsors, click on: http://thomas.loc.gov/cgi-bin/bdquery/z?d108:HR03476:@@@P , or take a look below at the state-by-state breakdown posted in the ACA Government Relations war room. If your representative in the U.S. House isn't on the list, please visit www.acatoday.com and take immediate action via ACA's online Legislative Action Center. Here's how: With a few mouse-clicks, every DC, student, CA and chiropractic patient can join the ACA's grassroots effort to pass HR 3476 by clicking on the fo! llowing link to the ACA Legislative Action Center â€“ http://econstituent.votenet.com/(xd2nwjzfzsfi5ef0huphfx45)/index.aspx/aca/letterwriting.aspx?issueid=538 . Once you're there, simply follow the step-by-step directions to find and contact your Congressman/Congresswoman. You will be able to send a message urging your representative to co-sponsor HR 3476 and go on record in support of making chiropractic care seamlessly available in the military health system. 60 Current co-sponsors of HR 3476, the Chiropractic Health Parity for Military Retirees and Dependents Act

State / Member of Congress

Arizona - GrijalvaCalifornia - Bob Filner, ita Millender-Mc, Adam Schiff, Darrell IssaColorado - Marilyn MusgraveFlorida - Corrine Brown, , Deutsch, Jeff , Lincoln -BalartGeorgia - Sanford Bishop, Linder, MajetteHawaii - Neil AbercrombieIllinois - Lane , Gutierrez, , Jerry Costello, Ray LaHood, ManzulloIowa - Leonard Boswell, Jim Leach, Tom LathamKansas - Jim RyunLouisiana - JeffersonMaine - Michaudland - Ben CardinMassachusetts - Capuano, MeehanMichigan - Dale KildeeMinnesota - Olav Sabo, Collin Missouri - Sam GravesNew Hampshire - Jeb BradleyNew Jersey - Bob Menendez, Payne, Rob sNew Mexico - New York - Ed Towns, Steve Israel, BishopOhio - Gillmor, Marci Kaptur, Ted StricklandOklahoma - B! rad CarsonPennsylvania - Phil English, Tim Holden, Jim GerlachSouth Carolina - Joe , Gresham BarrettTennessee - Bart GordonTexas - Frost, Gene Green, Chet Virginia - Ed Schrock, Rick Boucher, Virgil Goode, Bob GoodlatteWashington â€“ Rick LarsenWisconsin - Mark Green

7. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

May 26, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, ACA Board of Governors, House of Delegates and Other Interested PartiesFrom: Garrett CuneoRe: ACA EVP Weekly Report MEMBERS ONLY ISSUEDate: May 24, 2004

MEMBERS-ONLY ISSUE

This week's report includes the following items:

1. ACA, VCA PETITIONS THE COURTS2. BREAKTHROUGH COACHING: COMMITTED TO THE CAUSE3. NATIONAL BOARD MAINTAINS ITS SUPPORT4. OTHER ORGANIZATIONS CONTINUE THEIR SUPPORT5. ACA MENTIONED ON NATIONAL PUBLIC RADIO6. WOMAN'S WORLD FEATURES TOUCHING CHIROPRACTIC SUCCESS STORY7. ACA RESPONDS TO WALL STREET JOURNAL, NEW YORK TIMES AND MORE8. ACA ATTENDS NATIONAL MANAGED HEALTH CARE CONGRESS9. PAC WILL BE A FORCE AT 2004 POLITICAL PARTY CONVENTIONS IN BOSTON AND NEW YORK10. ACA PROVIDES YOUR OFFICE WITH CODING SOLUTIONS

1. ACA, VCA PETITIONS THE COURTS

Last Friday, Mcs, Esq., submitted to the 4th Circuit Court of Appeals a motion for rehearing before both the three-judge panel that submitted the recent ruling, and before the entire appellate court. A copy of the petition laying out the justification for this request, and the argument refuting the decision, can be found on our Web site at: <http://www.acatoday.com/media/releases/pdf/03-1675%5B1%5D.prh.all.pdf>.

We anticipate that the court will review our motion in fairly short order (two weeks to a month) and render a decision on whether or not to rehear the issue. If it decides to rehear it, it will give notice to Trigon to respond. If it does not rehear it, then we have laid the foundation to file a motion with the United States Supreme Court, a process that would most likely take an additional six to eight months.

Weâ€™ve prepared a fact sheet on the Trigon suit that outlines what we have accomplished thus far and why it is our duty to continue this struggle. If you have any doubt that weâ€™re doing the right thing, please visit: <http://www.acatoday.com/media/releases/nclaf_bulletin.shtml>.

2. BREAKTHROUGH COACHING: COMMITTED TO THE CAUSE

Itâ€™s really gratifying to see the level of support from the profession for continuing our crusade against Trigon. The organizations and doctors in the profession are continuing to contribute to the National Chiropractic Legal Action Fund. An example of this took place this past weekend in New York City. Dr. Mark Sanna and his Breakthrough Coaching staff discussed the litigation and their commitment to it with the more than 200 doctors who attended the Breakthrough Coaching seminar. Joining Dr. Sanna in support were Dr. Terry Yochum; Dr. Glenn Manceaux, ACA Council of Delegates President; and Dr. Spoto, ACAâ€™s Pennsylvania delegate. The group succeeded in signing up an additional 15 monthly contributors for an annualized total of $15,000.

Dr. Sanna and his teachers have been one of the strongest supporters of the National Chiropractic Legal Action Fund. Not including what theyâ€™ve succeeded in raising from their clients, Dr. Sanna and his group have contributed $100,000 and have pledged an additional $110,000. We received the first payment on this pledge in the amount of $25,000 today bringing his total to $125,000.

3. NATIONAL BOARD MAINTAINS ITS SUPPORT

At the recent meeting of the Federation of Chiropractic Licensing Board, Dr Ferguson, President of the National Board of Chiropractic Examiners presented to Dr Glenn Manceaux, delegate from Louisiana and President of the ACA Council of Delegates a check for $25,000 to support the legal action fund. This brings total support from National Board at $300,000. That is stepping up for the future of this profession.

4. OTHER ORGANIZATIONS CONTINUE THEIR SUPPORT

Over the last few weeks, a number of other organizations have submitted contributions to the National Chiropractic Legal Action Fund. Here is a list:

Sherman College Students: $146 (first contribution)Tennessee Chiropractic Association: $1,000, bringing total to $7,700Missouri State Chiropractic Association, District 2: $1,200, bringing total to $2,700ACA Sports Council: $1,000, bringing total to $2,935American Chiropractic College of Radiology: $2,015, bringing total to $9,900The Masters Circle: $500, bringing total to $14,000Performance Health: $100, bringing total to $2,000Missouri State Chiropractic Association, District 1: $100, bringing total to $7,400Missouri State Chiropractic Association: $100, bringing total to $2,600NYCC SACA chapter: $1,000, bringing total to $1,809.37North Dakota Chiropractic Association: $7,500, bringing total to $57,505Wyoming Chiropractic Association: $500, bringing total to $4,500Unified Chiropractic Association of Oklahoma: $200, bringing total to $16,200Allied Health of Wisconsin: $50, bringing total to $33,5! 25Florida Chiropractic Association: $1,250, bringing total to $27,500

5. ACA MENTIONED ON NATIONAL PUBLIC RADIO

On Thursday, May 13, National Public Radio (NPR) broadcast from coast to coast a segment on heavy backpacks and a measure in California that would limit the amount of weight kids have to haul on their backs. The broadcast mentioned the ACA, citing our recommendation that kids not carry more than 10% of their weight on their backs. To hear the audio of the segment, visit:<http://www.npr.org/features/feature.php?wfId=1895690>

6. WOMAN'S WORLD FEATURES TOUCHING CHIROPRACTIC SUCCESS STORY

After consulting with the ACA, Woman's World magazine published a moving story of a woman who found relief thanks to chiropractic care from trigeminal neuralgia - a painful condition that left her unable to smile. Woman's World published the story in its May 11, 2004 issue. The magazine enjoys a circulation of over 1.6 million readers. At the end of the article, ACA national spokesperson Jerome Mcs, DC, provides a partial list of some not-so-obvious ailments that chiropractic has had success with. The article also provides ACA's Web site, through which prospective patients can locate ACA members -- like you -- in their communities. Thanks in part to ACA's media relations efforts, nearly 10,000 people use ACA's "Find-a-Doctor" search each month. Try it yourself today: <http://www.acatoday.com/search/m! emsearch.cfm>

7. ACA RESPONDS TO WALL STREET JOURNAL, NEW YORK TIMES AND MORE

ACA continues to serve as the vanguard of the profession by responding promptly to media organizations that misrepresent chiropractic care or portray it in a negative light. Recent ACA responses include letters to the Wall Street Journal, the New York Times and the Miami Herald, plus a positive response to a recent Newsweek article that exposed the dangers of unnecessary back surgery. To view these and other recent ACA's media responses, visit: <http://www.acatoday.com/media/record/>

8. ACA ATTENDS NATIONAL MANAGED HEALTH CARE CONGRESS

ACA President Krippendorf, DC, was invited to the largest gathering of managed care executives held by the National Managed Health Care Congress (NMHCC) in Washington, DC, May 5-6, 2004. Specifically, he was part of the National Medical Directors Forum, which met for two full days to discuss the new dynamics in health care, centering around quality, best practices and performance pay. National insurance plans such as Anthem, BC/BS, United Healthcare and major payers such as CMS, General Electric, and others were in attendance.

After listening to how the MDs would tweak the current system, Dr. Krippendorf challenged the group to think outside the box and to create patient-preferred options to neuromuscular care that keep costs down and do not contribute to the drivers in today's health care market, which are prescription costs, out-patient facility services and surgery. This idea was supported by NCQA, a national accreditation agency for managed care networks that is expanding patient programs of this nature. ACA plans to meet with NCQA officials for further discussions.

The senior editor for Business Insurance also interviewed Dr. Krippendorf for a story that will continue to challenge policymakers to incorporate chiropractic into core insurance benefits.

9. PAC WILL BE A FORCE AT 2004 POLITICAL PARTY CONVENTIONS IN BOSTON AND NEW YORK

As the national voice for doctors of chiropractic and their patients, and one of the most effective health care advocacy groups at work in Washington, DC, the ACA is once again ready to make its presence felt when the nation's elected leaders - Republicans and Democrats - gather this summer for the presidential nominating conventions. For five days beginning on July 26th, the Democrats will meet in Boston to nominate Senator Kerry and a yet to be selected running mate as their candidates for president and vice president in November. President W. Bush and Vice President Dick Cheney will be re-nominated by their party at the Republican Convention in New York during the week of August 30th. The political conventions present opportunities to educate key members of Congress and administration officials about the concerns of the nation's 60,000 doctors of chiropractic and 30 million chiropractic patients. The AC! A's government relations team is now planning advocacy activities focusing on the chiropractic profession's priority legislative and regulatory issues, including prompt implementation of the ACA-backed demonstration of expanded access to chiropractic care through Medicare, full inclusion of and direct access to DCs (HR 4051) in the VA health care system and enactment of a legislation (HR 3476) to extend chiropractic care benefits to military retirees and dependents. In addition, the ACA will officially recognize two leaders in Congress who have supported the chiropractic profession on key votes time and again, Senator Tom Harkin (D-IA) and Congressman McHugh (R-NY). Senator Harkin, a speaker once again at ACAâ€™s National Chiropractic Legislative Conference in March, serves on the Senate Appropriations Committee and has worked tirelessly in support of funding for chiropractic research initiatives and is leading the fight for fairness for DCs in the National! Health Service Corps student loan re-imbursement program. Congressman McHugh, the Chairman of the Armed Services Subcommittee on Total Force, was a driving force behind enactment in 2003 of ACA-backed legislation ordering the Pentagon to accelerate by a full year the availability of chiropractic care to America's active-duty military personnel.

Although space is limited, the gatherings with Senator Harkin and Congressman McHugh will be open to ACA members who are interested in attending events related to the political conventions. If you will be in Boston or New York when the conventions are in session and would like more information, please contact Kim Krocker, ACA-PAC Manager, at (800) 986-4636.

10. ACA PROVIDES YOUR OFFICE WITH CODING SOLUTIONS

If you missed ACA's live teleseminar, "Coding Solutions," order your CD-ROM of this educational teleseminar today. Speaker Hamm, DC, Chairman of the ACA Coding and Reimbursement Committee and ACA Representative to the American Medical Association RVU Update Committee (RUC) and Health Care Professionals Advisory Committee (HCPAC), spoke about key coding issues including chiropractic manipulative treatment, physical medicine, modifiers, troubleshooting and other chiropractic related services.

Just read what one participant of this live teleseminar had to say.

"Thank you for the opportunity to participate in the seminar. I learned quite a bit of information and love to participate in future teleconferences, or actual seminars related to insurance/billing/motivational as well." - Kathy ez, Sylvia Chiropractic Center

*Price: ACA Member: $39.00; Non-member: $69.00To order your CD ROM version of "Coding Solutions" call 800-368-3083. Order Item Audio 32.*Includes conference materials and speaker handouts

This audio CD-ROM is the perfect compliment to the ACA's 2004 Chiropractic Coding Solutions Manual. Developed by doctors of chiropractic and coding experts, this completely revised 2004 edition is your one-stop desktop reference for proper coding and billing. These manuals are selling fast, so be sure to call soon for your copy! Includes a free CD-ROM and a free subscription to the quarterly newsletter, the ACA Practice Advisory. Call 800-368-3083 to order or visit our online store now at www.acatoday.com <http://www.acatoday.com> (Just click on the shopping cart).

11. CANâ€™T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************To be removed from further mailings from our list please click the unsubscribe link

June 3, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: June 1, 2004

This week's report includes the following items:

1. NATIONAL HEADACHE AWARENESS WEEK: AN OPPORTUNITY FOR PR IN YOUR LOCAL AREA2. NCLC UPDATE -- CONGRESSMAN ROB SIMMONS KEEPS PROMISE TO ENSURE CONNECTICUT VETERANS HOSPITALS WILL BE THE FIRST TO INTEGRATE CHIROPRACTIC CARE3. GEORGE MCANDREWS INTERVIEWED BY DYNAMIC CHIROPRACTIC4. DR. BAZAKOS SPEAKS AT NEW YORK CHIROPRACTIC COLLEGE; NEW YORK CHIROPRACTIC ASSOCIATION SHOWS ITS CONTINUED SUPPORT FOR LEGAL ACTION5. POPULARITY OF CHIROPRACTIC DEMONSTRATED AGAIN6. EVER VIGILANT, ACA AND ACC SEND PT LOBBY IN DISTRICT OF COLUMBIA BACK TO THE DRAWING BOARD7. CORRECTION8. DOD CHIROPRACTOR GETS CREDENTIALED ON SHIP9. ACAâ€™S NEW CODING EDUCATION PROGRAM GOES DOWN TO GEORGIA10. FEEL FREE TO CONTACT ME

Late Breaking News: Not unexpectedly, the Appeals Court turned down our request for a rehearing in the Trigon suit. This now allows us to pursue a petition to the Supreme Court. Look to this report and other ACA sources for additional information in the coming weeks.

1. NATIONAL HEADACHE AWARENESS WEEK: AN OPPORTUNITY FOR PR IN YOUR LOCAL AREA

June 6-12, 2004 is National Headache Awareness Week, sponsored by the National Headache Foundation -- a perfect time for you to educate your community about chiropractic's role in headache treatment.

For those members who would like the convenience of a ready-made news release on headaches and chiropractic treatment, visit our Web site at <http://www.acatoday.com/media/tips/headache.shtml>. Feel free to use the release, add your own name and contact information and send to your local paper. You can add reference to June 6th being "Headache Awareness Week."

In fact, ACA has a wide variety of consumer health information that you can use as news releases or fact sheets for your patients. HTML/text versions of our consumer health information can be found here: <http://www.acatoday.com/media/tips/> (scroll down to the bottom of the page and you'll see a listing of all topics available). Attractively designed patient handouts on these same topics can be accessed by members only at the following link (you'll need to enter your username and password): <http://www.acatoday.com/publications/tips/>. Simply download the fact sheets, print them out and photocopy to distribute in your waiting room. These are PDF files, so you'll need Adobe Acrobat Reader to view them.

We also have compiled a comprehensive list of health observances throughout the year that you can use to gain PR in your local area. The list comes as part of our Practice Promotion Tool Kit -- a popular product that is available through our ACA store. More information can be found on our shopaca Web site: <http://www.acatoday.com/store/index.cfm?frm=details & piid=73 & scid=20 & CFID=31269 & CFTOKEN=84337415>.

If you'd like more information on any of these items, please contact ACA's Communications Department at 1-800-986-4636.

2. NCLC UPDATE -- CONGRESSMAN ROB SIMMONS KEEPS PROMISE TO ENSURE CONNECTICUT VETERANS HOSPITALS WILL BE THE FIRST TO INTEGRATE CHIROPRACTIC CARE

Attending the National Chiropractic Legislative Conference (NCLC) and working with the ACA to educate your elected representatives on Capitol Hill about chiropractic care does make a difference - A BIG DIFFERENCE. Here's an example of some excellent lobbying work done by ACA Connecticut Delegate Dr. Overland and his Connecticut colleagues, including Dr. Bellows, President of the Connecticut Chiropractic Association (CCA), and Dr. Kane.

After receiving a briefing earlier in the year from the ACA Department of Government Relations, Dr. Overland and the CCA began to enlist the help of a key congressman from their state to ensure that the impact of the U.S. Department of Veterans Affairs' (VA) decision to make DCs the first providers in 25 years added to the massive veterans health care system was felt close to home. In March, during NCLC, Congressman Rob (R-CT) met with Dr. Overland, Dr. Kane and other CT DCs who were in Washington, DC and committed to help ensure that veterans hospitals in Connecticut would be among the first to integrate chiropractic care and hire a doctor of chiropractic. Congressman then arranged a meeting with the top VA official in the state of Connecticut and invited the ACA, the CCA and the Association of Chiropractic Colleges to attend.

It is a pleasure to report that the meeting was held on May 26th and produced a commitment from the Director of the Connecticut VA system to appoint panel of DC "advisors" - including representatives from the CCA - to assist him in integrating chiropractic care and hiring the first DC to provide care for veterans at both the Newington and West Haven VA facilities, likely as early as the Fall. In addition, it is now expected that the integration of chiropractic services into the VA facilities in Connecticut will ultimately result in formal working agreements, internships and exchange programs between the University of Bridgeport Chiropractic College and the Connecticut VA system.

The opportunities for DCs to work in the VA system in Connecticut and at other facilities across the U.S. is a direct outgrowth of legislation developed by the ACA and ACC, mandating the integration of chiropractic care into the VA system. That law was originally enacted in 2002, but was improved upon in 2003 with enactment of legislation to grant the VA explicit authority to hire DCs as full-time employees. Congressman , who represents the Hartford area and chairs the Veterans Affairs subcommittee that oversees the VA health system, was instrumental in working with the ACA and ACC to enact the hiring legislation - and has pledged to continue to work closely with the ACA, ACC and the CCA to ensure that DCs and their patients are treated fairly by the VA.

