Colorado Chiropractic Association

providers and consumers - Cuts in payments to providers and increased consumer health insurance premiums quantified in report

February, 19, 2008 - A report released today by Governor Ritter’s Office of Policy and Initiatives verifies what trauma care providers have been saying for four years: the sudden switch from a no-fault auto insurance system to a tort system left Colorado’s trauma care providers with millions of dollars in unpaid costs after providing medical transports and treatments. These costs are shifted onto health insurers and consumers through higher charges for other services and increased co-pays or deductibles.

The Governor’s office contracted with BBC Research and Consulting, an independent research firm, to study the effects of Colorado’s change from a no-fault auto insurance system to a tort system in July 2003. The scope of work for the study was developed through a collaborative process with the Trauma Care Preservation Coalition (TCPC) and representatives of the auto insurance industry.

Insurance coverage for medical payments would benefit consumers. If the Colorado State Legislature were to mandate that all Coloradans carry medical payments coverage (‘med pay’) on their auto insurance policies, it would help consumers cover out-of-pocket medical expenses such as co-pays and deductibles (page 16). Contrary to the arguments of the auto insurers, very few Coloradans have the extremely high level of health care coverage that would make a mandatory med pay truly duplicative of health insurance.

Many factors have led to reductions in auto insurance premiums in the last few years, with the switch from no-fault to tort only one factor. The report cites a 35% decrease in auto insurance rates, based on auto insurance reports to the state. But the report also indicates that auto insurance rates after the switch decreased as a result of many factors, including a significant drop in auto insurance coverage since no-fault and a statewide decrease in the number of accidents that result in injuries or fatalities. Additionally, the report shows actual expenditures by consumers for their auto insurance policies does not reflect the same decreases.

Health insurance premium increases have negated any auto insurance savings for consumers. Savings that consumers may have experienced in their auto insurance policies have been negated by the increases seen in health insurance premiums as a result of the switch to a tort system.

Hospitals are losing tens of millions of dollars every year for treating motor vehicle accident patients. In 2002, hospitals were reimbursed for 60 percent of the care they provided to motor vehicle accident patients. But by 2006, after the switch to tort, that percentage had plummeted to only 36 percent.

Ambulance companies and fire departments have suffered similar declines in reimbursement. For Colorado’s first responders, 18 percent of patient transports from motor vehicle accidents went uncompensated in 2002. By 2006, that number had more than doubled, rising to 37 percent (page 12).

By substantiating a small portion of the economic losses that Colorado’s trauma system has incurred since the switch from no-fault auto insurance to a tort system, the report demonstrates the unintended consequences.

It is important to note the report significantly underestimates the financial impacts on Colorado’s trauma system. It does not quantify the impacts of unreimbursed care on physicians who treat auto accident patients; nor does the report address the majority of auto accident patients who are treated in the emergency departments and discharged the same day. Researchers were only able to report data that relates to the small percent of patients admitted to hospitals.

Additionally, the report makes the case for all drivers to carry medical payments coverage on their auto policies. (The Trauma Care Preservation Coalition is advocating this private sector solution for a small, reasonable med-pay; state funding solutions are not feasible under current budget and taxing constraints.) This solution would ensure that their health care would be fully covered if they were at fault in a car accident. Currently, bodily injury coverage is required in Colorado, but it only covers the people who are injured by the at-fault driver. Without med pay, the at-fault driver has no bodily injury coverage for him/herself or any relatives in that car.

Many people don’t realize that their auto insurance no longer covers medical expenses unless they specifically elect (and pay for) an optional med-pay coverage. Chiropractic clinics and many other health care providers are treating auto accident patients, but resources are being bled away. More and more Coloradans don’t have health insurance, and medical bills are not covered by their auto insurance anymore. As a result, in more and more cases providers are not paid for our services, and are left with no means to recoup those costs. Patients then face bills they cannot pay.

