Advocacy and Legislation
As the largest professional association representing Doctors of Chiropractic in Pennsylvania, public policy advocacy is a mission-critical function of the Pennsylvania Chiropractic Association.
Public policy advocacy, especially when it comes to federal and state legislation, as well as state regulations, includes embracing and touting a health policy founded on the concept of conservative care first, which is well known to the Chiropractic profession, but a concept that is still developing within the public policy arena.
Advocacy--shaping legislation, regulations and overall public policy--is one of the Pennsylvania Chiropractic Association's five strategic pillars and included in PCA’s 5-year strategic plan, PCA2020. One of the most vital roles of the PCA is to promote the passage of legislation and regulations that support Doctors of Chiropractic and their patients, as well as oppose legislation that is detrimental to Chiropractors, our current health care system, and patients. PCA’s advocacy initiatives and efforts directly affect every Doctor of Chiropractic in the Commonwealth of Pennsylvania.
As a PCA member or a Pennsylvania-licensed Doctor of Chiropractic, one of the most important things YOU can do to assist YOUR Chiropractic profession is to know your state legislators! Click here to find your local State Representative and State Senator. Of course, PCA’s Legislative Committee is also always open for more PCA members to join and advocate on behalf of Chiropractors in Pennsylvania. Click here for more information on joining the Legislative Committee.
As an example of PCA’s advocacy success, PCA and its members were THE driving force in successfully drafting and ultimately passing Senate Bill 487 (the Fairness in Co-Payment Act) and having it signed into law by the Governor as Act 39 of 2015. Click here to find more information and to read PCA General Counsel Jason Martin's response as to what Act 39 means for Pennsylvania Chiropractors and their patients.
Unlike many associations, PCA is never content to rest on its successes. Instead, PCA is constantly looking years "down the road,” envisioning other important legislative and regulatory initiatives that advance the Chiropractic profession and preserve and protect the patient-doctor relationship--which seems forgotten in the chaos of today’s ever-changing health care system.
The PCA is pleased to announce that YOUR GENEROSITY made OUR target for the PCA Legal Fund a reality. THANK YOU!
As you know, in the case of State Farm Mutual Automobile Insurance Company v. Robert J. Cavoto, Jr, et al., a Delaware County Common Pleas Judge declared that chiropractors may not delegate massage, manual therapy, and therapeutic exercises to unlicensed chiropractic staff. A post-trial motion filed by Dr. Cavoto was denied. Dr. Cavoto is now appealing the decision to the PA Superior Court. Your contributions will cover the “delegation” portion of Dr. Cavoto’s legal fees and costs for the appeal to the PA Superior Court of this unfortunate decision.
Since the PCA has raised the necessary funds for the “delegation” appeal, the PCA does not want to rest on such an achievement by so many generous and forward-thinking DCs, so the PCA will continue to accept contributions for PCA’s Legal Fund for other similarly far-reaching and serious legal matters, which are certainly going to arise in the future.
Separate contributions are also welcomed and appreciated for PCA’s Political Action Committee (PAC). As you no doubt realize, the legislative process is vitally important to the profession, especially in efforts to support a growing cadre of legislators who ”get” Chiropractic and are willing to stand tall for the profession and patients, regardless of the money thrown around by the health insurance industry and lobbyists. Please consider ensuring the “public policy and legislative” future of Chiropractic by contributing generously to PCA’s PAC (CLICK HERE TO CONTRIBUTE TO PCA’s PAC)
The PCA thanks every contributor for stepping up to the plate quickly on this very important matter. The PCA is in close contact with Dr. Cavoto’s attorney and the PCA will continue to update its membership as this case develops.