Great work from all of those involved in Connecticut and here at ACA office. Now lets go out and replicate this fine example of a coordinated and successful local and national effort to bring chiropractic care to other VA facilities around the nation. For the latest information from the ACA on employment of DCs by the VA and the Department of Defense, please click on the following links to the ACA Web site: <http://www.acatoday.com/government/va/042304.shtml>

<http://www.acatoday.com/pdf/military_bases.pdf>

Here's a map of the VA's 21 service regions, or VISNs: <http://www1.va.gov/directory/guide/division_flsh.asp?divisionId=1>

Here's a map of VA health facilities: <http://www1.va.gov/directory/guide/home.asp?isFlash=1>

3. GEORGE MCANDREWS INTERVIEWED BY DYNAMIC CHIROPRACTIC

The upcoming issue of Dynamic Chiropractic includes a front-page interview WITH Mcs, Esq. Mr. Mcs comments on the status of the lawsuit against Trigon, what we have accomplished and why we need to continue to pursue this matter to the end. If you want an advance view of the interview please visit:<http://www.chiroweb.com/archives/22/13/01.html>

4. DR. BAZAKOS SPEAKS AT NEW YORK CHIROPRACTIC COLLEGE; NEW YORK CHIROPRACTIC ASSOCIATION SHOWS ITS CONTINUED SUPPORT FOR LEGAL ACTION

A little over a week ago, ago Dr Lew Bazakos, member of ACAâ€™s Executive Committee, was given the opportunity to speak before the members of the New York Chiropractic Association and the faculty of New York Chiropractic College. Dr. Bazakos was asked to speak on the issue of the challenges and opportunities facing the chiropractic profession. Dr. Bazakos presented a PowerPoint presentation noting ACAâ€™s successes in numerous areas including the Department of Veterans Affairs, Medicare and DoD. Dr. Nichi has asked that he make a similar presentation before the board of trustees, of which he is a member and also before the NYCC SACA chapter. Following Dr. Bazakosâ€™ presentation, he was presented with a check for $1,000 by the President of the New York State Chiropractic Association in support of the National Chiropractic Legal Action Fund

5. POPULARITY OF CHIROPRACTIC DEMONSTRATED AGAIN

Solucient, LLC, the group that maintains the nation's largest health care database, recently released a report on the shift that is occurring in popularity towards outpatient health care. This change in care has resulted in growth in a number of different health care services, among them, complementary and alternative medicine. The Solucient report indicates that acupuncture "had a 200 percent increase in volume from 1999 to 2001 and chiropractic care rose 91 percent in that three-year period." This study also indicates that increased coverage of chiropractic care by insurers results in an increase in chiropractic patients. The Solucient report not only demonstrates an increase in popularity of alternative therapies by patients, but also an increase in referrals to complementary and alternative therapy providers from primary care physicians. The Solucient study makes mention of the 1996 survey of the Kaiser Permanente Northern California medical group which revealed! that "90 percent of adult primary care physicians and obstetrics-gynecology clinicians recommended at least one alternative therapy to their patients, primarily for pain management." Special note is also made of a 1998 article in the Journal of the American Board of Family Practice, which found that in regard to family practitioners 29 percent were "open to integrating chiropractic in their practices." For the full report please check: <http://www.acatoday.com/media/research/>

6. EVER VIGILANT, ACA AND ACC SEND PT LOBBY IN DISTRICT OF COLUMBIA BACK TO THE DRAWING BOARD

In a united and winning effort to safeguard the scope of practice of doctors of chiropractic in the nation's capital city, the ACA's Washington DC Delegate, Dr. Bruce Nordstrom, and ACC Executive Director, O'Bryon, confirmed on May 20th that the District of Columbia's Physical Therapy Board had withdrawn a proposal to include spinal manipulation from its proposed scope of practice regulations. In April and May, PT lobbyists in Washington, DC were attempting to pass their national association's model state law as a proposed rule change, but were defeated by an aggressive ACA and ACC response that resulted in a pro-chiropractic ruling by the DC's corporation council. The ACA/ACC position -- that only the elected city council, not an appointed regulatory panel like the Physical Therapy Board, could make changes to the existing scope of practice statute - was entirely upheld by city officials. Kudos to Dr. Nordstrom and O'Bryon for their fine work, which was suppo! rted by ACA's Government Relations Department.

7. CORRECTION

My report of two weeks ago mentioned the success of Dr. Stiso and the leadership of the newly formed Association of New Jersey Chiropractors in passing out of committee legislation that would require chiropractic along with other practitioner to be reimbursed at the same rate under various health and accident plans. Dr. Stiso indicated that I failed to mention one doctor whose participation in this effort was particularly important. Dr. Tim D'Elia, the associationâ€™s insurance chair. I regret the oversight.

8. DOD CHIROPRACTOR GETS CREDENTIALED ON SHIP

Dr. Kildow, who for nine years has been the chiropractic doctor at the Naval Hospital at Camp Lejeune, North Carolina, was mobilized last year as a Naval Special Intelligence Officer to the Horn of Africa aboard the USS Mount Whitey. He reported the following to Joe Keating, PhD, a well-known chiropractic historian:

â€During the deployment it was learned by the Medical Officer (MO) aboard the ship that I was a chiropractor. He asked if I would see some of his patients and of course I was happy to, but I wanted it to be in an official capacity, not just as an aside. The MO requested my credentials from the credentialing office at the hospital that I work for. The credentials were faxed and I became a licensed/credentialed chiropractor rendering chiropractic care aboard a navy ship in a war zone.

To my knowledge, this is the first time that "officially recognized chiropractic care" has ever been available aboard a ship and I would think that it would be important to have it recognized by an authority such as yourself. Who knows, maybe we can get a program initiated aboard ships at sea in addition to the bases. As you may know, some of the larger ships will contract teachers to teach, why not chiropractors to treat? It is hard for me to imagine a more ergonomic challenging environment than a ship at sea."

Times they are a-changing.

9. ACAâ€™S NEW CODING EDUCATION PROGRAM GOES DOWN TO GEORGIA

The Georgia Chiropractic Association (GCA) is the first state association this summer to take advantage of ACA's new coding educational program, â€œNavigate the Insurance & Coding Process,â€ on Saturday, June 5. Designed for chiropractic professionals, this new program was developed by the ACA in cooperation with Breakthrough Coaching as a vehicle to provide expert coding instruction to state associations in full or half-day seminars. Participants learn ways to cut insurance administrative time in half, negotiate successfully with insurers, and steer clear of costly coding errors, claim delays, billing reviews, and fraud investigations. If you are interested in registering for the GCA seminar or would like to find out to bring this program to your area, visit ACA's new coding web resource section today at <http://www.acatoday.com/about/products/coding_seminars/>. /! P>

10. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@...

************************To be removed from further mailings from our list please click the unsubscribe link

June 8, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: June 7, 2004

MEMBERS-ONLY EDITIONThis week's report includes the following items:

1. CMS SET TO PLACE NEW "FREQUENCY LIMITS" ON CHIROPRACTIC SERVICES UNDER MEDICARE2. ACA/VCA TAKES CASE TO SUPREME COURT3. SOME STIRRING IN THE HHS CASE4. PROFESSION CONTINUES TO SHOW SUPPORT FOR LAWSUITS5. DEADLINE FOR SCHOLARSHIP APPLICATIONS APPROACHING6. MEMBERSHIP IS A CONTACT SPORT7. ACA-PAC: ADVANCING CHIROPRACTIC ON CAPITOL HILL NEARLY THREE DECADES8. LEADERSHIP ON THE ROAD9. LIVE ACA TELESEMINAR: OUTCOMES ASSESSMENT MEASURES HELP PREPARE YOU FOR CHIROPRACTIC AUDITS10. FEEL FREE TO CONTACT ME

1. CMS SET TO PLACE NEW "FREQUENCY LIMITS" ON CHIROPRACTIC SERVICES UNDER MEDICARE

We have been speaking for some time with the Centers for Medicare and Medicaid Services (CMS) regarding their plan to develop a new spinal CMT modifier designed to distinguish between "active/correctiveâ€ services, which are covered, and "maintenance therapy,â€ services, which are not.

The regulation to implement this change came out on May 28, 2004 and contained something we did not expect. In addition to the new modifier procedure, the regulation also would permit Medicare carriers to establish "frequency limits" in place of the current screening parameters now in place. When a claim reaches the new "frequency limit," the carrier is given the ability to "auto-deny" the claim without any review for medical necessity.

Currently, the carriers are required to "screen" a claim for medical necessity before the claim is denied. The new system appears to us to be nothing more than a hard cap on chiropractic services and a violation of Medicare law, which requires a determination of medical necessity before a claim is denied. The change would become effective on October 1.

We see this action as being very serious, and we plan to make this a priority in our discussions with HHS Secretary Tommy . We will keep you apprised.

2. ACA, VCA TAKE TRIGON CASE TO SUPREME COURT

Not unexpectedly, the 4th Circuit Court of Appeals rejected our petition for a rehearing in the Trigon suit, setting the stage for an appeal to the U.S. Supreme Court. The issues raised in our petition suggest a direct conflict between the decision of the Court of Appeals in the Trigon case and two previous decisions of the Supreme Court of the United States (weld Corp. vs. Independence Tube Corp., 467 U.S. 752 [1984] and U.X. vs. Paramount Pictures, Inc., 334 U.S. 131 [1948]), as well as a direct conflict between the decision of the 4th Circuit and a decision of the U.S. Court of Appeals for the 6th Circuit (Nurse Midwifery Assoc. vs. Hibbett, 918 F.2d 605). Both are issues that are frequently examined by the Supreme Court: 1) a lower court being out of step with a controlling decision of the Supreme Court, and/or 2) a conflict between two lower courts of appeals requiring refereeing by the Supreme Court to determine which appeals cour! t decision and reasoning is correct.

For more details, visit: http://www.acatoday.com/media/releases/060304.shtml.

3. SOME STIRRING IN THE HHS CASE

After two years of silence from the court that is considering our motion for summary judgment in our case against HHS, there are some signs from the court that imply that the issue may soon receive some attention. The court has asked both parties if they have any new information to provide in the case since the time the summary judgment notices had been filed. We will naturally take advantage of the opportunity to provide information.

4. PROFESSION CONTINUES TO SHOW SUPPORT FOR LAWSUITS

Voting with their checkbooks, doctors and students of the profession continue to fund the lawsuits against Trigon and HHS. For the month of May, we collected $199,687 in contributors from various organizations, state associations, doctors, and students. More significant was that the number of monthly contributors increased by 26, bringing the total number of monthly contributors to 1,121. Only the enemies of this profession who hoped that the recent action by the courts would discourage us are disappointed. I for one am pleased to be part of a profession that is willing to put its money where its mouth is.

5. DEADLINE FOR SCHOLARSHIP APPLICATIONS APPROACHING

SACA students who are applying for American Chiropractic Foundation (ACF) scholarships need to get their applications and supportive information to the ACA office before June 15th. For more details, contact the SACA leaders at your institution.

6. MEMBERSHIP IS A CONTACT SPORT

Take a moment next week to talk with a non-ACA member in your community. You will be surprised by just how little they know about what is happening at the ACA. You might even consider sharing with them this document: http://www.acatoday.com/membersonly/leadership/Done_lately.pdf, which discusses some of our current initiatives. If they have any questions you can't answer, refer them to me. If you think they might be helped by a subscription to this weekly report, please send me their email address. 7. ACA-PAC: ADVANCING CHIROPRACTIC ON CAPITOL HILL NEARLY THREE DECADES

The ACA-PAC is the only federal political action committee helping to elect and re-elect candidates for the U.S. Congress who are committed to fighting for doctors of chiropractic and their patients -- in Medicare, the Veteransâ€™ Affairs health care system and the military health care system. In 2003, with ACA-PAC's support, Congress passed, and the President signed into law three ACA-backed bills establishing a test of expanded access to chiropractic services for Medicare beneficiaries, authorizing the Veteransâ€™ Affairs health care system to hire DCs, and accelerating the availability of chiropractic care for America's military personnel. To continue to defeat the opponents of chiropractic care and achieve the profession's legislative objectives, we need a pro-chiropractic Congress. Please join the ACA-PAC today and join the fight for your practice and your patients.

Although there are many larger PACs with anti-chiropractic agendas, including PACs that support organized medicine, the physical therapy lobby and the pharmaceutical giants, ACA-PAC is known and respected in Washington, DC for focusing solely on helping the friends of chiropractic profession compete and win on Election Day. This year, as Americans prepare to go to the polls to choose a President and determine which party will control Congress, the ACA-PAC has already weighed-in to support pro-chiropractic leaders like senators Chuck Grassley, Tom Daschle, Orrin Hatch, Arlen Specter and Tom Harkin, and representatives like Dennis Hastert, Jim Ramstad, Earl Pomeroy, Ed Schrock and Bob Filner. Also, in critical open seat contests in Florida, Georgia, Colorado and other states, the ACA-PAC is urging candidates to publicly announce pro-chiropractic positions on key issues.

Although the candidates are getting the message, the resources of the ACA-PAC are at a low level as we head into the final months of the campaign. As you may know, the ACA-PAC is funded solely by the voluntary contributions of ACA members. If you are interested in supporting your PAC, please visit http://www.acatoday.com/membersonly/acapac/contribution_form.pdf and enter your ACA Membership ID and password, then fill out the form. Or simply contact Kim Krocker, ACA-PAC Manager at (800) 986-4636 or kkrocker@....

8. LEADERSHIP ON THE ROAD

ACA Chairman Dr. McClelland traveled to Western States Chiropractic College to attend the investiture of the collegeâ€™s new president, Dr. Jim Brimhall, and to speak to the attendees about various ACA initiatives, including legislative activities and lawsuits.

Dr. Zange, member of ACAâ€™s Board of Governors, attended the meeting of the ACA Council on Orthopedics held in Orlando, Florida. Also meeting at that time were the Academy of Orthopedists and the American College of Chiropractic Orthopedists. Dr. Zange spoke to all the groups about ACA activities and conducted important ACA business. Dr. Zange was honored on Saturday evening by the ACCO as their Chiropractic Orthopedist of the Year. A well-deserved honor.

Drs. Don Krippendorf, J. Flynn and Kerwin Winkler traveled to Singapore as ACA representatives attending the conference of the World Federation of Chiropractic.

Dr. Gentile spoke last week before a gathering of the South Carolina Chiropractic Association. Nearly 140 doctors heard a presentation by Dr. Gentile, who provided an update on the lawsuits and other ACA activities.

9. LIVE ACA TELESEMINAR: OUTCOMES ASSESSMENT MEASURES HELP PREPARE YOU FOR CHIROPRACTIC AUDITS

Did you know the average amount insurance companies demand back from chiropractic audits is $50,000? One of the best ways to prevent this from happening to your practice is to document the cost-effectiveness of chiropractic care to insurers through the proper legal use of common questionnaires and functional evaluations used in clinical practice as a basis of outcomes assessment measures. ACA's next live teleseminar, Using Outcomes Assessment Measures Effectively, will make insurance inquiries a WIN for your patient and demonstrate to insurers how effective your treatment is. The program covers the proper legal use and application of over 30 questionnaires and evaluations in 12 key outcomes assessment areas: General Health, Pain Measurement, Spine-related Conditions, Upper and Lower Extremities, Psychometrics, Risk Factors, Range of Motion Strength & Endurance, Patient Satisfaction, and Functional Assessment.

The program is presented by Kim Christensen, DC, DACBR, CSCS, CCSP; a full-time hospital-based chiropractor and the author of numerous texts on musculoskeletal rehabilitation, including the Outcomes Assessment CD-ROM and accompanying textbook. A board-certified rehabilitation chiropractor who has practiced for 25 years, Dr. Christensen has also served as a faculty member to chiropractic colleges throughout the U.S. and as a team chiropractor to numerous high school and university athletic programs.

Date: Tuesday, June 15Time: 3:00 to 4:30 p.m. Eastern Standard TimeCost: ACA Members $69; Non Members $99, SACA Members $35.

Register today! Cost includes free materials and speaker handouts sent via email to each participant upon receipt of registration. Click here for more information about the Outcomes Assessment teleseminar or to register: http://www.acatoday.com/about/products/teleseminars/tele_2004_june.shtml. For more information about the Outcomes Assessment products available through the ACA, visit our online product store at www.acatoday.com. (Just click on the shopping cart).

10. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

June 16, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: June 14, 2004

MEMBERS-ONLY EDITION

This week's report includes the following items:

1. NATIONAL ASSOCIATION OF CHIROPRACTIC ATTORNEYS REAFFIRMS SUPPORT FOR TRIGON SUIT2. ACA REQUESTS YOUR INPUT ON AN UPGRADED â€˜ACA TODAYâ€™3. ACA WORKING TO ENSURE THAT CONGRESS DOESNâ€™T INTERFERE WITH CHIROPRACTIC PATIENTSâ€™ ACCESS TO SAFE AND EFFECTIVE DIETARY SUPPLEMENTS4. GEORGIA DOCTORS WORK WITH ACA-PAC IN SUPPORTING CANDIDATE FOR U.S. SENATE5. DR. MARK CHARRETTE ADDS HIS SUPPORT TO NATIONAL CHIROPRACTIC LEGAL ACTION FUND6. DON'T TELL ME THERE WAS NO COLLABORATION/CONSPIRACY7. CORRECTION TO STORY ON RECENT VICTORY IN THE DISTRICT8. MEDICARE VENDORS, CLEARINGHOUSES OR OTHER THIRD-PARTY BILLERS AND THE HIPAA/MEDICARE CONTINGENCY PLAN9. STATE ASSOCIATION CODING PROGRAM A SUCCESS IN GEORGIA10. FEEL FREE TO CONTACT ME

1. NATIONAL ASSOCIATION OF CHIROPRACTIC ATTORNEYS REAFFIRMS SUPPORT FOR TRIGON SUIT

The National Association of Chiropractic Attorneys (NACA) has formally passed without a dissenting vote the following resolution regarding the ongoing lawsuit against Trigon Blue Cross/Blue Shield:

WHEREAS, the American Chiropractic Association in conjunction with the Virginia Chiropractic Association has filed suit against Trigon seeking to support the interests of chiropractic physicians and their patients; and

WHEREAS, the U.S. Court of Appeals for the Fourth District has issued a decision upholding the lower tribunal's summary judgment effectively dismissing the suit which the court refused to reconsider upon the motion filed by the American Chiropractic Association and the Virginia Chiropractic Association; and

WHEREAS, the best interests of chiropractic and chiropractic patients are served by the vigorous prosecution of an appeal to the U.S. Supreme Court; and

WHEREAS, the American Chiropractic Association in conjunction with the Virginia Chiropractic Association plan to appeal to the U.S. Supreme Court; and

WHEREAS, the National Association of Chiropractic Attorneys continues to support of the American Chiropractic Association and the Virginia Chiropractic Association in their efforts through monetary and informational support to pursue an appeal to the U.S. Supreme Court;

NOW THEREFORE BE IT RESOLVED, that the National Association of Chiropractic Attorneys reaffirms its support of the American Chiropractic Association and the Virginia Chiropractic Association in their appeal to the U.S. Supreme Court and urges the chiropractic community nation wide to continue or add its support to the American Chiropractic Association and the Virginia Chiropractic Association in their endeavor to successfully prosecute the pending appeal.

2. ACA REQUESTS YOUR INPUT ON AN UPGRADED â€˜ACA TODAYâ€™

As part of our ongoing efforts to serve you better, weâ€™d like to get your feedback on the future direction of your association newsletter, ACA Today. We are considering expanding the content of the newsletter in the near future to include not only updates on ACA programs and activities, but also more in-depth information on clinical and wellness topics. Your input now could help determine the direction ACA Today takes, and how well it will serve you in your practice.

What articles in the current ACA Today do you enjoy reading? What articles would you rather do without? Are there particular topics youâ€™d like to see covered that currently are not?

In addition to the current ACA Today content - such as insurance reimbursement information, the latest advocacy and government relations news, practice management advice and updates on ACA activities - would you be interested in any of the following?

Â· clinical pieces written by chiropractors Â· articles on documentation Â· wellness-related items Â· stories on fraud and abuse Â· features about chiropractors with unusual or groundbreaking practices Â· financial advice Â· analysis of general health care news and how it affects youÂ· Other topics that arenâ€™t mentioned here?

We want to hear from you. Please e-mail your comments to me at gcuneo@..., so we can tailor ACA Today to meet your needs.