At its Sunday, October 14, 2007, CCA Board of Directors meeting, and after much deliberation and discussion, the CCA Board of Directors decided to retain a new lobbying firm, Integrated Legislative Solutions (ILS). The firm is comprised of three lobbyists and a legal staff who can be called into service when needed. The core lobbying team is Erik Groves (303-228-1219), Terry Snyder (303-629-6360 or terrancesnyder@yahoo.com), and John Zakhem (303-228-1200 or jzakhem@zakhematherton.com).

The CCA Executive Committee did extensive research in interviewing six different lobbying firms prior to making a recommendation to the full CCA Board. The ILS team brings a high level of energy and experience to the table and has hit the ground running a day after they were retained. Meetings have been set up with the Governor, legislators, and agency directors who are important to our legislative agenda. Planning is underway to hold CCA Key Doctor training sessions and to extend their expertise concerning how to approach and discuss CCA issues with your elected leaders.

· Significant improvements to the CCA interactive web site with on-line registration for seminars, conventions and committee meetings; evaluation solicitations on-line for seminars attended; exercise videos and much more.

· Membership rallies combined with premier educational opportunities at affordable pricing.

· Other plans in the pipeline to look for include: a new format and look to the CCA UPDATE newsletter; more timely information on legislative issues; training for CCA Key Doctors; new opportunities to provide added support to the profession through more affinity programs and direct benefit programs to doctors of chiropractic.

Please join us in welcoming our new lobbying team by becoming active in your CCA District, participating fully in helping our Mandatory Med Pay bill pass in 2008, and in working to elect the representatives in our state who will support our Practice Act in 2009.

Finally, for the CCA to emerge successful with the Mandatory Med Pay bill and the Practice Act, we need all 1,600 doctors in the state of Colorado participating in the financial and volunteer support of the CCA. As a member, please assume responsibility this year to recruit at least ONE new member to the CCA. As a non member, join ON-LINE or call the CCA and sign up to be on the winning team. Be a part of making chiropractic in the state of Colorado the powerful force it can be. We need all of your help. Let’s not leave it to the few to do the work of the many.

Click here for complete report on CCA's activity
during the 2007 Colorado Legislative Session

Implications of SB79 - the Standard Contract Bill
Memo by CCA Lobbyist Don Mielke 5-17-07

SB 79 will reduce administrative costs associated with processing multiple payer contracts, all of which have different language and conditions. It ensures that all contracts are drafted in plain language and use set of terms. The bill requires payers to notify providers of changes and updates to their contracts. Previously, payers might make changes which providers might to be aware of, and those added conditions had a negative impact. If someone from the office did not regularly check a payer’s web site, they would be unaware of material changes to their contract. After January 1, 2008, providers are no longer obligated to accept unilateral changes made by the plans during the term of their contract. This will bring transparency to the contracting process. It eliminates “contracts of adhesion” that all doctors are required to sign when they join a managed care network. The law will eliminate “phantom” networks, stop retroactive contract changes, require that a copy of the fee schedule be attached to the contract, and provide other helpful contractual provisions that will allow you to evaluate whether to sign the contract or get out of the network.

SB 79, as set forth in the bill summary, requires any person or entity contracting with a health care provider on or after January 1, 2008, to use a standard form contract . Requires each contract to include a summary disclosure form that contains:

Compensation and payment terms that are sufficient for the health care provider to identify the compensation for health care that is provided that shall include a fee schedule;
The duration of the contract and reasonable termination terms;
The identity of the claims processors;
Dispute resolution terms; and
The subject and order of an addenda, if applicable.

Requires the person or entity to identify a program used to review, monitor, evaluate, or assess the health care services provided. Exempts a person or entity from providing a fee schedule to a provider if the fee schedule is for dental services whose providers include licensed dentists, and the fee schedule is based on fees filed by the dental provider and is revised periodically.