Raymond J. Benedetto, DC, DACNB
On July 7, 2017, in the case of State Farm Mutual Automobile Insurance Company et al. v Robert J. Cavoto, Jr., et al., a Delaware County Common Pleas Judge rendered a decision that chiropractors may not delegate massage, manual therapy, and therapeutic exercises to unlicensed support personnel/staff. The decision disregards the plain language of the Chiropractic Practice Act, the position of the State Board of Chiropractic, as well as other state agencies and years of Pennsylvania case law. This decision affects ALL chiropractors, including those who do not bill insurance, because this is an interpretation of the Chiropractic Practice Act. Chiropractors who delegate these procedures to unlicensed individuals could face disciplinary action by the State Board of Chiropractic that could result in license suspension or revocation. For chiropractors who bill insurance, improper delegation may cause certain insurance payers to use the decision as justification for claim denials and to seek recoupment of previously paid claims – and perhaps even to bring fraud actions against other Pennsylvania Chiropractors. (see attached)
Click here to read more.
Major Regulations Being Proposed
PCA also attends, monitors and periodically comments on the deliberations and actions of the Pennsylvania State Board of Chiropractic, the Commonwealth’s licensing board for DCs, and as importantly, a consumer protection entity. The State Board of Chiropractic usually meets every other month: January, March, May, July, September, November.
Current regulations being considered and developed by the PA State Board of Chiropractic include:
- Unlicensed supporting personnel
- Independent Chiropractic examiners
- Non-PA licensed federally-employed DCs (e.g., Veterans Administration, TriCare, Public Health Service) practicing in Pennsylvania
- Radiation procedures and examinations
Senate Bill 892 - Chiropractic Education Bill
PCA-supported Senate Bill 892 unanimously passes PA Senate
By a vote of 49-0, the Pennsylvania Senate today passed Senate Bill 892 (link to the legislation), which allows via Act 188 (Chiropractic Practice Act) chiropractic college students to have credit-worthy educational experiences under the supervision of PA- licensed Doctors of Chiropractic.
SB 892 clarifies language in current law relating to chiropractic education and training, and moved quickly through the legislative process, with no anticipated opposition.
The next step, of course, is successful passage of the legislation in the PA House of Representatives. PCA’s lobbyists, The Winter Group, advised PCA this afternoon that they already alerted the House Professional Licensure Committee that the bill was “on its way” to them. PCA has requested that the House act as quickly as possible to pass the proposed legislation and send to Governor Tom Wolf for signature.
Unfortunately, Winter Group reports that both chambers- Senate and House- will recess for the holidays at the end of the December 13 session (today). There is a non-voting session on January 2 but there is no expectation of any legislative actions until the General Assembly returns in late January.
PCA will update members once the General Assembly returns for session in January.
“HB 18 has been referred to the House Committee on Human Services.
Representative Gene DiGirolamo (R- Bucks) is the Chair of that committee and OPPOSES HB 18.
This means that it is dead – at least for now!”
DCs should make no mistake about this workers comp issue- it will come up again and again, so your vigilance and your willingness to engage with your state legislators remain critical to effecting reasonable reforms to PA’s Workers Comp system.
More information to follow as we get it. This initial victory would not have been possible without each and every one of you who chose to take a stand for your profession and your workers comp patients!
Again, THANK YOU!
Click Here to read HB18
Click Here to read PCA's Position Letter
House Bill 1737 - The PA Chiropractic Education Bill:
Addresses Chiropractic Colleges and the education of US Chiropractic students in PA (i.e. internships and externships) under the supervision of PA-licensed DCs. Right now, PA is one of the ONLY states that students cannot do their externships at, depriving students the ability to finish their training in the state they wish to practice. This also deprives our 4054 licensed doctors from passing on their wisdom and knowledge to the next generation, while allowing the doctors to "test drive" students as potential associates in their practices.
There are new developments in both the House and Senate on this legislation.
The House Profesional Licensure Committee has scheduled HB 1737 for consideration on Wednesday, September 27.
No amendments have been drafted and we are not expecting any opposition at this point.
Sen. Reschenthaler has introduced his own version of the bill today and will be nudging his own leadership to act as soon as possible.
Both Rep. Ravenstahl and Sen. Reschenthaler have said that they would support either version of the bill and we will make sure that the momentum continues.
PCA looks forward to sharing more insights on these and other items at the convention in October.
PCA continues its work for quality health care and enhancement of our profession.
Conservative Care First - In a presentation to the Senate Republican and Democratic Policy Committees, Dr. Eric Osterberg took our Conservative Care First (CCF) campaign to key decision makers.