3. ACA WORKING TO ENSURE THAT CONGRESS DOESNâ€™T INTERFERE WITH CHIROPRACTIC PATIENTSâ€™ ACCESS TO SAFE AND EFFECTIVE DIETARY SUPPLEMENTS

ACAâ€™s Government Relations staff continues to be a force on Capitol Hill, educating members of Congress about the potential harm that would be done by proposed legislation to impose new barriers for consumers who want to use dietary supplements that are proven to be safe and effective. In 2003, ACA declared its opposition to S. 722, a bill introduced by Senator Durbin (D-IL), to create a series of new government reporting requirements for dietary supplements, and has been working to defeat the bill. Since then, S. 722 has gained only four co-sponsors -- senators Hillary Clinton (D-NY), Schumer (D-NY), Dianne Feinstein (D-CA) and McCain (R-AZ) -- and has not been considered at the committee level. However, on Tuesday, June 8th, the Senate Governmental Affairs Subcommittee on Oversight of Government Management held a hearing -- attended by ACAâ€™s Government Relations team -- that did focus on some of the issu! es related to the bill and to consider the larger matter of the overall impact of the 1994 Dietary Supplement Safety Act. Some groups, like the American Medical Association (AMA), used the hearing as an opportunity to try to justify new anti-consumer requirements that would make supplements available by prescription only. Based on the comments of senators at the hearing, S. 722 has not gained new support and remains unlikely to be considered by this Congress. The ACA will continue to closely monitor S.722 and legislation with similar goals as well as any new efforts by the AMA to turn back the clock on the important consumer (and DC) protections contained in current law.

4. GEORGIA DOCTORS WORK WITH ACA-PAC IN SUPPORTING CANDIDATE FOR U.S. SENATE

When it comes to supporting the re-election of pro-chiropractic members of Congress, ACA members from communities across the country and the ACA-PAC (political action committee) are working together to maximize the clout of the profession and ensure that friends of the profession win on Election Day. By focusing on key Senate and House races in 2004, the activism of individual ACA members is solidifying the ACA's status as a powerful political force. Here are some examples:

Dr. Jim Anchors of Atlanta, GA, spearheaded a drive in Atlanta and across the state of Georgia, raising $14,000 for the campaign war chest of Congressman ny Isakson (R-GA), who is the frontrunner to succeed the retiring Zell (D-GA) in the U.S. Senate. Dr. Anchors has known and supported Congressman Isakson for 35 years, and arranged a June 1st meeting in Washington, DC, to discuss the campaign and chiropractic issues. ACA-PAC weighed-in with a contribution of $5,000 to Congressman Isakson's campaign, in addition to the support from Georgia DCs delivered by Dr. Anchors.

Of course, the December 2003 chiropractic-only fundraiser for Senator Chuck Grassley (R-IA) was also a tremendous success thanks to the participation of DCs from across the state of Iowa, including Dr. Ken Storjohann and other leaders of the Iowa Chiropractic Society, and from nearly 300 DCs around the country who were so impressed by Senator Grassley's determined stand against organized medicine and in support of the Medicare Chiropractic Demonstration Project. Follow-up fundraisers supporting Senator Grassley's re-election this year have been hosted by ACA's Iowa Alternate Delegate, Dr. Kraus of Carroll, IA, and ACA members Drs. Bradley, Chad and Mickey Burt of Walcott, IA.

We have additional fundraisers scheduled where we are cooperating with state associations and will report on these in subsequent EVP reports.

5. DR. MARK CHARRETTE ADDS HIS SUPPORT TO NATIONAL CHIROPRACTIC LEGAL ACTION FUND

Dr. Mark Charrette, a prominent chiropractic lecturer, has scheduled a two-day seminar in October on extremity adjusting on behalf of the National Chiropractic Legal Action Fund (NCLAF). Dr. Charrette has waived his honorarium and announced that all proceeds from the seminar will go toward NCLAF. The program is scheduled for October 2nd and 3rd in Chicago, Illinois, at the Wyndham Lisle Hotel. Look to the ACA for further details.

6. DON'T TELL ME THERE WAS NO COLLABORATION/CONSPIRACY

You might recall the headlines in the Chicago Sun-Times on December 8, 1994 and in other newspapers throughout the country shortly after the AHCPR guidelines were released, indicating that spinal manipulation was the preferred treatment for low back pain. "When it comes to low back pain, think twice before resorting to the usual remedies--best rest, prescription drugs and surgery. Try a chiropractor instead..." Even the ls of Internal Medicine characterized the AHCPR conclusions about spinal manipulation as historic.

So what did Trigon do to provide this treatment to its insured? Instead of implementing the recommendation of providing what the federal government determined to be the most effective means to treat low back pain, they convened a group of medical doctors, recommended by the medical specialties in the state (without chiropractic representatives), and came up with a distorted version of the guidelines. Dr. Haldeman, a member of the AHCPR panel, stated the following under oath:

"By omitting the AHCPR's definition of manipulation, Trigon and its Managed Care Advisory Panel materially altered the recommendations of the AHCPR. That alteration created a Trigon guideline that did not recommend the manipulation that is provided primarily by doctors of chiropractic, as did the AHCPR guidelines. A point that became evident from the AHCPR guidelines was that manipulation was the only treatment approach that required a medical physician, in most instances, to make a referral of a patient with uncomplicated low back pain. The inevitable, and obviously intended consequences of Trigon's and the Managed Care Advisory Panel's alteration of the AHCPR guidelines, is to deprive patients of the benefit from spinal manipulation as practiced by doctors of chiropractic, and to deprive doctors of chiropractic of the opportunity to treat those patients."

7. CORRECTION TO STORY ON RECENT VICTORY IN THE DISTRICT

My report of two weeks ago discussed how the cooperation between ACA and the doctors in the District of Columbia is helping to stop the physical therapists in their attempt to include spinal manipulation in their scope of practice. As usual, in attempting to include those involved in this effort I left someone out. In this case, Dr. Bruce Nordstrom, ACAâ€™s District of Columbia delegate, reported to me the great work of Dr. Tony Mirando, Chairman of the Washington, DC, Board of Examiners, as well as the significant involvement from the President of the District of Columbia Chiropractic Association -- Dr. Salcedo -- who is also an ACA alternate delegate. I apologize for the oversight.

8. MEDICARE VENDORS, CLEARINGHOUSES OR OTHER THIRD-PARTY BILLERS AND THE HIPAA/MEDICARE CONTINGENCY PLAN

The Centers for Medicare and Medicaid Services (CMS) has indicated their understanding that many physicians, providers, and suppliers do not submit claims directly to Medicare, but submit their claims through a third party, such as a billing vendor, clearinghouse or other third-party billing agent. CMS recognizes the importance of these third parties to many providers and the extent to which providers rely on those entities to meet HIPAA requirements in a cost-effective manner with minimal impact on the provider's most important mission, i.e., delivering high quality medical care to those who need it. But, did you know that there have been instances where some third-party billers are taking claims submitted to them by Medicare providers that are HIPAA compliant and then converting them into a non-compliant format before sending them to a Medicare claims processing contractor?

CMS urges Medicare providers to understand the following issues:

Issue #1 - Understand where your vendor, clearinghouse, or other third-party biller stands in terms of HIPAA compliance.

Issue #2 - Make sure your agent builds on the HIPAA compliance you have achieved.

Issue #3 - Understand when your vendor, clearinghouse, or other third-party biller will stopaccepting non-compliant transactions.

Click here to read more from CMS on the issues outlined abovehttp://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0414.pdf.

9. STATE ASSOCIATION CODING PROGRAM A SUCCESS IN GEORGIA

The Georgia Chiropractic Association (GCA) was the first state association to hold the coding educational program, "Navigate the Coding and Insurance Process," now available for state associations and chiropractic colleges through the ACA.

This turnkey program was developed in association with Breakthrough Coaching (BTC), and provides chiropractic professionals with the tools needed to negotiate successfully with insurers and steer clear of costly coding errors, while protecting your practice from claim delays, billing review and fraud investigations.

Registration for the program was simple. Once the GCA registered for the program with the ACA, GCA received a packet of materials, including sample slides, handouts, speaker information, program and speaker evaluation forms, sample ads, and product order forms for the ACA's 2004 Chiropractic Coding Solutions Manual.

"I was very pleased with the outcome of the program and with the quality of the speakers," said Honea of the GCA. "The process with the ACA was handled smoothly from the get-go, and we received everything we needed to make this program a success. We are already looking into adding additional dates for the state later in the year so more of our doctors can take advantage of this valuable program." Mr. Honea encourages all state associations to take advantage of the program available now through the ACA.

Dr. Mark Sanna and Kathy Mills of BTC, two of the ACA-approved speakers for this program, presented the "Navigate the Coding and Insurance Process" program on Saturday June 5 in Atlanta, GA. More than 50 GCA members attended the successful six-hour program. Each attendee was provided with handouts and materials, and the speakers, Dr. Sanna and Kathy Mills, guided the attendees on coding clarifications for evaluation and management (E & M), chiropractic manipulative treatment (CMT), manual therapy, massage, CPT modifiers, and other chiropractic-related services, such as writing a diagnosis, x-rays, and hot/cold packs.

"Navigate the Insurance & Coding Process" is a must for DCs, billing/coding professionals, students, and practice managers. Don't wait to sign your state association up -- dates are going fast!

For more information contact: Janet Ridgely, ACAâ€™s Director of Education and Meetings at Telephone: 1-800-986-INFO (4636), x216 or Email: jridgely@..., or visit the Coding Program section of our Web site at http://acatoday.com/about/products/coding_seminars/.

10. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

June 23, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: June 21, 2004

MEMBERS-ONLY EDITION

This week's report includes the following items:

1. ACA SUBMITS ADDITIONAL INFORMATION IN THE HHS SUIT2. ACA AND ANJC FILE RESPONSE TO HORIZON BC/BS IN ADMINISTRATIVE FACT-FINDING 3. TEMPLATE LETTERS FOR ACA MEMBERS AID IN CORRESPONDING WITH SELF-FUNDED/ERISA EMPLOYERS4. 2004 STATE CHIROPRACTIC ASSOCIATION JOURNALISM AWARDS AROUND THE CORNER5. ACA-PAC, ALABAMA ASSOCIATION RECOGNIZE A MEMBER OF CONGRESS6. ANTHEM IN THE SIGHTS OF THE FEDS7. LEADERSHIP ON THE ROAD8. ACA HOLDS LIVE TELESEMINAR ON OUTCOMES ASSESSMENT9. FEEL FREE TO CONTACT ME

1. ACA SUBMITS ADDITIONAL INFORMATION IN THE HHS SUIT

Taking advantage of a recent request from the judge handling our lawsuit against HHS in which the Medicare chiropractic benefit is at stake, ACA submitted a Supplemental Memorandum of Points and Authorities to reinforce our petition for summary judgment against the U.S. Department of Health and Human Services. It has been over two years since HHS and ACA each submitted a petition for summary judgment. The judge requested recently briefs from both parties on whether there was any additional evidence relevant to the case that had taken place since those last filings. It seems to be a good sign that the judge is taking a closer look at the case, and we may be able to anticipate a decision shortly. The brief can be found at http://www.acatoday.com/pdf/HHS_Lawsuit_update062104.pdf

In addition to doing a great job of summarizing the arguments Mcs had made previously, the brief adds recent events, including the inclusion of the chiropractic benefit in the Department of Veterans Affairs and the Department of Defense, as well as recent findings in the Journal of Bone and Joint Surgery that reaffirm the basic principle behind this lawsuit: that in 1972 when Congress added the chiropractic benefit into Medicare using the words "spinal manipulation to correct a subluxation," it had no one else in mind but doctors of chiropractic to provide this service, and therefore only chiropractic doctors should be reimbursed in Medicare for the service.

Quoting directly from the brief:

"Congressâ€™ most recent amendments to our nation's laws providing medical benefits for our nation's military and veterans reflect that Congress continues to recognize what it must have in 1972--that medical doctors and osteopaths cannot provide chiropractic services because they do not receive the same education and training relating to the musculoskeletal system that doctors of chiropractic received. This fact was confirmed in a 2002 study conducted by the Journal of Bone and Joint Surgery, a leading medical journal that reported on the nationwide test, which found that the vast majority of recent medical school graduates failed to pass a basic competency exam on the musculoskeletal systemâ€¦The study concluded that 'it is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.' This lack of basic knowledge of the musculoskeletal system is in addition to the fact that no medical doct! ors or osteopaths receive any training on how to physically manipulate the spine to correct a subluxation."

2. ACA AND ANJC FILE RESPONSE TO HORIZON BC/BS IN ADMINISTRATIVE FACT-FINDING

The ACA and the new Association of New Jersey Chiropractors (ANJC) have filed a response to Horizon BC/BS in connection with the complaint initiated by both chiropractic groups with the NewJersey Department of Insurance. The ACA and ANJC have requested an administrative fact- finding process to address whether Horizon is failing to comply with New Jersey law in its failure to cover certain services provided by a doctor of chiropractic. Horizon responded by suggesting that a federal case in Florida in which Horizon is a defendant and involving some chiropractic plaintiffs, precluded the New Jersey Dept. of Insurance from initiating the administrative fact-finding process. The ACA and ANJC have responded that neither group is a party to the Florida action and the activities in a foreign jurisdiction should not preclude New Jersey from exercising its role to protect the interests of it citizens. The state agency will now de! cide whether it will go forward with the fact-finding process. This is yet another example of how the ACA is engaged with state associations to further the interests of doctors of chiropractic and their patients.

3. TEMPLATE LETTERS FOR ACA MEMBERS AID IN CORRESPONDING WITH SELF-FUNDED/ERISA EMPLOYERS

ACA is pleased to provide its members with two new template letters to assist in working with self-funded/ERISA employers. The letters will assist you in requesting information on a patient's health care benefits, the plan's appeal procedure, and in filing an appeal under new ERISA guidelines. These template letters can be found on ACAâ€™s Web site at: http://www.acatoday.com/insurance/education/erisa.shtml. Simply enter your ACA identification number and password as prompted. Follow the instructions to download the letters to your personal computer. From there, you can customize the letter for the payer and the patient. These template letters are exclusive to ACA members -- another value-added ACA benefit.

4. 2004 STATE CHIROPRACTIC ASSOCIATION JOURNALISM AWARDS AROUND THE CORNER ACA will be handing out awards again this year for the best journals, newsletters, and Web sites. The postmark deadline is Wednesday, June 30th for all publications in 2003. Awards are given for associations with 1,000+ members, those with 500-1,000 members, and those with fewer than 500 members. Plaques will be handed out to delegates for the associations at ACAâ€™s House of Delegates meeting St. sburg, FL, in early September. If those who work at your state association do a good job with their publications, encourage them to compete. For entry forms, or if you have questions, email cmkline@....

5. ACA-PAC, ALABAMA ASSOCIATION RECOGNIZE A MEMBER OF CONGRESS

ACA Delegate Griffiths, DC, of Pinson, AL, and the Alabama State Chiropractic Association presented Congressman Mike (R-AL) with the ACA Military Health Care Leadership Award two weekends ago at ASCA's annual convention. The association also conducted a fundraiser for Congressman , through which they raised over $30,000. This total included a contribution from the ACA-PAC.

There was good reason to honor the Congressman. Recently, at the request of local DCs, Congressman successfully urged Cahaba Government Benefit Administrators, a division of Blue Cross and Blue Shield of Alabama, to ensure that Alabama Medicare beneficiaries are able to access the same quality chiropractic care in Alabama as they do in neighboring states. It was noted that the payment parameter for the carrier in Alabama was only 12 covered treatments, while adjoining states allowed doctors a total of 24 visits. After an exchange of correspondence between Congressman and CMS, the carrier agreed to increase the number of visits in Alabama was to 24.

6. ANTHEM IN THE SIGHTS OF THE FEDS

It was reported in the media recently that Anthem, one of the largest Blues plans in the country that now owns Trigon, is facing investigation by the U.S. Department of Justice into their contract tactics used to guarantee that doctors and hospitals always give it the biggest discounts. That tactic is commonly referred to as a "most favored nationâ€ clause. Doctors who sign a contract containing such a clause agree to a certain fee schedule. If discounts to other plans ever rise above these levels for any procedure, the payer with â€œmost favored nationâ€ status can adjust its payment schedule to regain a price advantage. The â€œre-pricingâ€ goes on constantly and doctors are seldom even aware of it. Officials have also questioned other insurance companies about whether this process gives Anthem an unfair business advantage. While the Justice Department had no comment on the investigation, it was noted that bo! th the Justice Department and Federal Trade Commission held seven months of public hearings last year on health care competition. The ACA participated in those hearings. One of the issues reviewed was the use of most favored nation clauses.

7. LEADERSHIP ON THE ROAD

Many ACA leaders were out in force at the recent annual convention of the Texas Chiropractic Association in San . Dr. Jim , ACA Governor for District VI; Dr. Brassard, VP of ACA; Dr. Vaughn, Delegate for Texas-East; and Dr. Don Handley, delegate from Texas-West were given opportunities at various times to discuss ACA activities, including an update on the lawsuits and on other initiatives. Also present were Dr. Gillespie, alternate delegate for Texas-West and Dr. Kanz, alternate delegate for Texas-East.

Leadership note: Congratulations to Dr Glenn Manceaux, ACA Council of Delegate President and Delegate from Louisiana who received earlier in the month the Distinguished Alumni Award from the Logan College of Chiropractic. I also want to recognize Dr. Ed McKenzie, ACAâ€™s alternate delegate for Kansas, who was selected as the Cleveland College of Chiropracticâ€™s Alumnus of the Year. No question that the ACA has the leaders of this profession.

8. ACA HOLDS LIVE TELESEMINAR ON OUTCOMES ASSESSMENT

ACAâ€™s June 15th live teleseminar, â€œUsing Outcomes Assessment Measures Effectivelyâ€ was a success, according to the participants. â€œVery informative and well planned.â€ - Dr. Damon ; â€œExcellent!â€ - Dr. Ron Oler; â€œVery good - a timesaver!â€ - Dr. Bill Thesier

The program, presented by Dr. Kim D. Christensen, DC, DACRB, CSCS, CCSP, focused on the how to make insurance inquiries a WIN for chiropractic patients and guided the registrants on how to demonstrate effective treatment. More than 40 doctors of chiropractic and chiropractic professionals took part in this live teleseminar. With the combination of Dr. Christensenâ€™s knowledge and expertise in the area of Outcomes Assessment and detailed handouts, registrants were guided on ways to document the cost-effectiveness of chiropractic care to insurers through the proper use of common questionnaires and functional evaluations used in clinical practice as a basis of outcomes assessment measures. The program briefly covered the proper legal use and application of more than 30 questionnaires and 12 key outcomes assessment areas including: General Health, Pain Measurement, Spine-related Conditions, Upper and Lower Extremities, Risk Factors, Range of Motion, S! trength & Endurance, and Patient Satisfaction.

The CD-ROM of this live teleseminar will be available for purchase in early July 2004. The ACA is currently taking orders for this informative program. Please call 800-368-3083 to place your order today. Order Item Audio 33.

Cost for CD-ROM of teleseminar - ACA Member: $39; Non-member: $65. (CD-ROM includes necessary handouts and materials).

Other Helpful Materials: The Outcomes Assessment 2004 CD-ROM (Order Item OACDROM04) includes valuable functional and evaluation forms, including 150 Functional Spine Exercises. The CD-ROM is the perfect compliment to the book, Clinical Application of Outcomes Assessment which includes detailed information about the practical use of objective and subjective assessment tools and how to apply them in the clinical setting. (Order Item OABOOK). Both items are available for purchase through ACA.

To purchase, visit ACAâ€™s on line store at: http://acatoday.com/store/index.cfm?frm=prod-view & scid=20 & CFID=65328 & CFTOKEN=32719566 or call 800-368-3083.

9. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

June 29, 2004

ï»¿

ACA EVP Weekly Report

MEMORANDUM

TO: ACA MembersHouse of DelegatesBoard of Governors Other Interested Parties

FROM: Cuneo

RE: ACA EVP Weekly Report

DATE: June 28, 2004

This weekâ€™s report includes the following items:

1. The Walls of Military Medicine Are Continuing to Crumble2. VA Announces Site Selections3. U.S. Supreme Court Acts on the Davilla Case (Our Point of View)4. Coding Information Online5. Grassroots Action; Iowa Leads the Way6. Deadline Approaching for Nominations for Awards and for Bylaws7. Leadership on the Road8. ACA Online Classifieds Offer Members Free Advertising9. Feel Free to Contact Me

1. THE WALLS OF MILITARY MEDICINE ARE CONTINUING TO CRUMBLE

I had a chance to participate in a little bit of chiropractic history last week when I joined Dr. Brassard and Dr. Goertz in attending the 2004 graduation and awards ceremony for interns, residents, and fellows from the Uniformed Services University of the Health Sciences and the National Capital Consortium at the National Naval Medical Center in Bethesda, land. Included among the graduates of military and Navy interns was Dr. Joanne Hudec, who completed a fellowship in Integrated Medicine at the National Naval Medical Center. Let me properly set the scene. There were hundreds of people in the audience and medical brass from all branches of the Army and Navy were present. On stage were Dr. Carmona, U.S. Surgeon General (who presented the commencement address); Dr. Kiley, Major General and Commander of Walter Army Medical Center; and numerous other dignitaries. Each program director was an! nounced and invited on stage to present diplomas to the graduates. Included was our own Dr. Bill as a program director, who presented recognition to Dr. Hudec before the entire group of assembled military brass. I donâ€™t think anyone could have predicted a few years ago that the bastion of conservative medicine would be the setting for honoring one of our own.

I know there is a lot of gloom and doom in the profession and many of our doctors are struggling in the managed care profession. But there are also a lot of good things happening. The glass is half full, not half empty.

2. VA ANNOUNCES SITE SELECTIONS

â€œToday, VA makes another significant improvement to the world-class health care we provide for eligible veterans. Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health.â€ -- VA Secretary Principi, June 25, 2004.

With surprising speed, and certainly at a pace that exceeded the DoD, the VA announced on Friday the selection of 26 sites throughout the country where the chiropractic benefit will be provided to our veterans. Not only did the speed with which it was implemented surprise our friends on the Hill, but we were also pleased that the VA went beyond the mandate of requiring at least one site in each of the 21 VISN regions.

You will recall that under legislation enacted by Congress and the resulting three dozen administrative recommendations developed by the VA's Chiropractic Advisory Committee and then approved by Secretary Principi in March 2004, the VA is to make chiropractic care available to the veterans it serves through at least one facility in each of its 21 regions. Last weekâ€™s announcement by the VA, coming less than 90 days after the Secretary's acceptance of the recommendations, demonstrates that the VA leadership in Washington and in its regional offices has moved quickly to begin to implement the recommendations.

The following facilities will provide chiropractic care: Togus, Maine; West Haven/Newington, Conn; Buffalo and the Bronx, New York; , Pennsylvania; sburg, West Virginia; Salisbury, North Carolina; Augusta, Georgia; Tampa and Miami, Florida; Mountain Home, Tenn; Columbus, Ohio; Danville, Illinois; Iron Mountain, Michigan; Kansas City, Missouri; , Miss; San , Temple, and Dallas, Texas; Albuquerque, New Mexico; Phoenix, Arizona; Fort on, Montana; Seattle, Washington; ez and Los Angeles, California; and Sioux Falls, South Dakota.

Other than the West Haven and Newington, CT VA facilities, which have committed to hiring a DC on staff to provide care, it is unclear at this time whether the other facilities will hire or contract with DCs as they proceed to make chiropractic care available. GR will make a thorough study of the formal announcement and other information as it becomes available. Though many or most of these facilities may choose initially to contract with DCs, ultimately, the decision to hire -- as well as decisions in the future to expand the availability of chiropractic care to additional facilities in the VA -- will be guided by the demand for that care.

Here is a link to an ACA "Fact Sheet" on the integration of chiropractic care in the VA that has been made available to ACA members since Secretary Principi's March 2004 adoption of the advisory committee recommendations: <http://www.acatoday.com/government/va/042304.shtml>. The VA suggested that doctors interested in seeking employment or providing contract services should contact the Human Resources office of any of the above facilities. Some VA positions may be advertised at <http://www.vacareers.com>.

3. U.S. SUPREME COURT ACTS ON THE DAVILLA CASE (OUR POINT OF VIEW)

You may have read in the papers last week that the court ruled that state laws holding HMOs liable for malpractice claims are preempted by ERISA. I asked Tom Daly, our legal counsel, what impact this decision would have on what appeared to be the courtâ€™s previous direction in penetrating the ERISA preemption. He indicated that this ruling, combined with the courtâ€™s earlier decisions in Pegram/Moran and the Kentucky case, should now give us a clearer idea of the limits and extent of the ERISA preemption of state laws. To some extent, it reinforces the preemption, but now, the issue becomes which types of state laws are preempted and which are not. Malpractice liability statutes are now definitely preempted; state statutes dealing with such things as external review, any willing provider, and insurance regulation are not.

The decision has no impact on our appeal in the Trigon suit as the issues are different. We are continuing to update our ERISA material, and I refer you to our web page. <http://www.acatoday.com/insurance/education/erisa.shtml>

4. CODING INFORMATION ONLINE

You will be surprised at the online coding information available to ACA members. It was developed by ACAâ€™s PDR Department, whose expert staffers work closely with the ACA representatives on the AMA Coding Committee (where codes are developed). The fact sheets youâ€™ll find online cover a wide variety of information regarding codes used for billing purposes.

You can view the web site at: <http://www.acatoday.com/pdf/PDR/CPTCoding.pdf>

5. GRASSROOTS ACTION-IOWA LEADS THE WAY

Once again, I am reporting on a political event in Iowa. A couple of months ago, Dr. Rod and Rebarcak hosted a fundraiser at their home for Sen. Chuck Grassley. It included many prominent Republicans from Story County. Other doctors were in attendance, including Dr. Dow and Del Bates, Dr. Ken and Shirley Storjohann, Dr. Alan Schuldt and Dr. Rebarcak.

If you are aware of doctors in your community involved in such events, let me know. I would be pleased to promote them. This is an example of grassroots power at its best. It would help if they are members.J

6. DEADLINE APPROACHING FOR NOMINATIONS FOR AWARDS AND FOR BYLAWS

Just a reminder that nominations for the major ACA Awards is July 19. Included among the awards are Chiropractor of the Year, Humanitarian of the Year, Delegate of the Year, Alternate Delegate of the Year, Flynn/Lynch Award, Researcher of the Year, and Academician of the Year.

Additionally, any proposed resolutions to be considered by the House of Delegates in September must also be submitted to the ACA Secretary at the same time. The deadline for Bylaws changes is July 5, 2004.

7. LEADERSHIP ON THE ROAD

Dr. Bazakos, ACA Governor and member of the ACA Executive Committee, was selected last weekend as the Chairman of the Board of Trustees for New York Chiropractic College. During his investiture, he gave a PowerPoint presentation on the various legislative activities of the ACA.

Dr. R.E. , member of the NCLAF Executive Committee, attended a recent meeting of the Board of Directors for District 6 of the Ohio State Chiropractic Association. He presented a check for $3,150 for the Legal Action Fund and indicated the strong support of the District for our continued pursuit of Simple Justice. This brings the total contribution of District 6 to $4,650 and the total for Ohio to $120,080.30.

8. NEW! ACA ONLINE CLASSIFIEDS OFFER MEMBERS FREE ADVERTISING

Is your office looking to hire additional staff? Do you have used equipment for sale? Is someone you know looking to buy a practice? ACA can help! Posting FREE classified ads online is now part of the many benefits ACA provides to you as a member. Classified ad listings up to 500 characters can now be posted for 30 days in ACAâ€™s new Online Classifieds. Only ACA members will be able to post ads, but any visitor to the ACA website homepage, which regularly receives over 90,000 visits a month, can view the ads. Try it today! Read all about this valuable new member benefit at <http://www.acatoday.com/membership/classifieds/>.

9. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

July 7, 2004

ï»¿

ACA EVP Weekly Report

Memorandum ACA Members, House of Delegates, Board of Governors, and Other Interested PartiesFrom: CuneoRe: American Chiropractic Association EVP ReportDate: July 6, 2004

This weekâ€™s report includes the following items:

1. NEW INTEREST IN PATIENT BILL OF RIGHTS IS JUST ONE RESULT OF SUPREME COURT DECISION 2. ACA MESSAGE HEARD ON THE HILL: SENATE AMENDMENT TO RESTRICT VITAMIN SUPPLEMENTS WITHDRAWN3. ACTIONS OF SOUTH DAKOTA ASSOCIATION SPEAK VOLUMES4. OTHER ORGANIZATIONAL CONTRIBUTIONS TO ACA LEGAL ACTION RECEIVED THIS WEEK5. ACA A FORCE AT WFC MEETING6. NEXT STATE ASSOCIATION CONFERENCE CALL TO FOCUS ON WORKERSâ€™ COMPENSATION7. ACA LEADERSHIP ON THE ROAD8. SACA SIZZLES9. ANOTHER FELLOWSHIP10. TAKE ANOTHER LOOK AT HEALTH SAVINGS ACCOUNTS11. FEEL FREE TO CONTACT ME

1. SUPREME COURT DECISION STIMULATES NEW INTEREST IN PATIENT BILL OF RIGHTS AND HAS OTHER EFFECTS

Last week I reported on the Supreme Court decision in the Davila matter which further defined the preemption provision under ERISA. In the 9-0 decision, Judge Ruth Bader Ginsburg seemed to reflect the sentiments of other justices when she stated that she joins â€œthe rising judicial chorus urging that Congress and this Court revisit what is an unjust and increasingly tangled ERISA regime." Ginsburg acknowledged that under the current law there is no remedy for people who have been damaged by an HMO.

Not surprisingly, these sentiments quickly reached Capitol Hill, where there was a flurry of activity attempting to resurrect the patient bill of rights legislation. Representative (D-CA), ranking member of the House Education and Workforce Committee, announced that that the democratic members of the committee are triggering a rarely used parliamentary device to force action on the patients bill of rights in the wake of the U.S. Supreme Court's decision. We suspect that this is only the beginning. While it is unlikely anything will pass this year in the highly charged and partisan Congress, we do expect significant activity next year.

Finally, there was a very interesting legal issue raised in the concurring opinion by Justices Ginsburg and Breyer. The issue concerns a section of ERISA which provides for the awarding of "appropriate equitable relief.â€ Ginsburg and Breyer suggest that this equitable relief should be extended to the types of "make whole" damages not otherwise provided under ERISA. They suggest that in order to fix the current "unjust" ERISA regime that either the Supreme Court or Congress expand what is meant by "appropriate equitable relief.â€ They are suggesting a very activist view by the Court which would make available the types of damages under ERISA that currently may only be obtained through a state court action. This issue could very well be the topic of the next year's U.S. Supreme Court ERISA decision, since the Court seems to come out with at least one ERISA decision every year. This would also affect both insured and self-insured ! ERISA plans. We will obviously be watching this very closely.

2. ACA MESSAGE HEARD ON THE HILL: SENATE AMENDMENT TO RESTRICT VITAMIN SUPPLEMENTS WITHDRAWN

I am pleased to inform you that since the last time I reported on this issue, Senator Durbin (D-IL) withdrew his ill-conceived, anti-consumer amendment from further consideration on Tuesday, June 22nd, after hearing from the ACA and other groups that are strongly opposed to restricting access to safe and effective dietary supplements. Senator Durbin had tried to use the Senate's debate over the FY 2005 Department of Defense authorization bill to pass legislation to limit access to dietary supplements available to America's military servicemen and women on military bases and impose new reporting guidelines on manufacturers whose vitamins and other supplement products are available for sale on military bases. The ACA's Department of Government Relations coordinated its efforts with Senator Orrin Hatch (R-UT) and worked in opposition to the Durbin amendment. Clearly, the ACA and its members succeeded in educating key senators about! the harm that would be done by unfairly limiting access to supplements that are known to be safe and effective and undermining existing safeguards for consumers. Similarly, the ACA remains strongly opposed to S. 722, Senator Durbin's broader legislation intended to create a series of new government reporting requirements for dietary supplements. Since its introduction in 2003, S. 722 has gained only four co-sponsors -- Senators Hillary Clinton (D-NY), Schumer (D-NY), Dianne Feinstein (D-CA) and McCain (R-AZ) -- and has not been considered at the committee level. While S. 722 has not gained new support and remains unlikely to be considered by this Congress, the ACA will continue to closely track other attacks on the rights of consumers that may be launched by Senator Durbin.

3. ACTIONS OF SOUTH DAKOTA ASSOCIATION SPEAK VOLUMES

With fewer than 400 doctors practicing in South Dakota, you wouldn't expect the South Dakota Chiropractic Association to be a major contributor to the National Chiropractic Legal Action Fund (NCLAF). Yet this week their contribution of $10,000 increased their total to $70,000, making them the second-highest state association contributor, behind only the Ohio State Chiropractic Association for contributions to the lawsuits.

4. OTHER ORGANIZATIONAL CONTRIBUTIONS TO ACA LEGAL ACTION RECEIVED THIS WEEK

The Master's Circle ($500, bringing total to $14,500)Performance Health ($100, bringing total to $2,100)Missouri Chiro Assn-Dist 1 ($100, bringing total to $7,500)Missouri Chiro Assn ($100, bringing total to $2,700)Mountain X-Ray & Equipment ($500, bringing total to $2,000)Mid Ohio Chiro. Assn. [OSCA Dist. 6] ($3,150, bringing total to $4,650)

By the way, the total number of monthly contributors to the NCLAF has reached 1,120 doctors and students. This probably won't make some of the insurance carriers or a small cabal in the profession happy, but it does demonstrate the continued support within the profession for this worthwhile cause.

5. ACA A FORCE AT WFC MEETING

Three ACA representatives to the World Federation of Chiropractic (WFC) traveled to Singapore for meetings June 8-11, which included a meeting with the Singapore Minister of Health. ACA president Don Krippendorf, DC, led the delegation, filling in for Dr. Mike Pedigo, along with Dr. Kerwin Winkler and Dr. J. Flynn. Chiropractic events and issues around the globe were addressed by WFC Council as were the draft WHO Guidelines on Basic Training and Safety of Chiropractic. Continued development of the Identity Conference and the electronic survey of the profession were discussed. New officers were elected; Dr. Metcalf of the United Kingdom is the new president; Dr. Gerry Clum 1st Vice President; Dr. Efstathios Papadopoulos of Cyprus the 2nd Vice President and Dr. J. Flynn Secretary-Treasurer. Immediate past-president Dr. Carey of Canada will continue to serve on the executive committee and outgoing i! mmediate past president Dr. Bruce Vaughn of Hong Kong was recognized, along with Dr. Carey, for meritorious service to the WFC.

6. NEXT STATE ASSOCIATION CONFERENCE CALL TO FOCUS ON WORKERSâ€™ COMPENSATION

Earlier last month we held a conference call with leaders of state associations to discuss a variety of issues effecting the profession. Included was an update on the Medicare Demonstration Project, changes to the Medicare r Manual imposing treatment caps which we are fighting; ERISA information currently available to states on-line and the new material being developed; recent VA activities and HIPAA. Included on the call were representatives from Kentucky, Arizona, Louisiana, Virginia, South Dakota, North Dakota, California and Colorado.

At the request of some of the executive directors on the call, the focus of our next conference call will be the growing threat from the business community to take us out or reduce our role in treating workersâ€™ compensation patients. The call is scheduled for Tuesday, July 20th at 1:00 pm ET. We are inviting the California Chiropractic Association, Texas Chiropractic Association and the Florida Chiropractic Association to share their experiences from recent battles in their respective legislators. They will be asked to focus on what worked and what didn't work. We will also have a representative from the industry that will discuss their perspective on trends and on the data that has been developed regarding the cost of workersâ€™ compensation. State association executives wonâ€™t want to miss this call.

7. ACA LEADERSHIP ON THE ROAD

A couple of weeks ago, ACA Past President Daryl D. Wills, DC, shared a podium with Dr. C.J. Mertz, President of the ICA, at a Cleveland College of Chiropractic conference in Kansas City, MO, where the two discussed the issue of ethics in chiropractic. The discussion was very well received, with over 200 doctors in the audience.

ACA was out in force at the convention of the California Chiropractic Association. Caroline Fuchs, Vice President of Member Services and Business Development, joined Drs. Jerilynn Kaibel, Dubro, Brad Sullivan and Jim in promoting ACA activities to the California doctors. Joining ACA at CCA were representatives of Chirocere -- an innovative, web-based service designed to revolutionize the management of chiropractic offices. ACA exclusively endorses Chirocere in the chiropractic marketplace and was pleased to unveil it to California practitioners at the San Diego meeting.

8. SACA SIZZLES

Student ACA (SACA) National Vice Chair Marc Persson recently reported on the ongoing SACA membership campaign. In September of last year, 49% of all chiropractic students in the U.S. were SACA members. As of this week, that number is up to 56%, and the students have set a goal of reaching 60% of the students by this September. They even have 110 students who are monthly contributors to the ACA-PAC. I bet they exceed their 60% goal.

9. ANOTHER FELLOWSHIP

It never ceases to amaze me how this profession is integrating into Americaâ€™s health care system. Last week I talked about the recognition given to Dr. Joanne Hudec, who completed a fellowship in Integrated Medicine at the National Naval Medical Center. I just learned the other day that Quinn V. Bui, DC, is a Postdoctoral Fellow in Gynecologic Oncology for the Center for Research on Minority Health for the University of Texas MD Cancer Center.

10. TAKE ANOTHER LOOK AT HEALTH SAVINGS ACCOUNTS

I've mentioned to you in one of my previous reports that ACA now has a Health Savings Account (HSA) available to members through Golden Rule Insurance Company. I'm pleased to announce that weâ€™ve just added another HSA plan through American Medical Security.

HSAs are tax-advantaged savings accounts that you can use to help pay for your medical expenses. An HSA needs to be accompanied by a high deductible ($1,000 for individual and $2,000 for family) health insurance policy. There are three basic ideas behind HSAs.

Â· Individuals can manage and control some of their own health care dollars.Â· Money from the fund can be used to pay for expenses not covered by insurance.Â· Individuals should profit for being wise consumers of medical care by having their account balance grow tax-free.

The primary features of an HSA are as follows:

Â· Under the new law, deposits to a HSA avoid all federal income taxes.Â· Deposits to a HSA are tax deductible.Â· Can contribute up to $2,650 for individual and $5,150 for family coverage per year.Â· Account balances earn interest or can be invested in stocks or mutual funds and grow tax-free.Â· HSA is a portable, personal trust account. (Account balances belong to the individual)Â· HSA becomes an IRA at age 65 and can be used for any purpose with no penalties.

I encourage you to call our insurance administrator, Marsh Affinity Group, at (877) 886-0110 to see how you may be able to benefit from one of these HSA plans. You can also visit our insurance web site at http://aca.healthinsurance.com/hi/ to get quotes on standard health insurance plans.

11. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

July 14, 2004

ï»¿

ACA EVP Weekly Report

MEMORANDUM

TO: ACA Members, ACA House of Delegates, Board of Governors and Other Interested PartiesFROM: Garrett CuneoRE: American Chiropractic Association EVP ReportDATE: July 12, 2004

ACA MEMBERS ONLY ISSUE

This weekâ€™s report includes the following items:

1. ACA TEACHING THE VA2. UPDATED INFORMATION ON CHIROPRACTIC CARE IN THE VA HEALTH SYSTEM ON ACA'S WEB SITE 3. NEW CMS PUBLICATIONS NOW AVAILABLE4. BETHESDA NAVY DOCTOR SPEAKS AT ACA OFFICE5. COMMENT ON MOBILE DIAGNOSTIC SERVICES6. REMINDER: DEADLINE FOR RESOLUTIONS FAST APPROACHING7. DASCLE EVENT WAS A SUCCESS

1. ACA TEACHING THE VA

At the invitation of the Department of Veterans Affairs â€œEmployee Educational System,â€ Dr. Vaughn, member of the Chiropractic Advisory Committee for the VA and ACA Texas East delegate flew to St. Louis recently to be videotaped on chiropractic coding and billing at the VA satellite feed studios. She was filmed utilizing an ACA Power Point presentation on the VA that lasted for 35 minutes. It will be broadcast over the VA satellite system four separate times for VA coders and billers. She referenced the ACA Coding Solutions Manual and the ACA Web site during her presentation. She did so well, the VA producers invited her back to do a live satellite broadcast with a questioner interviewing her about chiropractic. At least in this early stage, and consistent with the actions of the VA Secretary, the VA is making a good faith effort to bring this profession into the system. Itâ€™s good news for our future.