Requires the person or entity to state how a completed claim was adjudicated and any outstanding balance owed. Requires the payment and compensation terms to be disclosed in writing when a contract is proposed by the person or entity. Allows a material change to a contract only if the change is provided in writing 90 days prior to the change. Allows a contract to be terminated by either party if there is written objection to the change, unless the objection is to an addition of a new category of coverage. Prohibits a person or entity from assigning, allowing access to, selling, renting, or giving the rights to the provider's services unless specific conditions are met. Prohibits a contract from requiring a waiver of the provider's legal rights as a condition of entering into the contract. Allows a health care provider to decline services to new patients upon 60 days' notice. Allows for termination of a contract without cause

by either party if the contract is for less than 2 years, otherwise requires the termination without cause terms to be specified in the contract. Exempts certain entities from the requirement of using the contract. Allows a contract to include an agreement for binding arbitration.

Requires the availability of private rights of action, equitable relief, reasonable attorney fees when the provider is the prevailing party in an action, and the option to introduce prior arbitration awards regarding a violation.

A word about legislative strategies:

The CCA office has fielded several questions on our legislative strategies. We will often ask for action on particular bills when they are in committee or ready for floor votes in the House or Senate. Often the intentional strategy on bills is NOT to have doctors of chiropractic or their patients call legislators. One of the reasons for this may be to not have the bill be perceived as just a chiropractic bill – put the focus on a bill as a small business bill – or patient rights bill – or health care in general bill. In addition, we have assembled a group of DCs – CCA Key Doctors – who are assigned to each representative and senator. We often will ask these doctors, who have formed a relationship with their legislators – to contact legislators on particular issues or bills. It is important for you to know that MONTHS of work are behind developing, drafting and sponsoring a bill.

Be on the lookout for CCA Legislative Alerts and PLEASE respond to them promptly!

Due to the way the legislative process works,

we often do not have much time to plan and respond to actions on a bill.

If you are interested in becoming a CCA Key Doctor – a grassroots legislative program that develops one-on-one relationships with Colorado legislators and chiropractors – please contact the CCA.

To visit the Colorado General Assembly web site click here OR paste http://www.leg.state.co.us/ in your browser.

2006 Colorado Legislative Wrap-Up

Even as the Colorado Legislative Session adjourned on May 9, 2006, the CCA continued to work on crucial managed care legislation. In addition, the CCA joined forces with health care organizations across the nation to oppose FEDERAL LEGISLATION (S1955), which was defeated.   The CCA monitored over 20 bills this session. Here are a few highlights from the legislative session:

SB198 - This bill, sponsored by Speaker of the House Andrew Romanoff and co-sponsored by 37 other legislators, was created to standardize managed care contracts. Not surprisingly, the insurance companies and managed care plans OPPOSED this bill.   These groups lobbied for drastic changes in the bill and urged the Governor to veto it if it did pass.   Governor Owens did veto the bill on May 26, 2006.
The CCA organized testimony for Senate and House committee hearings and rallied doctors to attend the hearings as a show of support for the bill. CCA Lobbyist Don Mielke kept his finger on the pulse of this bill all the way through each committee hearing and Senate and House votes, working with a strong coalition of all types of health care providers. SB198 would have affected ALL health care providers who live, work, and treat patients in Colorado.
SB198 would have accomplished several goals regarding managed care contracts. It promoted FAIR and COMPLETE contracts in an arena where free market philosophies cannot be applied. A third party currently controls your “customers.” You do not compete for their business – a for-profit company controls their access to you. It DID NOT dictate contract terms. It DID NOT set reimbursement rates. SB198 did provide access to contract information you need and deserve in order to sign a contract. CLICK for Governor Owens’ official response to SB198.

S1955 - This was a bill proposed at the FEDERAL level which would have severely limited OR eliminated state-mandated benefits from insurance coverage. The CCA and other groups vigorously opposed this bill using fax and e-mail alerts, patient flyers, talking points, and more. Click here for more information on S1955.

