Board of Directors

November 7, 2002

Minutes

 

The following are informative minutes of the November 7, 2002 meeting of the WCA Board of Directors. Please note that these minutes may not cover all of the subjects discussed or motions passed by the board. The portion of the minutes dealing with confidential attorney-client communications, personnel issues, legislative strategies, communications with legislators, communications with government employees, political contribution strategies and specific complaints or information about individual practitioners is considered confidential by the board. WCA members may obtain detailed minutes by contacting the WCA office.

 

The meeting was called to order at 8:30 a.m. by WCA President Sherry Walker, DC at the WCA building in Madison. Wendy Hendricks, DC was absent.

 

Motion: Moved by McMahon, seconded by Varish to nominate Jeff Lyne, DC as WCA Vice President. Motion carried

 

Motion: Moved by Lyne, seconded by McMahon to nominate Wendy Hendrichs, DC as Financial Secretary. Motion carried.

 

Motion: Moved by McMahon, seconded by Baker to nominate Wendy Varish, DC as Treasurer. Motion carried.

 

Motion: Moved by Varish, seconded by Douglas to nominate Donn Gurske as Recording Secretary. Motion carried.

 

Antitrust Responsibilities of the Board

 

This being the first meeting of newly elected board members, the entire board was briefed on their antitrust responsibilities. In addition to the briefing each member of the board received copies of the state and federal antitrust compliance agreements for their review.

 

Motion: Moved by McMahon, seconded by Baker to approve the September 26, 2002 minutes. Motion carried.

 

Motion: Moved by Varish, seconded by Lyne to approve the following:

 

Applicants seeking regular membership:     

 

            Tammy O. Amoth, DC                          Hudson

Lynette Boshoff, DC                             Franklin

            Terry Carr, DC                                     Mayville

            Mark R. Cope, Dc                                 Wausau

James J Corneiller, DC                          Eau Claire

            Angela M. Engel, DC                            Marshfield

Kristen U. Fox, DC                               Edgerton

Amy L. Heffernan, DC                         Waukesha

Thai Lee, DC                                        Milwaukee

            Jonathan R. Lo, DC                               Brookfield

Michelle L. Nelson                                Freeport

Patrick T. O’Reilley                              Green Bay       

John A. Petry, DC                                 Evansville

Charity K. Pupp                                                LaCrosse

Dustin D. Riddle, DC                             New Berlin

Todd M. Schulfer, DC                           Neenah

 

Applicants seeking student membership:    

 

            John M. Reitz                                        Palmer

            David D. Wolf                                      Palmer

            Anthony R. Worachek                           Palmer

 

Motion carried

 

Motion: Moved by McMahon, seconded by Lyne to approve the attached list of speakers for 2003.

 

Motion carried.

 

Election Results

 

The board discussed the election results in which of the 87 candidates supported by the WCA, 82 won election. The board also discussed the pending changes in leadership in both the Senate and the Assembly. Working relationships with the likely leaders have been established for a number of years and there is not likely to be an impact on the WCA’s legislative agenda as a result of the leadership changes.

 

OCI Proposed Rule Ins 9

 

The Insurance Commissioner Office has proposed a rules that would allow PPO’s and reporting exemption if they offer the benefits prescribed by the rule. The WCA has requested the following modifications in the rule:

 

Requested Modifications to Ins 9

 

The Wisconsin Chiropractic Association respectfully requests the following modifications to Ins 9 relating to defined network plans and preferred provider plans.

 

Ins 9.01 Section 7 (15) (b) (1)

 

9.01 Section 7 (15) (b) (1). If the charges of a nonparticipating provider are higher than a participating provider, the coverage of services performed by nonparticipating providers is subject to a co-insurance that is not more than an additional 30% greater than the coinsurance applicable for services performed by a participating provider, but not greater than a total co-insurance of 40%. If the charges of a nonparticipating provider are lower than a participating provider, the plan may not charge any additional co-insurance or,

 

Rationale: This modification is a “win-win” proposition for the insurer and the insured. It rewards those insureds that select low cost non-participating providers by not assessing additional co-insurance at the same time the insurer benefits by reimbursing the non-participating provider at a lower rate than its participating providers.