2. UPDATED INFORMATION ON CHIROPRACTIC CARE IN THE VA HEALTH SYSTEM ON ACA'S WEB SITE

On June 25th, VA Secretary Principi announced a listing of 26 U.S. Department of Veterans Affairs health facilities at which chiropractic care services will be made available to America's veterans starting this Fall 2004. The ACA Government Relations team has prepared an updated fact sheet detailing the most current information available on the inclusion of chiropractic care in the VA health care system. You can access this fact sheet, as well as sample letters to send to members of Congress, through the ACA Web site at http://www.acatoday.com/government/va/042304.shtml. ACA and SACA members are urged to take immediate action in support of expanding the number of VA facilities that will hire a DC and offer chiropractic care to veterans. The VA has informed the ACA that fu! rther expansion will be driven by demand by veterans for chiropractic care.

Grassroots Action Requested -- DCs, Students and Chiropractic Patients take action to expand the number of VA facilities that will offer chiropractic care. Click on the link below to visit the ACA'S LEGISLATIVE ACTION CENTER to send letters of support to your members of Congress!!! http://econstituent.votenet.com/(4lr0wfruvlgto322lkszs245)/index.aspx/aca/letterwriting.aspx?issueid=761

3. NEW CMS PUBLICATIONS NOW AVAILABLE

CMS has recently released several new and revised publications that are useful to doctors of chiropractic. Please visit http://www.cms.hhs.gov/medlearn/pubs.asp to see the full list of helpful materials, including complying with Medicare Secondary Payer Requirements; the Medicare Appeals Process: Five Levels to Protect Physicians; Physicians Edition: Medicare & You 2004; the CMS Online Manual System and Helpful HIPPA Resources.

4. BETHESDA NAVY DOCTOR SPEAKS AT ACA OFFICE

In late June, the ACA hosted a meeting in its office in Arlington, VA with local doctors. Special guest was Dr. Bill , chiropractor to members of Congress and physician at the National Naval Medical Center, who spoke to more than 25 doctors regarding his experience at the Bethesda hospital where the model of health care integration is more about patient care than turf battles among health care practitioners. Dr. was very complimentary about the ACA, noting that his presence as the chiropractor for Congress was a result of a well thought out plan by our government relations staff. He reminded everyone that there were a number of members of Congress who wanted a chiropractor at the Capitol, but their requests were resisted by the military medical establishment that used the excuse that only doctors from Bethesda could treat members of Congress. So we included Bethesda on the list of hospitals that we added to the demonstration project in! legislation in 1998. Soon after, Bill was hired, and shortly thereafter, he was treating members of Congress and the Supreme Court. What an asset to this profession.

5. COMMENT ON MOBILE DIAGNOSTIC SERVICES

All too often, insurers want to use a broad brush to paint DCs as the leaders in provider fraud. While the statistics the insurance industry publishes don't support this, the mindset still exists and needs to be corrected. Part of eliminating this black cloud of suspicion is taking direct action to prevent DCs from entering into any activity that is or could be perceived to be fraud. Knowing how to stay off thin ice is viewed by our members as a protective device, one they appreciate and take to heart. We know, because our Web site resources on fraud and billing related materials are among the items that regularly receive the highest number of â€œhits.â€ We're adding another reference on Mobile Diagnostic Services that we feel every doctor of chiropractic should read -- http://www.acatoday.com/insurance/managed_care/mo! bile_diagnostic_services.shtml.

Just so I am clear, we are not commenting on whether electrodiagnostic services are appropriate or how and when they should be used. We are commenting on questions the treating provider should ask themselves to determine if a lease or rental agreement with a mobile service is right for them and their patients. We're told that upward of 80 percent of providers who use these services are doctors of chiropractic, followed by a much lower percentage of podiatrists. If it's risky business, we want you to know. If it's not, you will have a full arsenal of questions to ask yourself to determine if the relationship always places the welfare of the patient at the forefront.

While this statement was being developed, ACA was also developing fraud benchmarks approved by the BOG June 26 -- http://www.acatoday.com/insurance/policy/fraud_abuse_benchmarks.shtml.This is a protective document for DCs that makes insurers more accountable for fraud investigations. Some of the features include: privacy, eliminating intimidation tactics, alleging fraud without a basis for fraud, and incorrect edits that prompt erroneous repayment demands, among others. While we clearly express our disdain with any type of fraud, we also make the insurance companies accountable for their actions. Our claims solution workshops have been helpful in communicating this message to the industry.

6. REMINDER: DEADLINE FOR RESOLUTIONS FAST APPROACHING

The deadline is fast approaching for submitting proposed resolutions to the House of Delegates for its annual meeting in September or to nominate someone for the various major awards presented by the ACA. The recommendations must be submitted to me as Corporate Secretary no later than July 19th.

7. DASCHLE EVENT WAS A SUCCESS

Last week, I had the privilege of joining Dr. Kerwin Winkler, former ACA Chairman of the Board from Aberdeen, SD, and members of the ACA government relations and PAC staff in hosting a private breakfast with Senator Tom Daschle (D-SD), the Senate Democratic leader who has been a great supporter of this profession. He is in a tight race for reelection against former Congressman Thune. Also at the breakfast was a regional coordinator from Veterans for Kerry as well as Bobby Mills, a lobbyist for the Association of Chiropractic Colleges. We had an opportunity to update the Senator regarding various ACA initiatives, including our recent successes with the Veterans Administration.

Senator Daschle is a great supporter of this profession. You will recall that it was his intervention in the Senate -- when our VA bill that had been passed out of the House of Representatives was being opposed in its current form by Senator Jay Rockefeller, who was chairman of the VA Committee -- that saved our legislation in the Senate and resulted in its becoming law. I am pleased to indicate the profession is showing its appreciation for his efforts. I understand that $25,000 was raised for the Senator -- not only from a contribution from the PAC, but also 40 or more contributions from doctors throughout the country.

You probably have heard that chiropractic has been delisted from the Canadian health care system. This will end over 30 years of public funding for chiropractic in Ontario. It could happen here. Do you need another reason to contribute to the PAC? If you arenâ€™t a PAC contributor and you are an ACA member, please go to the following link, download the application and send it in: http://www.acatoday.com/membersonly/acapac/contribution_form.pdf.

8. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@... .

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....To be removed from further mailings from our list please click the unsubscribe link

July 20, 2004

ï»¿

ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: American Chiropractic Association EVP Weekly ReportDate: July 19, 2004

MEMBERS ONLY ISSUE

This weekâ€™s report includes the following items:

1. REVOLUTIONARY CHIROPRACTIC OFFICE SOLUTION - CHIROCERE: A BETTER WAY TO MANAGE YOUR PRACTICE 2. PRESIDENT'S LETTER TO WASHINGTON POST3. VA ADVISORY COMMITTEE MEETING: PROGRESS CONTINUES4. ACA EXPANDS CMCI SERIES TO INFORM DOCTORS ON INSURANCE, MANAGED CARE5. MOBILE DIAGNOSTIC SERVICES STATEMENT RECEIVES PRAISE6. ACA-PAC TO HONOR SENATOR TOM HARKIN AT DEMOCRATIC NATIONAL CONVENTION7. ACA'S ONLINE CLASSIFIEDS VIEWED OVER 1000 TIMES!8. ANOTHER D.C. IN IRAQ9. FEEL FREE TO CONTACT ME

1. REVOLUTIONARY CHIROPRACTIC OFFICE SOLUTION - CHIROCERE: A BETTER WAY TO MANAGE YOUR PRACTICE

The newly ACA-endorsed Chirocere service not only reduces overhead costs, but also streamlines clinical and administrative operations for practice of all sizes, leaving doctors of chiropractic free to spend more time caring for their patients. As a web-based program, Chirocere completely eliminates the need for costly software, maintenance and upgrades associated with traditional office management. With Chirocere, your office will manage a patient from scheduling to submitting insurance claims. You'll find the financial and operational benefits are sure to increase efficiency and improve communication within your chiropractic clinic.

ACA members receive a special discount off the monthly fee. You can view a live demonstration of the services provided by Chirocere through the ACA website at http://acatoday.com/about/products/ChiroCere/index.cfm or call Chirocere directly at 866-573-9404.

I went online to view the demonstration of Chirocere, and if I can do it, anyone can. It is the cutting edge and itâ€™s worth investigating.

2. PRESIDENT'S LETTER TO WASHINGTON POST

In the old days - just a few years ago -- getting a letter to the editor published by a major newspaper was reason to celebrate. Now, it's a more common occurrence as the media is recognizing the importance of chiropractic and ACA as its voice for views regarding the profession. As an example, a letter from President Krippendorf to the Washington Post regarding the recent NCCAM survey on alternative medicine was published in the July 6 edition of the Post â€œHealthâ€ section. The Post is such a prestigious paper that it is worth mentioning. If you want to see our response visit our Web site at: http://www.acatoday.com/media/record/washington_post3.shtml

Or go directly to The Washington Post web site at: http://www.washingtonpost.com/wp-dyn/articles/A29777-2004Jul5_2.html

3. VA ADVISORY COMMITTEE MEETING: PROGRESS CONTINUES

Last week, I attended the meeting of the VA Chiropractic Advisory Committee in Washington, D.C. Watching the proceeding two things were apparent: 1) Secretary Principi continues to make it known that this chiropractic project is important to him, and 2) that all members of the Advisory Committee, including the medical doctors, are working closely together and are committed to making this happen. I was particularly impressed with the medical doctors and other health care providers who continued to press the VA staffers about the implementation of the plan. From the various reports presented, it was also noted that the attitude of those in the VA field had changed over the last 12 months, from strong resistance to a willingness to make integration happen.

The meetings I attended focused on personnel issues and the status of implementation at the sites that had been selected at the end of June. A chart was provided that showed the various grades and salary opportunities for our doctors, along with another report that defined the qualification standards and how the salary ranges are determined. Another chart showed the information regarding each of the 26 sites where the chiropractic benefit would be offered. Included was whether the doctor would be hired or would be by contract; full-time or part-time; member of the medical staff or not; and whether privileges would be granted. All three of these documents can be found on the ACA Web page at: http://www.acatoday.com/membersonly/government/va/VAinfo.cfm

Salary grades are determined by qualification and experience. The common theme was to identify the most qualified doctor to practice in each location. The best doctor will ensure the best success, which in turn will ensure an expanded benefit. It was projected by the VA Department staff that the doctors would be hired and in place at each of the facilities by September 30th. This is considered lightening speed in the VA and an indication of the Secretary's commitment -- although many members of the committee questioned whether such a deadline was possible.

There was discussion on how each of the sites were selected. You will recall that Secretary Principi allowed the medical directors in each of the VA regions to determine which facility would provide the chiropractic benefit. In some cases, the medical directors of each of the hospitals were surveyed to determine interest. In other cases, hospitals with a particular specialty in spine work were selected. In every instance, the facility chosen was close to a regional facility so that the benefit could be closely monitored. Wherever possible, the selection was made where there was a need and desire to have the D.C. on board. This is different from the selection process in the DOD where the local base medical team had no input in the decision.

There were some really interesting stories regarding the selection. For example, the VA hospital in Buffalo will serve as a teaching experience for the clinicians from the New York Chiropractic College. Both faculty and clinicians will be treating the veterans. In Michigan, a doctor who has rented office space and practiced in a VA building next to the VA office will be appointed doctor at the request of the local medical director.

The only negative in the discussion was that nearly half of the facilities would be hiring only part-time practitioners. Many of the advisory committee members expressed concern about this. The VA indicated that as demand expands, so will the number of practitioners. Obviously, this is one area that we will want to continue to monitor.

One final comment. FCLB, in particular Donna Liewer and Dr. Cole, were complimented by the VA staff in coming up in short order with a summary of the scope of practices in each of the states.

4. ACA EXPANDS CMCI SERIES TO INFORM DOCTORS ON INSURANCE, MANAGED CARE

â€œYour Rights and Responsibilities as a Participating Managed Care Providerâ€ and â€œTaking the Mystery Out of Chiropractic Network Dataâ€ are the fifth and sixth in a series of articles developed by the American Chiropractic Association to inform the doctor of chiropractic and chiropractic office staff about insurance and managed care. Known as the Chiropractic Managed Care Index (CMCI), this is an ACA members-only value added service. Previous issues of CMCI have addressed: evaluation of a network/health plan, evaluation of a participating provider agreement, types of insurance, and insurance/managed care terms. These are available on the ACA website at: http://www.acatoday.com/insurance/mc_index/

CMCI should be referenced as needed and made available to new business associates and office staff for their education.

5. MOBILE DIAGNOSTIC SERVICES STATEMENT RECEIVES PRAISE

Last week, my report included a statement adopted by the ACA Board of Governors regarding Mobile Diagnostic Services. We received a very complimentary letter from Dr. Allan Korn, medical director of National Blue Cross/Blue Shield, regarding the statement. Dr. Korn has been helpful to us in improving relations with the local Blue Cross plans. To view Dr. Korn's letter, go to: http://www.amerchiro.org/insurance/managed_care/ACA_070704.doc.

6. ACA-PAC TO HONOR SENATOR TOM HARKIN AT DEMOCRATIC NATIONAL CONVENTION

For nearly two decades, Senator Tom Harkin (D-IA) has been working to advance pro-chiropractic legislation on Capitol Hill. He's a regular at our NCLC gatherings and proud to say that he's the chiropractic profession's "best friend in Congress." (See his most recent remarks from NCLC 2004 on our Web site at -- http://www.acatoday.com/about/nclc2004/videopage/.

Senator Harkin has used his ranking position on the powerful Senate Appropriations Committee to help break down barriers to chiropractic care, help ensure that DCs and their patients are treated fairly in federal health programs and secure critical federal funding for research into the effectiveness of chiropractic care. On Thursday, July 29, the ACA-PAC will be hosting a breakfast in conjunction with the Democratic National Convention in Boston, MA, to honor Senator Harkin and to support his re-election campaign. A contribution of $200 is suggested to attend this event. For additional information, please contact Kim Krocker, ACA-PAC manager, at (800) 986-4636 or by email at kkrocker@.... The ACA GR and PAC staff will be in force at the Democratic Convention. They also plan to be at the Republican Convention in August as wel! l, where we will be sponsoring a fundraiser for a Republican member of Congress. Look for details in upcoming issues of the weekly report.

7. ACA'S ONLINE CLASSIFIEDS VIEWED OVER 1000 TIMES!

More than 25 ads have been posted in ACA's dynamic new Online Classifieds, which together have been viewed over 1000 times in the three weeks since this new member benefit was launched. Doctors interested in hiring staff, purchasing or selling a practice, upgrading their equipment, as well as students looking for jobs -- be sure to take a look at this brand new marketplace for the chiropractic community. Please note that the ACA Online Classifieds is provided as a service to members and is not intended to be used for commercial endeavors. Anyone can view the ads, but posting ads is FREE and exclusive to ACA members. Try it today at www.acatoday.com/membership/classifieds.

8. ANOTHER D.C. IN IRAQ

Recently I received an email from a doctor on duty in Iraq who got my report and faces problems similar to Col. Losack in treating members of the armed forces. We are going to try to help him, but I thought you would find his comments interesting. By the way, Dr. Losack is back in the states and is well.

â€I am SGT Lytch, D.C., assigned to a S.C. national guard unit in Iraq. I saw the note in this weekâ€™s ACA newsletter about the D.C. getting recognized as officially being able to render chiropractic care on a ship. That is outstanding!! Since I am having to check spines â€™on the side,â€™ I think if I can become officially recognized here it would be a real advantage.

Thus far, I have had to â€˜have several discussionsâ€™ with my MO (medical officer). In his mind, he feels â€˜liableâ€™ for any harm that I could cause by adjusting spines. He is a well-meaning gentleman, but I just think if I had some â€˜documentâ€™ or â€˜presentationâ€™ of what this D.C. on the ship has done, it would help me out, as well as future D.C.s serving our country. Thank you, in advance, for your reply.

Chiropractically, Lytch

P.S. I am licensed and was practicing in South Carolina before being activated for OIF II (Operation Iraqi Freedom II)â€

9. FEEL FREE TO CONTACT ME

If you have questions about anything in this report, or if you have other concerns youâ€™d like to bring to my attention, please feel free to contact me here at the ACA office. The telephone number is 800-986-4636. Of course you can always reach me via email at gcuneo@....

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

July 27, 2004

ï»¿

ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly ReportDate: July 26, 2004

MEMBERS ONLY ISSUE

This week's report includes the following items:

1. DCs AT THE OLYMPICS2. ACA-PAC RUNS AHEAD OF THE PUNDITS IN GEORGIA SENATE RACE3. VA CONNECTICUT ADVERTISES FOR FULL-TIME CHIROPRACTOR 4. ACTIVATOR METHODS INC JOINS THE CHIROCERE TEAM5. ACTIVATOR HAS SUCCESSFUL PROGRAM6. DR. GEORGE McCLELLAND APPOINTED TO NEW URAC ADVISORY COMMITTEE7. WFC ANTI-TOBACCO POSTERS TO BE CENTERFOLD IN DYNAMIC CHIROPRACTIC8. NEW ONLINE VAD COURSE AVAILABLE FREE TO PROFESSION9. LEADERSHIP ON THE ROAD

1. DCs AT THE OLYMPICS

Drs. Ira Shapiro of Old Bridge, NJ, and Marc Jaffe of Summit, NJ, have been appointed as official doctors for the U.S. Olympic medical staff participating in the Athens Olympics. If you are also a team doctor or serve as the doctor for another country's Olympic team -- or are aware of others who are - please let us know. We are preparing an article for ACA Today regarding the profession's involvement. We have come a long way in being recognized by the U.S. Olympic Committee. I remember the controversy in the 70s when an American high jumper who was favored in the gold refused to compete until his D.C. was allowed to serve as his doctor.

2. ACA-PAC RUNS AHEAD OF THE PUNDITS IN GEORGIA SENATE RACE

The ACA-PAC generally avoids getting involved in primaries, unless the outcome would determine the eventual winner. After thoroughly studying the race and the positions of the candidates on chiropractic issues, we made an exception in the Republican Senatorial Primary in Georgia where three Republicans were vying for their party's nod to seek the seat occupied by retiring U.S. Senator Zell . On the night of the primary election, July 20th, the ACA-backed candidate, pro-chiropractic Congressman ny Isakson, won a tremendous victory, far surpassing the expectations of most political pundits. Of course, it was no surprise to us and the chiropractic profession in the Peach State. Along with ACA-PAC, DCs from across Georgia -- led by Dr. Jim Anchors and members of the Georgia Chiropractic Association -- succeeded earlier this year in raising $20,000 for Congressman Isakson's campaign, now the clear general election front! runner.

As in the 2000 and 2002 elections, your PAC will again be active in support of pro-chiropractic candidates across the country and place a particular emphasis on making a difference in close U.S. Senate and House races in which the chiropractic vote -- DCs and patients -- can be decisive. Contributing $500 or $1000 to a candidate is important. But contributing $20,000 and organizing "chiropractic-only" candidate fundraisers makes you a player, as we are in the Georgia's U.S. Senate race and several other races around the country. In the 2004 election cycle, chiropractic-only fundraisers hosted by ACA-PAC for Senator Chuck Grassley (IA), Senator Arlen Specter (PA), Senator Tom Daschle (SD), Senator Ben (NE), Senator Tom Harkin (IA), Congressman Rob and Congressman Ed Schrock have brought together DCs from coast-to-coast and made a powerful statement about the political power of the chiropractic profession. The next ch! iropractic-only fundraiser will recognize Congressman McHugh, the chairman of the Armed Services Subcommittee with jurisdiction over military health care, and is scheduled for August 31st in New York City, coinciding with the Republican National Convention. Former ACA Chairman Dr. Ken Padgett and other concerned DCs from New York, New Jersey and Connecticut are making arrangements to attend and thank Congressman McHugh for his support for the chiropractic profession.

