Med Demo project Update/>

SPECIAL ALERT BULLETIN
To: State Associations in the Medicare demo areas From: ACA Department of Government Relations October 13, 2005
Re: Medicare Demonstration Survey
Thank you for your prior efforts in encouraging participation in the Medicare Demonstration Project survey.
This is to let you know that the deadline for submitting completed surveys has been extended to Friday, October 28, 2005. Please let your members know of this date change immediately. To help ensure appropriate implementation of the demonstration project, and to help eliminate problems and/or procedural hurdles, we need to collect this important survey data. Therefore, in order to accurately collect and report the needed data, it is important that everyone participate.
If any of your members needs another copy of the survey, or if you have any questions, please contact ACA Department of Government Relations at 1-800-986-4636 x224.
Thank you in advance for your attention in this regard. John Falardeau Vice President Government Relations American Chiropractic Association 1701 Clarendon Boulevard Arlington, Virginia 22209 P: 703-812-0214 (direct) F: 703-243-2593 Visit our website: http://www.acatoday.com

June 12, 2005

RE: Medicare Demo Alert Physical Medicine Billing

Dear Colleagues,

I received a call and an alert today. The ACA has been in on-going talks with Medicare regarding the issue of CA’s assisting chiropractors with physical modalities in the office. We have been notified that CA’s will be eligible to assist the doctor with physical modalities on patients at the time of visit and the doctor may bill for these services. This will be changed so that it is retroactive back to April 1, 2005. This occurred as a result of a suit filed against Medicare and will be in effect until July 22, 2005. The suit is scheduled for a hearing at which time we should receive more information and we will continue to update you. Please note that CMS states that they are anticipating this to be temporary until July. At this point, we have not received any information if this will change the processing of claims. Please see a copy of the full notice received below:

“ACA representatives met with representatives from the Center for Medicare and Medicaid Services (CMS) this morning regarding the incident to requirements. It was confirmed that due to the pending litigation against CMS by National Association of Athletic Trainers (http://www.nata.org/), all "incident to" requirements on DCs in the demo areas have been temporarily rescinded retroactive to April 1, the beginning of the demo.  While we expect more information from CMS on how to file corrected claim forms in the near future, we wanted to make sure that the profession was aware of this vital information as soon as possible. It means that DCs participating in the demo are allowed to have their CAs perform "incident to" therapy services at this time. The ACA continues to raise its objection to the overall application of the incident to regulation to the demonstration project.

We have received advance copy of the CMS Q&A addressing this issue which will be posted on the CMS site (http://www.cms.hhs.gov/researchers/demos/eccs/default.asp) this upcoming Monday:

“Q: Can trained office staff who are not chiropractors, such as chiropractic assistants, provide therapy services “incident to” the chiropractor? A: Due to pending litigation, CMS has agreed to delay implementation of the regulation and manual provisions governing qualifications for auxiliary personnel furnishing services billed as physical therapy and occupational therapy services incident to the services of a physician or nonphysician practitioner. We anticipate this delay to be temporary, probably less than two months. By its terms, CMS's agreement to delay implementation will expire on July 22, 2005, unless the court enters an injunction order prohibiting implementation of the qualification provisions described above. If the court rules in favor of CMS before July 22, 2005, CMS will issue instructions requiring implementation of the provisions of the regulation and manual.

In light of CMS's agreement to delay implementing new Chapter 15 manual provisions and certain provisions of the regulations regarding “incident to” therapy services, chiropractic assistants, physical therapy assistants, or other trained office staff may provide therapy services incident to a chiropractor as of the beginning of the demonstration, April 1, 2005. Please note that the court has ordered that any hearing on the issue, if necessary, will take place on July 1, 2005. The incident to requirements for this demonstration will then mirror the court’s ruling regarding implementation of these manual provisions. If the court allows the CMS manual provisions to take effect, then chiropractors under the demonstration will also be subject to these requirements as of the effective date. This means that when a physical therapy service is provided “incident to” the service of a chiropractor, the person who furnishes the service must be a physical therapy qualified practitioner other than licensure (meeting the physical therapy definition at 42 CFR 484.4 other than licensure).”

Again, this is breaking news. At this time until mid-July, your CA’s may assist you with therapies. As soon as we receive further information it will be sent to you.

Respectfully,

Kathy Boulet, DC President, Maine Chiropractic Association