 

Section 15. Ins 9.34 (2)(b)

 

Ins 9.34 (2)(b) An insurer offering a preferred provider plan shall do all of the following:

 

1. Provide covered benefits by plan providers with reasonable promptness. Insurers shall also provide benefits that are representative of the normal practice and standards in the local area, as appropriate to the type of plan, with respect to hours of operation, waiting times, and availability of after hours care. Geographic availability shall reflect the usual medical travel times within the community. Provided, however, that the plan shall make a good faith effort to have sufficient providers so that a subscriber does not have to drive more than 20 miles to receive health care services.

 

Rationale: This modification improves the quality of rural PPO plans by requiring insurers to provide sufficient providers when the providers are available and willing to provide their services at no additional cost to the insurer.

 

2. Provide an adequate number of participating providers in each geographic area to service all insureds in that area. The insurer shall provide an adequate number of participating primary providers in each geographic area to ensure that at all times there is at least one provider who is accessible, qualified and accepting new enrollees with respect to covered benefits. This does not require preferred providers plans to offer a choice of participating providers in each geographic areas. Provided, however, the plan shall make a good faith effort to offer gender diversity when feasible.

 

Rationale: This modification improves the quality of PPO plans by reducing gender bias in the selection of providers.

 

Solutions Conference

 

The board discussed the planed Solutions Conference which is operating as a special committee to recommend legislative changes to the board.

 

Motion: Moved by McMahon, seconded by Varish to approve the topic list for the Solutions Conference. Motion carried.

 

Blue Cross Insurance Commissioner Complaint

 

The board was advised that the Insurance Commissioner has not yet ruled on the complaint filed by the WCA against Blue Cross over their pre-authorization requirement. Because of the election of a new Governor, it is possible that this issue will not be resolved until a new Insurance Commissioner is appointed.

 

American Family CMT Meeting

 

The WCA has had repeated problems with American Family over the denial of payment for  CMT code 98941. American Family’s position is that the number of regions within the diagnosis submitted by the provider must correlate to the number of regions indicated by the CPT codes billed.

 

The WCA recently met American Family and discussed the following points:

 

  • Their decision is contrary to the correct use of the CPT codes as established in Wisconsin.
  • It is quite normal for a patient for a patient to have a subluxation in one region that results in positive findings for multiple regions.
  • A chiropractor may use the 98941 or 98942 codes with a single diagnostic code as long as the chiropractor documents two positive findings in each spinal region that is adjusted.
  • The WCA policy was developed in 1997 under the procedures developed by Levin-VHI and HCFA for the establishment of these codes.

 

Motion: Moved by McMahon, seconded by Varish to request that the Executive Director write to the Examining Board over their refusal to acknowledge that the use of the 98943 code is within the scope of chiropractic practice.

 

Workers Compensation Research Study

 

The board was briefed on a study prepared by the Worker’s Compensation Research Institute that rated the performance of different elements of Wisconsin’s worker’s compensation system. While chiropractic is not specifically named in the study, it is likely that some elements will become the basis for management or labor proposals in the upcoming negotiations for a new WC bill.

 

Medicaid HMOs

 

The HMOs that offer Medicaid services have the choice of whether or not to offer chiropractic benefits. If the HMO does not offer the benefit, the patient is free to select any chiropractor they wish and the chiropractor will be paid on a fee for service basis.

 

Federal Laws on Advertising Medicare Services

 

In a review of Yellow Pages advertising, the WCA found dozens of examples where chiropractors advertised Medicare services. It is a violation of federal law for any person to advertise using the names, abbreviations, symbols or emblems of Medicare, Medicaid, or the Social Security Administration in a manner that conveys the false impression that the doctor is endorsed by Medicare or Medicaid. Violation of this law may result in a penalty of up to $5,000 ($25,000 in the case of a broadcast or telecast) for each time it appears in an ad.