With just 13 weeks until Election Day 2004, now is the time for every ACA member to get involved in ACA-PAC and help ensure that pro-chiropractic candidates -- including the members of Congress who fought hard for inclusion of chiropractic care in the veterans and military health systems and who took a stand for passage of the Medicare Chiropractic Demonstration Project -- are in Congress in 2005 and beyond. Only ACA members can contribute to ACA-PAC, the only major political action committee committed solely to electing and re-electing pro-chiropractic candidates to Congress. Call ACA-PAC Manager Kim Krocker for more information (800) 986-4636 or click on the following link to sign up and become a PAC contributor and help ensure that the profession is a force in the key Senate or House race near you: <http://w! ww.acatoday.com/membersonly/acapac/contribution_form.pdf>.

3. VA CONNECTICUT ADVERTISES FOR FULL-TIME CHIROPRACTOR

The legislation signed by the president calling for the establishment of a chiropractic benefit within the Veterans Administration is being implemented with surprising speed. VA Secretary Principi and his staff worked closely with the Chiropractic Advisory Committee, the ACA and the ACC in adopting more than 30 recommendations for the implementation of chiropractic in the VA -- a good beginning. Reading through the commentary from the Secretary regarding the recommendation, the common theme was that he wanted to do it right and wanted it be successful. This approval of the recommendations was followed shortly by another step forward -- the announcement of 26 sites throughout the country where the chiropractic benefit would be implemented.

Nowhere is the commitment to quickly implement the chiropractic benefit more evident than in Connecticut - where advertising has already begun to recruit a full-time chiropractor to serve the Newington and West Haven facilities. As mentioned in a previous report, this quick action in Connecticut was made possible by some excellent lobbying work done by ACA Connecticut Delegate Dr. Overland and his Connecticut colleagues, including Dr. Bellows, president of the Connecticut Chiropractic Association (CCA) and Dr. Kane. Thanks to their efforts, as well as the support of Rep. Rob (R-CT) and , director of the Connecticut VA health care system, for making this happen. The advertisement for the Connecticut VA position can be found on our Web site at <http://www.acato! day.com/government/va/ConnFTChiro.shtml>. Applications must be forwarded by August 15, 2004.

4. ACTIVATOR METHODS INC. JOINS THE CHIROCERE TEAM

During a recent meeting in Phoenix, AZ, Chirocere, ACA's newly endorsed Web-based chiropractic office solution entered into an agreement with Activator Methods, Inc. for the distribution of this product. Ken of Chirocere attended and presented the Chirocere service to the regional directors and General Assembly of Activator resulting in this positive outcome. Activator Methods, Inc. is a Phoenix, AZ based company that conducts chiropractic research and provides post-graduate educational seminars and chiropractic products to chiropractors.

"I can say with authority that the Chirocere product is light years beyond other office solutions," said Steve Conway, DC, JD, general counsel for Activator Methods, and past president of the ACA Council on Occupational Health. "I have no doubt that this system will help with the ever increasing denials from insurance companies."

ACA Members receive a special discount off the monthly fee. You can view a live demonstration of the services provided by Chirocere through the ACA website at <http://acatoday.com/about/products/ChiroCere/index.cfm> or call Chirocere directly at 866-573-9404.

5. ACTIVATOR HAS SUCCESSFUL PROGRAM

We were naturally pleased when Dr. Arlan Fuhr announced his support for Chirocere at his summer training program last weekend for 160 of his instructors from throughout the world. I understand the program was outstanding and had other pluses as well. Dr. Lou Sportelli was given an opportunity to speak and talked at length about our lawsuits and their value. He put it well when he said that, win or lose, "The Trigon suit was necessary, and the positive benefits of the Trigon suit are to be measured not in outright victory for the litigation, but rather for the long term rippling effect the suit has and will continue to have on third party reimbursements issues. If we, by default, do nothing, we will have nothing.â€ The program also included Dr. Kawchuk from the University of Calgary who provided an update on research, and Mr. Kiyosaki, who wrote the best seller Rich Dad/Poor Dad.

6. DR. GEORGE MCCLELLAND APPOINTED TO NEW URAC ADVISORY COMMITTEE

ACA is pleased to announce the appointment of ACA Chairman Dr. McClelland to URAC's Consumer Directed Health Advisory Committee. For those unfamiliar with URAC, it is an independent, nonprofit organization committed to promoting health care quality through accreditation, certification and other quality improvement activities. Today, URAC's accreditations cover 140 million Americans. The Committee's goal is to determine opportunities for consumer directed health through accreditation standards. Members of the committee represent constituents from all areas of the health care industry, including trade association representatives, experts in consumer education, benefits consultants, and leading consumer directed health plans.

7. WFC ANTI-TOBACCO POSTERS TO BE CENTERFOLD IN DYNAMIC CHIROPRACTIC

The upcoming August 16 international issue of Dynamic Chiropractic will contain a descriptive article plus a centerfold of two posters from the Health for All Committee of the World Federation of Chiropractic (WFC). These beautiful posters are part of that committee's "Chiropractors Against Tobacco" or C-A-T campaign, which is the chiropractic profession's effort in support of the World Health Organization (WHO) "Tobacco-Free Initiative." The Health for All Committee is chaired by Dr. Rand Baird and has nine doctors of chiropractic as members, plus three advisors from all the regions of the world.

The centerfold can be removed from Dynamic Chiropractic, separated into two posters (with vendor sponsors on the reverse) and displayed in your office. The goal is to have an anti-tobacco poster on display in every single chiropractic office in the world.

Tobacco use is the second major cause of death in the world. Use of tobacco products is currently responsible for the death of one in ten adults worldwide and kills about 5 million people each and every year.

Please support this important international public health campaign, and display the posters prominently in your offices.

As an aside, an earlier EVP report that mentioned the doctors who attended the WFC Conference in Singapore failed to include Dr. Baird. Sorry for the oversight.

8. NEW ONLINE VAD COURSE AVAILABLE FREE TO PROFESSION

As the efficacy and safety of chiropractic care continue to be validated by research - and satisfied patients - our detractors often take every opportunity available to sensationalize the extremely remote risks of spinal manipulation and its purported link to vertebral artery dissection (VAD). In response to the growing need to debunk myths and educate doctors of chiropractic on this topic, CEVantive.com, an online continuing education university, is offering a free two-hour course titled â€œStroke and Cervical Manipulationâ€ to all doctors of chiropractic. The course can be taken directly from the web site at www.cevantive.com <http://www.cevanti! ve.com>.

For as little as $50, you may also obtain CE credit - if your state accepts this course for continuing education. (You can refer to CEVantive.comâ€™s site map and list of approved curriculum to determine if your state does.) The net proceeds will be donated to FCER. Continuing education credit is obtained through Western States College of Chiropractic. After a doctor completes the two hours of required course work, WSCCâ€™s postgraduate department will automatically be notified, and a certificate of completion will be mailed out within seven to 10 days.

9. LEADERSHIP ON THE ROAD

ACA President Dr. Don Krippendorf recently traveled to National College to attend their homecoming. He was given an opportunity to update the attendees regarding ACA activities. He was presented with a Presidential Award from Dr. Winterstein. ACA Chairman Dr. McClelland was also given this recognition.

This weekend, Dr. Krippendorf traveled to Texas where he participated in the investiture of Dr. Brassard as president of the Texas Chiropractic College. He was also given the opportunity to speak to the Board of Trustees of the school.

Also this past weekend, Dr. McClelland traveled to Life Chiropractic University to participate in the investiture of Dr. Guy Reikman as President, where he was able to extend the greetings of the ACA.

Earlier in the week, Dr. McClelland traveled to Rhode Island along with Pat to meet with representatives of the Rhode Island Blue Cross/Shield plan at the request of the Rhode Island Chiropractic Association. Also in attendance were the president of the Rhode Island Association, Dr. Mastronardi, delegate from Rhode Island, and Dr. Donovan, alternate delegate from Rhode Island.

Dr. Mike Flynn, former chairman of the board, traveled to Palmer Florida to address the students on SACA day. He also attended the investiture of Dr. Brassard.

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

August 4, 2004

ï»¿

ACA EVP Weekly Report

Memorandum to ACA Members, ACA House of Delegates, Board of Governors, and other Interested PartiesFrom: Cuneo, ACA Executive Vice President

Re: ACA EVP Weekly Report, Aug. 2, 2004

This weekâ€™s report includes the following items:

1. Trigon Lawsuit Update: Petition to Supreme Court Due This Month2. Organizations Continue to Support Chiropractic Legal Fund3. ACA Seeks to Change Medicareâ€™s â€œFrequency Limitsâ€ Scheme4. Warning: Seminars Spreading Inaccurate Medicare Information5. ACA Is on the Move! Join Us and Walk Your Way to Better Health6. Athletic Trainers Reaching Out to ACA, Other Groups7. Doctors of Chiropractic Reporting for Duty

1. TRIGON LAWSUIT UPDATE: PETITION TO SUPREME COURT DUE THIS MONTH

ACA must file its petition for an appeal in the case against Trigon Blue Cross Blue Shield with the U.S. Supreme Court by Aug. 31. In order for a case to get the Supreme Courtâ€™s attention, one of three questions must be addressed:

1) Is there a conflict between two appeals courts regarding an issue?2) Is there a conflict between an appeals court decision and a previous action by the Supreme Court?3) Is the issue at hand of monumental importance to due process and the implementation of U.S. antitrust laws?

Mcs, ACAâ€™s lead attorney, believes we have a strong argument to make in response to all three questions.

We also believe that the issues addressed in our suit would be of interest to a number of other health care groups who face similar problems with the insurance and medical communities. ACA will circulate a draft of its petition on or around Aug. 10 to see whether any of these groups would be interested in filing an amicus brief with the court, indicating their support of ACAâ€™s action.

The Supreme Court generally takes three to eight months to decide whether it will accept a case. We will keep you informed as this process continues.

2. ORGANIZATIONS CONTINUE TO SUPPORT CHIROPRACTIC LEGAL FUND

As the ACA forges ahead to the U.S. Supreme Court with its case against Trigon Blue Cross Blue Shield, many chiropractic organizations and companies have rallied behind this effort to eliminate discrimination against doctors of chiropractic by continuing to provide financial resources to the National Chiropractic Legal Action Fund (NCLAF).

These important supporters include:

Â· The Master's Circle, $500 (via EZ Pay), bringing its total contribution to $15,000Â· Performance Health, $100 (via EZ Pay), bringing its total contribution to $2,200Â· Missouri Chiropractic Association-District 1, $100 (via EZ Pay), bringing its total contribution to $7,600Â· Missouri Chiropractic Association, $100 (via EZ Pay), bringing its total contribution to $2,800Â· South Carolina Chiropractic Association, $2,500, bringing its total contribution to $11,817.98

3. ACA SEEKS TO CHANGE MEDICARE'S "FREQUENCY LIMITS" SCHEME In response to assertions by the Centers for Medicare and Medicaid Services (CMS) that significant numbers of chiropractic claims under the Medicare program are improperly documented and result in improper payment of uncovered "maintenance therapy," the agency has issued new directives to Medicare carriers, scheduled to take effect on Oct. 1, 2004, requiring the use of the AT modifier. Under the new guidelines, the definition of â€œATâ€ will be changed from â€œAcute Treatmentâ€ to â€œActive Treatment.â€ DCs will be required to use the AT (â€œActive Treatmentâ€) modifier on all claims to denote when active/corrective spinal manipulative services (98940-98942) are provided to Medicare beneficiaries.

While the AT modifier language appears to be within CMS authority, the ACA is greatly concerned about another section of the same guidance that would provide carriers with the ability to establish arbitrary "frequency limits" on chiropractic services under Medicare and reject claims automatically without the benefit of prior medical necessity review. The new "frequency limits" scheme is apparently intended to replace the longstanding use of â€œscreensâ€ by Medicare carriers to determine when a medical necessity review should be conducted.

In the ACA's view, any mechanism that allows carriers to arbitrarily deny claims, without first performing a medical necessity review, is unacceptable and is contrary to current law that guarantees beneficiaries access to reasonable and necessary chiropractic care. In June, the ACA delivered to HHS Secretary Tommy its written objections to the "frequency limits" scheme and in the weeks since has held multiple meetings with CMS officials in their Baltimore, MD headquarters as well as in Washington, DC. On July 20, in response to the ACA's concerns, the HHS general counsel's office agreed to conduct a legal review of the proposed plan. In addition, after receiving a Capitol Hill briefing from the ACA, Sen. Ben (D-NE) sent his own letter to expressing concern about the creation of any new obstacles to providing Medicare beneficiaries with the chiropractic care they want and need. Other pro-chiropractic ! members of Congress are expected to weigh in with HHS and CMS on this issue and are now being activated on a select-targeted basis.

The true impact of the "frequency limits" scheme, if implemented in its current form, is unclear. The CMS guidance to carriers requires the use of the AT modifier while it only authorizes the carriers to set-up and impose "frequency limits" on chiropractic care. It is not promising if we have to rely on the good faith of the carriers to do the right thing. Even if the "frequency limits" scheme has only a limited impact initially, the ACA finds it unacceptable for any policy to eliminate or undermine medical necessity as the basis for reviewing claims. Accordingly, the ACA will continue intensive efforts to seek appropriate revisions in this or any similar CMS directive. Stay tuned!

4. WARNING: SEMINARS SPREADING INACCURATE MEDICARE INFORMATION

It has come to our attention that Medicare seminars are being taught across the country that may contain inaccurate information.

Contrary to what they may be teaching, CMS has not directed carriers to automatically deny after 12 visits (see â€œFrequency Limits Schemeâ€ article above). Also, they may be teaching that there will no longer be â€œsoft capsâ€-that the denials will be â€œfinalâ€ denials. This is also untrue. Another thing being promoted is that there is a â€œnewâ€ ABN (Advance Beneficiary Notice) form. Again, not true. It is the same form that has been around since June 2002.

Please be careful when signing up for seminars. The ACA recommends that chiropractors contact CMS, its contractors/carriers, the ACA, or their state association for Medicare information. Anyone with questions about Medicare is encouraged to contact the ACA at 1-800-986-4636 or at ahanley@... <mailto:ahanley@...>.

NOTE: As of Oct. 1, 2004, Medicare will require that an AT (Active Treatment) modifier be appended to all spinal CMT services (98940-98942) where active/corrective treatment is being performed. This will be applicable to both acute and chronic care. All spinal CMT services (98940-98942) billed without this modifier will be considered maintenance therapy and will, therefore, be denied. For more information, please see the AT modifier article in the next ACA Today.

5. ACA IS ON THE MOVE! JOIN US AND WALK YOUR WAY TO BETTER HEALTH

Itâ€™s easy to say you are in favor of wellness; itâ€™s another thing to practice it. When it comes to wellness, ACA staff is walking the walk, literally. Two weeks ago, ACA distributed pedometers to staff who signed up as a group for the America on the Move program, a free online program that encourages Americans to move more and eat less.

The main goals of the program are simple: Walk an additional 2,000 steps and eat 100 fewer calories each day than you do right now. The program was instituted at ACA by Griffith, project manager in the Professional Development and Research Department, who holds a degree in nutrition and wellness from Mason University and is the staff liaison to the ACA Wellness Committee. She chose the program because it encourages small, simple changes that are not overwhelming to the average person.

â€œEveryone walks throughout the day,â€ notes . â€œWe are simply asking them to walk a bit more and eat a little healthier." Just a few days into the program most of the staff are delighted at how many steps they were already taking and how easy it's been for them to add to their daily total.

I am now also a participant in the program, averaging about 3,500 steps a day. Last Friday, I reached 6,500 steps! To you doubting es: No, I am not cheating and haven't assigned someone to carry my pedometer around the office for me!

This program builds on other changes we have made in the office to promote wellness, such as the "Small Step for the Day" e-mail that sends to the staff every morning, offering advice on simple ways to move more or eat healthier. Our "Quotes in the Stairwell" program involves staff contributing inspiring quotes that are posted daily in the stairwell leading up to ACAâ€™s offices. The goal is to encourage staffers to use the stairs rather than the elevator and has been successful in motivating staff for more than three months now. And finally, last Friday we held an organized lunch time walk to provide support and encourage staff to fit even more steps into their day.

ACA is serious about wellness and we are demonstrating this by making it a priority within our own walls. We anticipate even more healthy changes to come as the program gets up and running.

JOIN US!

We encourage you to join our office in the quest for better health and wellness by joining the ACA group through America on the Move. You can encourage your staff, patients, families and communities to join as well. For more information, or to sign up, simply visit www.americaonthemove.org <http://www.americaonthemove.org/>, click on â€œJoin Nowâ€ and then select â€œIndividualâ€ and insert the registration code R*A7042 to start tracking your steps and monitoring how your profession is doing with the program. As the program moves forward, we will provide updates on everyoneâ€™s progress.

If you have questions about America on the Move or ACAâ€™s wellness initiatives, contact Griffith at cgriffith@... and look for the â€œWellness In Practiceâ€ section in your monthly JACA.

6. ATHLETIC TRAINERS REACHING OUT TO ACA, OTHER GROUPS

Recently, I was the guest of the National Athletic Trainers Association (NATA) during their annual convention held in Baltimore, MD. I was joined by four others representing hospital and rehabilitation centers for an afternoon of private presentations by NATA representatives covering athletic trainersâ€™ education, their obvious role in athletics, their role in a hospital setting and their involvement in workersâ€™ comp injuries and prevention.

Athletic trainers see themselves as a substitute for more expensive physical therapy services. It was an interesting presentation as they are trying to do what every other group is attempting to do-find a niche in the health care industry. They are recognized by the American Medical Association as an allied provider but they are trying to reach out to other groups-including chiropractors-to develop closer relationships.

They have a membership of 30,000 (9,000 attended the conference) and, like massage therapists, they have the potential to be a political player if they were ever to organize themselves. However, they aren't there yet. They are licensed in only a few states and they are organized regionally. Their state organizations are very spotty and their PAC is non-existent. Itâ€™s interesting to see how other health care groups are doing.

7. DOCTORS OF CHIROPRACTIC REPORTING FOR DUTY My article two weeks ago about the DC sergeant from South Carolina serving in Iraq resulted in reports of other doctors serving abroad. Dr. Carl Whetsel of Bishopville, SC, left last week for training before he is deployed in Iraq for the next 15 months. Dr. Rhonda McKinney of Phenix City, AL, who is a lieutenant colonel and also serves as the staff DC at Eglin Air Force Base in Florida, has also been activated. We wish them luck.

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

August 10, 2004

ï»¿

ACA EVP Weekly Report

ACA Members, ACA House of Delegates, Board of Governors, and other Interested Parties

From Cuneo

Re: ACA EVP Weekly Report

August 10, 2004

MEMBERS-ONLY ISSUE

This week's report includes the following items.

1. A DOSE OF COMPETITION?-FTC AND JUSTICE DEPARTMENT DISAPPOINT2. ACA ADVOCACY CREATES NEW OPPORTUNITIES FOR DCS IN VETERANS' HEALTH CARE3. NEW FACT SHEET: CAM USE IN THE UNITED STATES4. ONE MONTH AND COUNTING: ACA-PAC 2ND ANNUAL AUCTION QUICKLY APPROACHING5. SENATOR HARKIN RENEWS HIS SUPPORT OF CHIROPRACTIC AT THE DEMOCRATIC CONVENTION6. MORE INFO REGARDING OUR DOCTORS IN THE OLYMPICS7. LEADERSHIP ON THE ROAD8. LEARN WHAT YOU NEED TO KNOW ABOUT ERISA WITH ACA'S LIVE TELESEMINAR

1. A DOSE OF COMPETITION?-FTC AND JUSTICE DEPARTMENT DISAPPOINT The Federal Trade Commission and the U.S. Department of Justice recently released a final report of their year-long hearings on antitrust concerns in the health care marketplace entitled, "Improving Health Care: A Dose of Competition." Unfortunately, the dose of competition recommended in the Report is a very small amount. As reported previously, the ACA submitted a line of formal written commentary identifying the need to address the unbalanced and unfair competitive disadvantage individual doctors face in dealing with insurance and managed care giants. We suggested ways to level the playing field. Regrettably, the final Report rejects these pro-competitive approaches and specifically recommends against legislation to permit independent doctors to bargain collectively, something long advocated by the ACA and other major health care professional organizations.! We will continue to push for this type of pro-competitive legislation because we believe competition is improved when each party plays by the same set of rules. A copy of the full 361-page Report can be found at http://www.healthlawyers.org/docs/ask2004/FTC_report.pdf

2. ACA ADVOCACY CREATES NEW OPPORTUNITIES FOR DCs IN VETERANS' HEALTH CARE

As we have reported previously, the ACA has been urging the U.S. Department of Veterans' Affairs to hire as many DCs as possible as it begins to make chiropractic care available to veterans at an initial group of 26 selected VA health facilities around the U.S. Immediately after the VA's June 25 announcement of sites, the ACA and its members launched a grassroots lobbying effort targeting members of Congress and VA officials in Washington and at the regional office levels. Apparently, the message is being heard loud and clear.