HB1044 - Back to the COLORADO legislature. The CCA Legislative Committee began work on this auto insurance prompt pay bill during the summer of 2005. CCA Legislative Committee Co-Chairs Dr. Bob Nelson and Dr. Richard Keuhn, along with CCA Lobbyist Don Mielke, met and negotiated with numerous health care provider groups to craft specific language for this bill – a long and difficult journey. This bill would have required the at-fault driver’s liability insurance to begin paying claims as soon as fault was determined. Gripping testimony was provided by many of YOUR patients, who related compelling stories about being harassed by bill collectors, using their own money to pay auto accident bills, and still not knowing if there would be full reimbursement in the end. Unfortunately, due to a fiscal note, the bill was killed in committee.

HB1030 - This bill requires Colorado auto insurance carriers to provide FULL DISCLOSURE to consumers on policy provisions. The CCA supported this bill and had been working on it since summer of 2005. The bill was passed and signed into law by the Governor.

HB1076 - This bill concerns immunity from civil liability under the Volunteer Service Act. CCA Lobbyist Don Mielke made certain chiropractors were included in this bill AND drafted an amendment to eliminate written permission by the patient prior to treatment. The bill was signed into law by the Governor.

HB1097 - This bill would have provided injured workers with a one-time selection of health care provider. The CCA supported and worked on this bill, but it was killed.

HB1127 - This bill concerned the licensing of athletic trainers in Colorado. CCA Lobbyist Don Mielke and the CCA Legislative Committee worked with the bill’s sponsor to change, delete, and define terms in the bill. The athletic trainers wanted to provide “joint mobilization” - the CCA REMOVED that! With an eye on limiting their scope of practice, the CCA ensured that they could NOT practice chiropractic, clearly defined “athletic illness,” and specifically identified who they could treat. In addition, an amendment proposed by CCA Lobbyist Don Mielke was added to allow athletic trainers to work FOR other health care providers, like chiropractors. The bill was passed and sent to the Governor, but as of this writing he has not signed it into law.

HB1170 - The bill was originally written to license naturopaths. Since this would mean competition for chiropractors, the CCA opposed the bill and worked to water it down to almost nothing. The bill eventually died in committee. Watch for a new naturopath’s licensing bill to be proposed next year.

HB1193 - This was a “whistler-blower” protection bill to protect health care workers who complain about a provider’s standard of practice (including chiropractors). Our CCA lobbyist was the only active health care lobbyist to oppose the bill. A similar bill was opposed by CCA last year and it failed. The sponsors listened to the CCA and the bill was drastically amended and workable. The Governor vetoed the bill and an attempt at a veto over-ride failed on the final day of the session.

HB1243 - This was not a CCA bill, but the CCA supported the concepts of having chiropractic liability insurance cover the entire scope of practice. The bill also gives the Colorado Board of Chiropractic Examiners the latitude to fine (instead of suspend) chiropractors in certain instances. The bill was signed into law by the Governor.

HB1264 - This bill involved making the Department of Regulatory Agencies’ (DORA) positions uniform across all licensing boards. It allows the Colorado Board of Chiropractic Examiners to issue CONFIDENTIAL letters of concern instead of suspending doctors. It also makes cease and desist orders consistent and enforceable so unlicensed people who are practicing may be stopped. The Governor has signed this bill into law.

SB19 - This bill provided mandatory auto insurance medical payments (med-pay) for emergency care. The CCA was closely monitoring this bill, but it was killed in committee.

SB41 - This bill requires health insurance to pay promptly on auto accident claims. This bill was a product of the Auto Insurance Interim Committee of legislators who worked on bills over the summer.   The bill passed and was sent to the Governor, but he has not signed it.

For complete copies of any of these bills, visit www.leg.state.co.us and look under House or Senate bills.

Thank you to EVERYONE who responded to the 2006 Legislative Alerts by calling legislators, providing patients to testify, and writing letters to the editor.