Seven Senators, ten staff members and three House members joined Osterberg, Nielsen and Singel in a thoughtful discussion about physical medicine as a cost effective component of our health care system.
We also discussed recent studies that show how physical medicine and chiropractic in particular can help address the national opioid addiction epidemic.
Ed Nieslen took the lead in offering the full assistance of PCA as we develop administrative or legislative initiatives in this important area.
Several legislators offered help in drafting initiatives and we received some surprising, personal support from those who have benefited directly from chiropractic services.
After a number of thoughtful questions and some stimulating ideas, the panel agreed to work with us in the coming months to incorporate ideas into good public policy.
The exhange could not have been more productive.
Kudos to Dr. Osterberg for his thoughtful and professional presentation and demeanor.
He and Ed Nielsen made PCA proud.
Click Here for a summary of points made by Dr. Osterberg.
IBC Fee Cuts - PCA and Mark Singel of The Winter Group, PCA's lobbyist, met with Kim Kochler, VP of Government Relations for Independence Blue Cross.
Also in attendance was Sen. Bob Mensch and Abdul Barry and an associate from the PA Department of Insurance.
We presented Kim with information relating to three straight years of cuts in chiropractic billing codes and noted some disparity in payments to different providers for the exact same services.
She was responsive to our concerns and made it clear that the cuts were not intended to single out chiropractors.
The ongoing cost challenges for IBC in the expensive Southeast area required across-the-board adjustments and she noted that fee cuts are done after lengthy consideration by their medical and administrative staffs.
The Insurance Department affirmed that it does not intervene in fee arrangements but they were interested in assuring that costs and reimbursements were done fairly without reducing patients’ access to care.
IBC, according to Ms. Kochler, is very interested in any new developments that can contain their costs and, therefore, ward off fee reductions in the future.
This includes considering our initiatives to put conservative care first and to include physical medicine as an early entry opportunity in the health care process.
She also indicated that they were open to input from chiropractors and other providers when any future fee cuts were being considered.
We asked for a seat at that table and she committed to explore that for us.
She also committed to looking into the fee disparity issue.
The main take-away from the meeting was that we established a healthier line of communication and agreed to work together when possible in the future.
Retro Review Act 146 - PA Governor Tom Wolf signed Act 146 of 2016 (formerly HB1178) into law of Friday, November 3, 2016.
The legislation places two year limits on health insurers' ability to conduct retro-active reviews and make recoupment demands of providers. The PCA-initiated legislation garnered the support of a prominent and diverse group of health care associations, including PCA, PA Orthopedic Society, PA Optometric Association, PA Medical Society, Hospital & Health System Association of PA and others.
Click Here to read PCA's article
Fairness in Co-Payment Act - Act 39 of 2015 - Based on numerous members’ complaints and those of many Chiropractic patients, the PCA took the lead on this important health consumer and provider issue. Partnering with the PA Physical Therapy Association and a consortium of other health care providers, PCA was able to take on the insurance interests and win a victory for patients and providers.
Known as the Fairness in Co-Payment Act, Senator McIlhinney commented, “This measure will better protect health plan policyholders by preventing insurance companies from shifting an even greater share of the financial burden onto consumers.”
Said PCA’s chief lobbyist and former Governor, Mark Singel, President of The Winter Group, “At last, patients will no longer face multiple co-pays that were forced on them by insurers. It is now against the spirit and intent of the law for health insurance companies to extract more than one co-payment per office visit from a patient. There are some real ‘teeth’ in this law as well: insurance companies that violate the Fairness in Co-Payment Act will face penalties under the Commonwealth’s Unfair Insurance Practices Act.”
Click Here to read PCA's article
Helpful Links & Information
Be a strong voice for to advocate for Chiropractic professionals today. PCA’s website resources make it simple to let legislators know your opinion. You will find the information you need to contact Pennsylvania legislators or your member of Congress.
You can also find out the latest on legislative bills that may have an impact on Chiropractic care. Learn how to review bills for details about the proposed legislation. Click on the links below.