ACA has been tracking each opening for a DC in the VA system and has learned VA officials have taken steps to hire more DCs than first announced only six weeks ago. In fact, ACA's analysis reveals that a number of VA facilities that were slated to contract with a DC on a part-time basis have taken steps to hire a DC on staff full time. For the latest information on DC positions available through the VA health system, please visit www.vacareers.com or contact ACA Government Relations at ahanley@.... Every DC and every chiropractic patient eligible for care in the VA system can participate in this ongoing grassroots lobbying effort to strengthen veterans' health care a! nd make chiropractic care more accessible.

3. NEW FACT SHEET: CAM USE IN THE UNITED STATES

NCCAM has developed a new fact sheet that outlines results from the recent National Health Interview Survey on the use of complementary and alternative medicine (CAM) in the U.S. http://nccam.nih.gov/news/camsurvey_fs1.htm

4. ONE MONTH AND COUNTING: ACA-PAC 2ND ANNUAL AUCTION QUICKLY APPROACHING

I would like to personally invite you to the ACA-PAC 2nd Annual Auction to be held in conjunction with the HOD meeting in St. sburg, Florida on September 2nd. If you were present last year, I am sure you can attest to the wide variety of auction items generously donated by ACA members and the opportunity everyone had to support the ACA-Political Action Committee (ACA-PAC). Whether it's by placing an item up for bid or bidding on an item (by phone if necessary), ACA members can participate in the PAC Auction even if you will not be in St. sburg. As you may know, the ACA-PAC is the only major Federal PAC committed to helping elect pro-chiropractic candidates to Congress and relies solely on the voluntary contributions of ACA members. Thanks to devoted PAC members, we have been able to support ACA-backed legislative initiatives and helped make the ACA one of the leading advocacy groups in Washington D.C. !

I am excited to announce the following items are confirmed for the ACA-PAC 2nd Annual Auction: Autographed jerseys by the following sports stars: Magic , Zach , Elway, Bart Starr; baseball tickets; a signed collector's edition of The Faith We Have Not Kept by the late Senator Strom Thurmond; and much more. For additional information, please contact Kim Krocker, ACA-PAC manager at 800/986-4636, ext. 228, or email: kkrocker@....

5. SENATOR HARKIN RENEWS HIS SUPPORT OF CHIROPRACTIC AT THE DEMOCRATIC CONVENTION On July 29th, the ACA-PAC hosted another successful chiropractic-only fundraiser that honored Senator Tom Harkin (D-IA) in Boston during the Democratic Convention. As you may remember from NCLC, Senator Harkin is proud to say he's the chiropractic profession's "best friend in Congress." With all the demands on his time as a leader of his party, Senator Harkin and his staff were generous enough to spend two hours with ACA members and staff to discuss issues of importance to doctors of chiropractic and chiropractic patients. I would like to take this opportunity to personally thank the following ACA members who took time away from their practices to represent the ACA and chiropractic patients by participating in this event: ACA Iowa Delegate, Dr. Dow Bates; ACA Delegate Dr. Al Kalter; ACA Delegate Dr. C. Donovan; Dr. Ste! ve Saro; Dr. Mulhern. In addition, the following ACA members made strong contributions to this event: Dr. Dziura, ACA Alternate Delegate - Connecticut; Dr. Welch; Dr. , ACA Delegate - Nevada; Dr. Al Norville, ACA Delegate - Mississippi; Dr. Krause, ACA Alternate Delegate - Iowa; Dr. Sidney ; Dr. Barbati; Dr. Kerner; Dr. Girard; Dr. Kressin-; Dr. Rex ; Dr. ; Dr. Dixon; Dr. and Dr. Kent kson. At this juncture, the event has raised more than $10,000 for Senator Harkin.

If you are interested in becoming more involved with the ACA-PAC or learning more about future chiropractic-only events, please contact Kim Krocker, ACA-PAC manager at 800/986-4636 or by email: kkrocker@.... 6. MORE INFO REGARDING OUR DOCTORS IN THE OLYMPICS

My report of a couple of weeks ago generated some emails from members regarding other doctors involved in the Olympics. Dr Tom Hyde, ACA Delegate from Florida and prominent in sports medicine, reported that the World Olympians Association has also given us permission to send a group of DCs from around the world to treat Olympians, VIPs from the IOC, and individual members of each country's National Olympic Team and others at their headquarters, which will be located at the Athens Tennis Center. Included among the doctors involved are Drs. Tim Ray, Sherri Lashomb, Mark Hecimovich, Sue Bromley, and Faro going from the U.S. Carla How will represent Scotland; Tom Greenway the UK; Gordon Lawson Canada; Ramon , Saul Luengas, and le Monterrubio Mexico; and Rikke Craven Denmark.

Something else I learned from Dr Hyde is that a number of our chiropractic colleges are offering academic scholarships to Olympians who wish to become doctors of chiropractic. The participating schools are:National, LACC, , NY, Cleveland, Northwestern, Western States, AECC, Mexico, and CMCC.

Dr Mike Flynn noted that Dr. Beth(Larson) Iagorashvili and her husband Vaho made the U.S. Olympic Pentathlon teams. The U.S. has only four members (two men/two women) on this team. Dr. Beth has been very helpful to us in promoting the lawsuits at . The August 2nd issue of Sports Illustrated included a picture of Vaho and Beth on page 83, although there is no reference to her being a chiropractor.

Finally, I heard from another source that Dr. Fred Fritsch, a two-time Olympian himself (U.S. bobsled team) is the team chiropractor for the Guatemalan Olympic Team.

7. LEADERSHIP ON THE ROAD

Dr. Mike Flynn, former Chairman of the Board, traveled to California and addressed the students at Palmer West and then traveled across the bay to address the students at Life West. He also had a number of private meetings with SACA students and officers.

8. LEARN WHAT YOU NEED TO KNOW ABOUT ERISA WITH ACA's LIVE TELESEMINAR

Get the answers to these and other questions from the ACA experts with ACA's live teleseminar-ERISA:

What You Need to Know.Â· What is an ERISA plan? Â· How has my practice been affected by recent regulatory changes? Â· What does ERISA require for claims denials and the filing of an appeal? Â· What are the claim appeal response timelines? Â· How are denials and appeals handled?

This comprehensive teleseminar will cover all the following topics: regulatory changes, provider claims submission requirements, plan administrator requirements, appeal timelines, the denied claims appeal process, enrollee/beneficiary rights, authorization forms, and other resources. Participants will also have a 30-minute Q & A with the speakers to get answers to their own questions.

The program is presented by Page, Insurance Manager, ACA Professional Development and Research Department, and R. Daly, Esq., ACA Legal Counsel. Prior to joining the ACA, Mr. Page held several positions in managed care including Senior Business Analyst with ADP/Integrated Medicare Solutions, Inc., Manager of Network Services Department of UNICARE Mid-Atlantic, Inc., Manager of Network Management Department and Hospital Negotiator for America's Health Plan. Mr. Daly has served as legal counsel to the ACA for more than 20 years and is a member of the District of Columbia and Virginia Bar. He is a practicing attorney of health care and corporate law at the firm of Odin, Feldman, & Pittleman in Fairfax, Virginia.Date: Tuesday, August 17, 2004 Time: 1:30 - 3:00 p.m. Eastern Standard Time Cost: $69 ACA members, $35 SACA members, $99 Non-ACA members

One low-cost fee covers all participants in the office! Cost includes free materials emailed to each participant upon registration.

Register today! Call toll-free: 1-800-986-INFO (4636) or visit www.acatoday.com/about/products/teleseminars.

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

August 18, 2004

ï»¿

ACA EVP Weekly Report

Memorandum to ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: Cuneo Re: ACA EVP Weekly Report (Members-Only Report)August 16, 2004

This weeks report includes the following items:

1. ACA Continues to Collect Information on Managed Care Problems2. ACAâ€™s Message Will Reach Entire Profession in 20053. ACA-PAC to Host Chiropractic-Only Event at Republication National Convention4. Pedag Advertising May Be Misleading 5. Look Forward to Surprises and Friends at ACAuxiliary Dinner Event6. Did You Knowâ€¦7. More DC Involvement in the Olympics8. Leadership on the Road9. FEDs to ACA for Chiropractic Coding Advice

1. ACA CONTINUES TO COLLECT INFORMATION ON MANAGED CARE PROBLEMS

If you are having problems with managed care companies, ACA wants to hear fromyou. We have an ongoing program to identify coding, bundling, global fees and general reimbursement and process problems within managed care plans. If you are experiencing any of these problems or have any questions concerning our collection efforts, please contact Kara Murray, coding coordinator, at 800/986-4636 or kmurray@....

2. ACAâ€™S MESSAGE WILL REACH ENTIRE PROFESSION IN 2005

Beginning in January 2005, ACA will reach more than 60,000 doctors of chiropractic and students every month with a new professional newspaper called ACA News. This professionally written and designed newspaper will replace the current ACA Today newsletter and will educate doctors of chiropractic about developments affecting the ACA, their practices, their profession and their role as leaders in national health care issues. It will also frame the profession's national agenda, build a sense of community among all within the profession and inform and demonstrate to non-members that involvement with and support of the ACA and its programs are essential to the future and professional livelihood of every doctor of chiropractic. At the same time, the chiropractic profession's preeminent research journal-the Journal of Manipulative and Physiological Therapeutics (JMPT)-will become the official scientific journal of the American Chiropractic As! sociation. Print and online subscriptions will be provided free to all ACA general members. All other membership categories will receive deeply discounted rates on both print and online subscriptions. Not only will ACA members themselves benefit from the cutting-edge information contained in JMPT, but the American Chiropractic Association will also become synonymous with quality research-improving our credibility, image and status with legislators, policymakers, the media and the general public.

To accomplish these goals, the Journal of the American Chiropractic Association (JACA) will move to an online-only version-JACA Online-that will be housed in an online, fully searchable database allowing ACA members instant access to a wealth of clinical and educational materials to assist them in their practices. The database will be searchable by date, key word, author name or subject. It will be accessible 24 hours a day-at no charge-to members only. Non-ACA members will have to pay to access the full text of articles. JACA Online, like JACA before it, will be peer reviewed. It will also continue to be indexed by those organizations that have come to recognize its credibility and value to the profession. These dramatic and exciting changes will allow us to reach every doctor of chiropractic in the country and mobilize the entire profession to confront the challenges that lie ahead. It is no longer acceptable for doctors to stay on t! he sidelines and allow a small percentage of the profession to carry the load for the rest of profession. ACA News will not only be newsworthy and helpful in your practice but will make the case that the ACA is the only national organization with the staff and resources to make a difference. Only by expanding our message beyond our own "borders" can we hope to get those who currently sit on the sidelines to join our ranks and assist us in this important endeavor.

3. ACA-PAC TO HOST CHIROPRACTIC-ONLY EVENT AT REPUBLICAN NATIONAL CONVENTION

In just a couple of weeks, the ACA PAC and government relations staff will be traveling to New York to attend the Republican National Convention. In conjunction with the convention, the ACA-PAC will host yet another chiropractic-only breakfast, this time honoring Rep. McHugh (R-NY).

On Aug. 31, at The Iroquois Hotel in Manhattan, ACA members and staff will have the opportunity to personally thank McHugh for his commitment to the chiropractic profession and patients. Throughout his 14 years in Congress, McHugh has been determined to use his seniority and leadership position to ensure that America's active-duty military personnel have access to the chiropractic care they want, need and deserve. In fact, in 2003, as the powerful pro-chiropractic chairman of the Armed Services Subcommittee on Total Force, McHugh led the successful effort to direct the Pentagon's medical bureaucracy to accelerate implementation of the new chiropractic benefit in the military health care system. Today, DCs provide care in more than 40 military health care facilities around the United States-with more due to begin offering care in the weeks and months ahead. If you are interested in participating in the chiropractic-only event for ! Rep. McHugh in New York, or if you have questions about the ACA-PAC, please contact Kim Krocker at 800/986-4636 or kkrocker@....

4. PEDAG ADVERTISING MAY BE MISLEADING.

I received a call from a member the other day regarding a promotional piece titled, â€œPedag Offer to ACA Members.â€ I asked him to send me a copy of the promotion. The company was promoting an orthotic product and, in reading through the letter provided by the member, one might conclude that the ACA was promoting this product. Please be aware that the ACA has not endorsed Pedag products nor does it have any kind of relationship with the company.

Personally, if I am going to buy an orthotic product it will be from a company that supports this profession. A product from Foot Levelers would be my first choice.

5. LOOK FORWARD TO SURPRISES AND FRIENDS AT ACAUXILIARY DINNER EVENT

Join friends and colleagues at the ACAuxiliary-hosted Chiropractic Beach Party during the annual ACA House of Delegates meeting. The party takes place on Friday, Sept. 3, at the St. sburg Yacht Club, St. sburg Florida. There will be live surprise entertainment once again! Last year it was the Beach Boys; this year's entertainment will be just as good (and I promise not to sing!). There will also be prize giveaways like before. You don't want to miss this evening of fun, relaxation and great food! Tickets are $150 (which admits two people). To purchase tickets, contact Janet Ridgely at ACA: 800/986-4636 or jridgely@....

6. DID YOU KNOWâ€¦

Some of you may be new to the ACA and to this newsletter, so itâ€™s worth reporting on some notable accomplishments from late last year.

In the Nov. 26, 2003 issue of the Washington Times, an article appeared that really put ACA on the radar screen of the political pundits. An official with the American Political Science Association published an article that listed the ACA as one of the 25 most effective grassroots organizations for health care in the United States. Out of the thousands of groups that lobby Congress on health care issues, ACA was ranked 19th in the listing-ahead of the U.S. Chamber of Commerce, which was ranked 21st, and the American Physical Therapy Association, which ranked 24th.

Soon after this article was published, Chiropractic Economics published an article in its December 2003 issue in which they interviewed the author of the Washington Times article to learn more. The author explained that his list of the top 25 grassroots lobbying organizations was developed from a roll of more than 1,200 associations he initially compiled that have interest in health care legislation. He used several criteria, including recommendations by a panel, mentions in previous studies and lobbying efforts to narrow the list to the top 171 associations. This list was further narrowed to the top 25 after in-depth interviews with 77 congressional staff.

In response to an obvious question about where the other national chiropractic organizations were ranked, the author indicated that both ICA and the WCA met the criteria to be among the original 1,200 associations but did not make the list of the top 171 groups. An official with expertise in the area-with no tie to the profession-confirmed in an independent chiropractic publication what we have all known to be a fact: There is only one chiropractic organization in the country that has the political action committee, the lobbying teams and the grassroots organization to move this profession forward-and it is the ACA.

If you don't think there is a significant difference between the national organizations then think again. Please share this with your non-member friends and tell them that joining the ACA is money well spent. You can refer them to our Web site, where they can download a member application at http://www.acatoday.com/membership/application.shtml.

7. MORE DC INVOLVEMENT IN THE OLYMPICS

I continue to get reports from the field regarding the professionâ€™s involvement in preparing our athletes for the Olympics. I think its one of the best kept secrets in the profession and its too bad because there is a lot to be proud of. I learned last week from Dr. Steve Brodbeck that the Olympic Training Center (OTC) in Chula Vista, CA, provides chiropractic care for athletes. Dr. Brodbeck has been working as the OTC chiropractor for about a year now, after taking over from Dr. Russ Revilla. Dr. Stoddard also works at the center.

8. LEADERSHIP ON THE ROAD

Dr. Dick spoke last weekend at the Ohio State Chiropractic Association, providing an update on the ACAâ€™s lawsuits against Trigon Blue Cross Blue Shield and HHS. Dr. reports that doctors there expressed continued support of our legal efforts to end discriminations against DCs and chiropractic patients. Former ACA President Dr. Daryl Wills received similar encouragement when he addressed a gathering of the Nebraska Chiropractic Associationâ€™s board of directors and members attending their state convention.

Thanks also to Dr Reg Hug, former member of ACA Executive Committee and Dr. Welsh, an ACA member and president of the Palmer Alumni Association in Florida, who represented the ACA at a ACA/ICA reception at the Palmer Program in Davenport, IA.

9. FEDs TURNING TO ACA FOR CHIROPRACTIC CODING ADVICE

Federal Government Agencies seeking to gain a better understanding of chiropractic coding issues are turning to ACA's 2004 Chiropractic Coding Solutions Manual for answers. This one-of-a-kind resource was developed for doctors of chiropractic by doctors of chiropractic. The 2004 manual was recently revised and continues to fly off the shelves! Due to the high demand of this valuable resource, ACA has ordered an additional supply of manuals.

If you have not ordered your 2004 manual, now is the time to see why the ACA's 2004 Chiropractic Coding Solutions Manual is the most accurate and authoritative desktop coding reference available to doctors of chiropractic.

ACA is currently developing a 2005 edition of the coding manual and we are confident it will be even better, with a NEW â€œClinical Examplesâ€ section and additional design features to make it even easier to use.

To purchase your 2004 coding manual, go to www.ACAToday.com and click on â€œShop ACAâ€ in the upper right hand corner.

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************To be removed from further mailings from our list please click the unsubscribe link

August 25, 2004

ACA EVP Weekly Report

Memorandum

TO:

ACA Members, House of Delegates, Board of Governors and Other Interested

Parties

FROM: Cuneo

RE: ACA EVP Weekly Report

DATE: August 25, 2004

MEMBER

ISSUE

This

week’s report includes the following items:

1. CMS

PROPOSES TO LIMIT " INCIDENT TO " SERVICES UNDER MEDICARE

2. ACA ISN'T THE ONLY ONE ON THE MOVE

3. POLITICAL INFLUENCE DOESN'T JUST HAPPEN

4. HIPAA UPDATES

5. ANOTHER DC IS SCHEDULED FOR IRAQ

6. PROGRESSIVE FINALLY COMES THROUGH

7. APHA ANNUAL MEETING IN WASHINGTON, DC TO HAVE

STRONG CHIROPRACTIC PRESENCE

8. LEADERSHIP ON THE ROAD

9. DR. MARK SANNA PROVIDES EXPERT CODING INSTRUCTION AS PART OF ACA'S

HOUSE OF DELEGATES MEETING

1. CMS PROPOSES TO LIMIT " INCIDENT TO " SERVICES UNDER

MEDICARE

Last

year, we reported that CMS had issued a " discussion only " proposal

and request for comments on its idea of limiting " incident to "

physical therapy services under Medicare to P.T.s only. In our comments to the

" discussion only " proposal we stated: " The standards for

qualification of individuals providing outpatient physical therapy services as

outlined [in the proposal] are inadequate in that they fail to identify the

education and training in physical therapy received by doctors of chiropractic

and other health care providers. " Unfortunately, CMS chose to ignore our

concerns and, on August 5,

2004, issued proposed regulations which continue to

ignore such education and training for the purpose of providing " incident

to " physical therapy services under Medicare. We will renew our objection

in our formal comments to the proposed regulations.

2.

ACA ISN'T THE ONLY ONE ON THE MOVE

Following

mention of ACA's joining the America on the Move

Program in last week's report, FCER contacted ACA to let us know that they too

have started up the program and are excited to get their staff involved in

office wellness! We received calls from other individuals trying to set

up the program in their communities as well. The August 17 edition of the

Washington Post noted that workplace wellness and the use of pedometers to

track steps is on the rise with employers big and small, http://www.washingtonpost.com/wp-dyn/articles/A6558-2004Aug16.html.

Why not join ACA in this easy, free and healthy lifestyle change, and encourage

your patients, local employers, and communities to do the same? To join,

simply visit www.americaonthemove.org and use the

registration code R*A7042 to sign up under the American Chiropractic

Association group, or start your own group in your office or community!

If you have questions or comments, please feel free to contact Griffith,

Project Manager, at cgriffith@....

And

to the question that I am sure you would like to ask me: Yes, I am still adding

steps to my pedometer, and no, I haven't directed someone on staff to carry

it.

3.

POLITICAL INFLUENCE DOESN'T JUST HAPPEN

Politically,

the chiropractic profession and, in particular, the ACA reached a new level of

recognition this year when the major democratic candidates for president issued

positive statements about the profession just months before the Iowa

Presidential Primary. It started with former Governor Dean meeting

with ACA officials and the Iowa Chiropractic Society in the offices of the Iowa

association to address their concerns about his treatment of the profession as

governor, and then to urge him to issue a strong statement supporting the

profession. Shortly thereafter, the other leading presidential candidates,

including Kerry, issued equally strong statements. You can hear the

argument now that politicians will say anything to be reelected. And there is

some truth there. But if you compare the statement that we received four years

ago from former Vice President Al Gore and President Bush, to what we received

this year, there is a di! fference of day and night in the level of

understanding and commitment to our issues. So why the change in

attitude? Perhaps it had something to do with our comments to Senator

Harkin's staff that we were planning to target Dean in the Iowa Primary

that caused Dean to reach out to us. Do you know of a better state than Iowa where this

profession could impact the outcome of a close race? Or maybe it was the

fact that in the 2002 senatorial election, we purchased more than 1500 radio spots

the last two weeks before the election in support of Senator Tim , who

won by less than 500 votes. Or maybe it was the aggressiveness that we

showed in other races that year, including the substantial amount raised by the

profession on behalf of Senator Tom Harkin? It all builds up. The

one thing for sure, in politics, it is the organization with perceived power

that gets the attention.

We

are planning to be players again this year, buying radio time in targeted races

and doing other things to be an active participant in the political process. If

you are a PAC contributor, consider making an additional contribution. If you

aren't contributing, please consider doing so now. Particularly in small

states, organizations like the ACA-PAC are able to purchase radio time at a

fraction of the cost than we could in larger states. The more we have, the more

radio time we can purchase. Please go to the Web page and make your

contribution now: http://www.acatoday.com/membersonly/acapac/contribution_form.pdf.

4.

HIPAA UPDATES

We

have had some questions regarding a rumor that the small provider exemption

under HIPAA will be lifted starting in 2005, and small providers will be

required to file their claims electronically. We checked this out with

CMS and found that Medicare currently has no plans to require small providers

to file electronically. Click below to learn more about this and other

HIPAA matters. http://www.acatoday.com/membersonly/resources.cfm

5.

ANOTHER DC IS SCHEDULED FOR IRAQ

Spc.

Eldridge, DC, is currently stationed at Fort Steward (GA) and will be

going to Iraq in

December. His email is .paul.eldridge@....

Dr.

Eldridge indicates that he has been providing adjustments to members of his

unit after vigorous trainings. He would like to know if anyone might be

able to donate a table that he could send to Iraq so that he

can continue to treat men and women in the military.

6.

PROGRESSIVE FINALLY COMES THROUGH

After

numerous requests by ACA to participate in our Claims Solution Work Group,

Progressive Insurance has finally agreed to join us for our next meeting

scheduled for November 11, according to Pat . Apparently, what

convinced the company -- which is the third largest property and casualty

carrier in the country -- was a review of our statement on Mobile Diagnostic

Services.

7.

APHA ANNUAL MEETING IN WASHINGTON, DC TO HAVE

STRONG CHIROPRACTIC PRESENCE

If

you have an interest in the activities of the 14,000 members of the American

Public Health Association, you should mark your calendar for its annual

meeting, November 6-10, in Washington, D.C. The event

brings together more leaders in public health and government than any other

gathering.

The

chiropractic profession will have a strong presence as usual. There will be

four full sessions consisting of several public papers each dedicated to

chiropractic topics:

· Chiropractic

in the Changing Health Care Environment

· Issues in Chiropractic and Public Health Education

· Issues in Chiropractic Practice and Research

· Chiropractic Access, Outreach and Research

For

further details, go to www.APHA.org for details

on the program and chiropractic-related events.

8.

LEADERSHIP ON THE ROAD

This

past weekend, Dr. McClelland, ACA chairman of the board, traveled to Pennsylvania where he

spoke with doctors attending the Pennsylvania Chiropractic Association convention.

Dr. McClelland was also given the opportunity to speak to the group’s board of

directors. In both meetings, he was able to provide an update on the lawsuit

and other insurance and government relations initiatives of the association.

Dr.

Glenn Manceaux, president of the ACA Council of Delegates and delegate from Louisiana, traveled

to Texas where he

was the commencement speaker at the Texas College of Chiropractic.

9.

DR. MARK SANNA PROVIDES EXPERT CODING INSTRUCTION AS PART OF ACA'S HOUSE OF DELEGATES

MEETING

The

ACA is proud to announce Dr. Mark Sanna of Breakthrough Coaching as the

presenter of the coding educational program, “Navigate the Coding and Insurance

Process,” during ACA’s upcoming House of Delegates Meeting in St.

sburg, FL. The

program will take place on Saturday, September 4 from 8 a.m. to noon at the Renaissance Vinoy Resort and

Golf Club. “Navigate the Coding and Insurance Process” was developed by the ACA

in conjunction with Breakthrough Coaching to help chiropractic professionals,

students and practice managers avoid costly coding errors, while at the same

time learn ways to negotiate successfully with insurers and reduce the amount

of administrative time spent on insurance billing.

Join

us for this premier educational coding event, offered for one-time only at the

House of Delegates Meeting in St. sburg, FL. The program

reference text, the ACA's 2004 Chiropractic Coding Solutions Manual, will also

be available for purchase. Register Today!

Price:

$95 for ACA/FL Members; $115 Non-members. CAs and DCs from the same office only

pay $65.

Two

easy ways to register. Call us at 800-986-4636 or register online at http://www.acatoday.com/about/products/coding_seminars/.

************************

Some of you have been unable to download my PDF links. To view these file

types, you need Adobe's Acrobat Reader. This is a free utility available

at www.adobe.com. If

you need further assistance viewing anything referred to in this report, please

e-mail me at gcuneo@....

************************

</FONT

To be removed from further mailings from our list please click the unsubscribe

link

October 13, 2004

Who is ACA delegate in Oregon now? Why is Oregon not amongst the listed state associations that have sent letters endorsing this law suit? Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested PartiesFrom: CuneoRe: ACA EVP Weekly Report Date: October 12, 2004

MEMBERS ONLY ISSUE

This week's report includes the following items:

1. 45 STATE ASSOCIATIONS, COCSA, ACC AND NCMIC ANSWER THE CALL IN TRIGON CASE2. $200 GIFT FOR JOINING THE ACA; FOOTLEVELERS AND ACA FORM PARTNERSHIP3. ACA-PAC IS ON THE AIR: YOUR HELP IS NEEDED NOW TO KEEP US THERE4. OCTOBER IS SPINAL HEALTH MONTH! PROMOTE THIS EVENT IN YOUR COMMUNITY5. OCTOBER 12-20: BONE AND JOINT DECADE NATIONAL AWARENESS WEEK6. INDEFINITE HOLD ON CMS CAP: SENATOR GRASSLEY COMMENTS AS WELL7. JOIN ACA IN PLEDGING TO "GO THE EXTRA MILE FOR ENERGY BALANCE" ON AMERICA ON THE MOVE DAY 8. LEADERSHIP ON THE ROAD

1. 45 STATE ASSOCIATIONS, COCSA, ACC AND NCMIC ANSWER THE CALL IN TRIGON CASE

Led by the Pennsylvania Chiropractic Association, 45 state and local associations and the Congress of Chiropractic State Associations (COCSA), representing a cross section of the profession, filed an amicus brief to the U.S. Supreme Court supporting our petition in the Trigon suit. Additionally, NCMIC and the Association of Chiropractic Colleges (ACC) filed separate briefs, each providing their own arguments why the issue before the court is of such importance that it should consider our petition.

The list of state associations includes the following: Alabama State Chiropractic AssociationAlaska Chiropractic SocietyArizona Association of ChiropracticArkansas Chiropractic AssociationCalifornia Chiropractic AssociationColorado Chiropractic AssociationConnecticut Chiropractic AssociationDistrict of Columbia Chiropractic AssociationDelaware Chiropractic AssociationFlorida Chiropractic Association, Inc.Georgia Chiropractic Association, Inc.Hawaii State Chiropractic AssociationIllinois Chiropractic SocietyIndiana State Chiropractic Association Iowa Chiropractic SocietyIdaho Association of Chiropractic PhysiciansKansas Chiropractic Association Kentucky Association of ChiropractorsKentucky Association of Chiropractors, Inc. - First DistrictChiropractic Association of LouisianaMaine Chiropractic Association, Inc.land Chiropractic AssociationMassachusetts Chiropractic SocietyMichigan Chiropractic SocietyMinnesota Chiropractic AssociationMississippi Chiropractic AssociationMissouri State Chiropractic AssociationNevada Chiropractic AssociationNew Hampshire Chiropractic Association, Inc.Association of New Jersey ChiropractorsNew Mexico Chiropractic AssociationNew York State Chiropractic AssociationNew York Chiropractic CouncilNorth Carolina Chiropractic AssociationNorth Dakota Chiropractic AssociationOhio State Chiropractic Association Unified Chiropractic Association of OklahomaPennsylvania Chiropractic AssociationPuerto Rico Chiropractic AssociationSouth Dakota Chiropractic AssociationTennessee Chiropractic AssociationTexas Chiropractic AssociationVermont Chiropractic AssociationVirgin Islands Chiropractic SocietyWashington State Chiropractic AssociationWyoming Chiropractic Association

Special thanks to Gene Veno, executive director of the Pennsylvania Chiropractic Association (PCA), and to the PCA leadership whose amicus brief was used by all the state associations in communicating their position. Gene in particular did a great job in coordinating the various requests from state associations who wanted to participate. Also, thanks to Dr. Daryl Wills of the Board of Governors who kept the issue in the forefront of the Board and House of Delegates and made numerous follow-up calls with delegates and state associations to make this happen.

We also note that the Alaska Public Interest Group, a Ralph Nader affiliate, along with the National Association of Community Pharmacies, notified the courts of their concern and interest in having this matter considered by the Supreme Court. It is clear that the issue of whether the nation’s antitrust laws will be enforced to protect competition is of broad concern. Amicus briefs communicate to the court that there are organizations and/or individuals other than the ACA and the Virginia Chiropractic Association, the plaintiffs in the case, that believe the interpretation of the antitrust laws by the lower court is detrimental to them and needs to be overruled. Eighteen percent of the Supreme Court decisions of the last 12 months have included citations from such briefs - so the Court gives them significant weight.

Not surprising, Trigon has submitted a proposal to the Supreme Court opposing our petition. This is fairly routine and we anticipate that this will not stop our effort. Trigon and others (including, unfortunately, a minority within our own profession) will not enjoy hearing about the strong support for the lawsuits that exists in the profession. They will be less pleased to hear that we just finished a strong year in fund-raising for the lawsuits. Over the last 12 months we have received $1,780,122 in contributions. This amount is second only to the previous year’s amount of $1,988,068, which was the highest since we started fund-raising in 1998. Our job isn't to make Trigon and the dissidents in this profession happy, but to assure for our patients and doctors alike free access to our services and appropriate reimbursement.

We still need the continuing support of the profession, because we have to act quickly if the Supreme Court agrees to hear the case.

LATE BREAKING NEWS: THE JUDGE IN OUR SUIT AGAINST HHS ACCEPTED THEIR MOTION FOR SUMMARY JUDGEMENT. THE JUDGE’S WRITTEN OPINION HASN’T YET BEEN POSTED, BUT WE WILL UPDATE YOU AS INFORMATION IS AVAILABLE.

2. $200 GIFT FOR JOINING THE ACA; FOOTLEVELERS AND ACA FORM PARTNERSHIP

Foot Levelers and the ACA have formed a partnership to encourage chiropractors to join the ACA. If a chiropractor joins the ACA between now and the end of 2004, he or she will receive a $200 gift redeemable toward the purchase of Foot Levelers' Spinal Pelvic Stabilizers. Stabilizers are custom-made to support the individual's unique postural needs, and help adjustments hold longer.

The ACA also wants to encourage its current members to get other doctors to join. Current members can refer up to 5 new chiropractors, and also receive the $200 gift. The gift offer is a national campaign that will last through the end of 2004. If you are an ACA member interested in recruiting a non-member and wish to participate in this offer please visit our Web site for the appropriate application at http://www.acatoday.com/membersonly/Footlevelers-Gift-new.pdf?CFID=24836 & CFTOKEN=86101993.

3. ACA-PAC IS ON THE AIR - YOUR HELP IS NEEDED NOW TO KEEP US THERE...

ACA-PAC is now running the nation's only pro-chiropractic political advertisement - a 30 second radio spot featuring Dr. Kerwin Winkler's testimonial on behalf of Sen. Tom Daschle of South Dakota, one of the most effective supporters of chiropractic care ever to serve in Congress. Sen. Daschle helped eliminate the mandatory x-ray requirement for DCs under Medicare and fought successfully to pass legislation that required the federal government to provide chiropractic care to America's veterans. In 2002, he was awarded ACA's Humanitarian of the Year Award, the first non-DC ever to selected for this honor. He is now facing a very tough re-election fight and ACA-PAC is going all out to let voters in South Dakota's cities and small towns know that Tom Daschle has made a difference for DCs and their patients. You can listen to the ACA-PAC ad by clicking here: http://www.acatoday.com/government/other/.

Unfortunately, ACA-PAC can only keep this ad on the air for a few more days. Your contribution - $200, $150 or even $100 - is needed by October 27 to extend the "buy" and keep Dr. Winkler's message going out to voters through Election Day, Nov. 2. Of course, in addition to being of critical importance to the chiropractic profession, Sen. Daschle's race is being watched closely by Republicans and Democrats across the country because it could determine which party will control the U.S. Senate for the next two years. What an opportunity to keep chiropractic on the nation's political radar screen while keeping one of chiropractic's best friends in Congress. Please contact ACA-PAC Manager Kim Krocker today to make your contribution - kkrocker@....

4. OCTOBER IS SPINAL HEALTH MONTH! PROMOTE THIS EVENT IN YOUR COMMUNITY

Scores of health-conscious Americans are turning to natural, drug-free chiropractic care to treat what ails them. This October, during Spinal Health Month, help promote this event in your community and educate consumers about the natural ways they can improve their spinal health and enhance their overall well being. Sponsored each year by the ACA, Spinal Health Month is a perfect time to promote not only your profession but also your practice. To assist you, ACA has created a Spinal Health Month promotion kit that members can download for free from our Web site at http://www.acatoday.com/membersonly/frameset.cfm?FIND=SpinalHealthMonth2004.pdf. You will need your membership ID and password to access the kit.

The kit contains a sample press release, radio script, newspaper ad and proclamation for your local legislators to sign-as well as a variety of tips on how to promote the observance most effectively.

5. OCTOBER 12-20: BONE AND JOINT DECADE NATIONAL AWARENESS WEEK

In conjunction with Spinal Health Month, the ACA is urging doctors of chiropractic across the country to help promote Bone and Joint Decade National Awareness Week - October 12-20, 2004.

As a member of the steering committee spearheading the Bone and Joint Decade campaign in the United States, the ACA has joined with a multi-disciplinary group of health care organizations nationwide to raise awareness of the importance of musculoskeletal health and improve the quality of life for people with bone and joint disorders. Through promotion of Bone and Joint Decade National Awareness Week, supporting organizations like ACA hope to raise awareness about the growing burden of musculoskeletal disorders on society, promote prevention and empower patients through public education.

Help educate your patients about the importance of musculoskeletal health by photocopying and distributing a patient education sheet on Bone and Joint Decade Awareness Week. It can be found on ACA’s Web site at http://www.acatoday.com/membersonly/frameset.cfm?FIND=bone_joint.pdf. For more information on Bone and Joint Decade efforts in the United States, visit www.usbjd.org.

6. INDEFINITE HOLD ON CMS CAP: SENATOR GRASSLEY COMMENTS AS WELL

Our notification to you last week of HHS Secretary Tommy ’s decision to set aside the proposed CMS treatment cap understated the results. We reported that the proposal was placed on hold. Yesterday, I was informed by the Secretary's office that the proposal was actually put on "permanent hold" - the best kind. However, we need to continue to monitor this situation and recognize that part of what fueled this proposal in the first place was the lack of proper documentation by some of our doctors. The problem of documentation still exists and we as a profession need to deal with it. Sen. Chuck Grassley (R-Iowa), the chairman of the Finance Committee, was one of the key participants in this effort. His office released a press release on this issue that can be found at http://www.acatoday.com/government/medicare/regulatory/grassley-release.pdf.

7. JOIN ACA IN PLEDGING TO "GO THE EXTRA MILE FOR ENERGY BALANCE" ON AMERICA ON THE MOVE DAY

ACA has encouraged our membership, affiliates, and staff to join America on the Move, which motivates participants to move more and eat less for better health. Friday, Nov. 5 marks the first nationwide America On the Move Day. Please visit www.americaonthemove.org to get all the details about how you, your friends, family, patients, and staff can join the fun (even if you aren't registered for the program) and have a chance to win great prizes. You can take the pledge to Go the Extra Mile for Energy Balance anytime between Oct. 1 and Nov. 5. If you would like to join the ACA group of America on the Move, please do so by using the registration code: R*A7042 when you sign up. We hope you will join us personally, as well as encourage others to take this pledge.

8. LEADERSHIP ON THE ROAD

Dr. Gentile, Governor of District 5, attended the ACA Sports Council meeting held in San Francisco. He was given the opportunity to discuss ACA activities before the more than 200 doctors who were in attendance. Dr. Daryl Wills represented the ACA in a continuing education seminar on technique presented by Dr. Mark Charrette. All the proceeds of the seminar went to the Legal Action Fund. Dr Charrette, a very popular technique lecturer, not only waived his honorarium but also made a personal contribution.

District VI Governor Dr. and East Texas Delegate Dr. Vaughn both gave presentations at the Kansas Chiropractic Association Annual Convention in Topeka, Kan. last weekend. Dr. gave an update on the many recent ACA victories and Dr. Vaughn gave a current update on the implementation of chiropractic into the VA system. Both presentations were given at the 90-minute "ACA Luncheon" that was attended by 100 people and resulted in several new ACA members and LAF contributions.

************************Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@....

************************

To be removed from further mailings from our list please click the unsubscribe link

---Incoming mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.776 / Virus Database: 523 - Release Date: 10/12/2004

---

Outgoing mail is certified Virus Free.

Checked by AVG anti-virus system (http://www.grisoft.com).

Version: 6.0.776 / Virus Database: 523 - Release Date: 10/12/2004

October 13, 2004

Coby and Colleagues:

The current ACA Delegate to Oregon is Strom. told me of the brief on Sept. 30 at a luncheon the CAO put on for Rep. Carolyn Tomei. believed we had more time than we really did have to get the brief signed and sent in. I received a cell phone call from Dr. Daryl Willis at lunchtime in the middle of my "Gold's Gym" work-up that we needed to get the signed faxed brief in by 2:00 PM our time. All of which was a little bit of a stretch at that time but I thought the CAO office had accomplished this task?

Vern Saboe, DC

FW: ACA EVP Weekly Report