Advocacy & Legislation Archives - Page 2 of 3

View the Original Position Statement here

View the PDF

February 23rd, 2020

The California State Oriental Medical Association (CSOMA), would like to announce again its support of adopting the NCCAOM exam for CA Licensure to replace the California Licensing Exam, CALE. By adopting the NCCAOM exam, acupuncturists would align themselves with the “gold standard” of professional competency, as is seen in other medical practitioners. Per the NCCAOM “A national board certification […] is the hallmark of excellence in acupuncture and oriental medicine (AOM). NCCAOM certification makes an important statement about professional competence that is recognized by regulatory bodies, third-party payers, the profession and the public.”

Now more than ever our patients need us in hospitals and programs such as the Veteran’s Association, Medicare and other national healthcare institutions. The need for our profession to be engaged in a variety of settings will continue to increase, and we need to be positioned as a profession to be available to fill the needs of patients at a large scale level. With the current pandemic the world is facing, there have been more conversations than ever in recent history about the strength of our medicine and the need for its widespread availability. January 21st, 2020 marked a historic time for the L.Ac. profession. The Center for Medicare and Medicaid Services (CMS) announced its decision to cover acupuncture for low back pain. This is a major step forward for our profession, not only for job development, but also in being recognized as an integral part of the medical provider community.

What continues to hold us back, however, is having multiple licensing requirements, different professional titles for acupuncturists and no set credentialing national body for our profession as a whole. This not only confuses our counterparts, but also sets us apart from our colleagues in the professional workplace. National Board Certification is the standard across many healthcare professions. CSOMA supports the NCCAOM Certification as this gold standard. The benefits far outweigh the limitations set by not creating a streamlined way to enter the standard of care. Our profession is integrating, and we must be positioned to grow so we are not left behind. We as a profession have the ability to open the doors for jobs with federal agencies, hospitals and clinics across the US.

In early January 2018, CSOMA’s Public Policy Advisory Committee first introduced their position statement on the NCCAOM Exam. CSOMA would like to reinstate this position to our members and the public. We hope to foster a collaborative effort with other acupuncture professional associations to support the advancement of adopting the NCCAOM Certification as a gold standard of criteria for the AOM profession. CSOMA will continue to advocate for and provide more information to Diplomats as the bill progresses.

Additional Information/Resources:

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM®) Fact Sheet: Information for California Licensed Acupuncturists and Other Interested Stakeholders about the NCCAOM Testing and Certification Program – January 8, 2018
http://www.nccaom.org/wp-content/uploads/pdf/NCCAOM%20Fact%20Sheet%20CA%20Updated.pdf

Review of the National Certification Commission for Acupuncture and Oriental Medicine Examinations by the California Acupuncture Board – January 2016
http://www.acupuncture.ca.gov/pubs_forms/nccaom_audit.pdf

Q & A on Follow-Up Questions Submitted to the NCCAOM Based on the Audit, and How the NCCAOM Can Provide Exam Development and Administrative Services to the CAB for Purposes of Licensure: A Presentation to the CAB – June 11, 2016
http://www.nccaom.org/wp-content/uploads/pdf/NCCAOM%20QA%20for%20CAB%20Meeting%20June%2011%202016.pdf

Center for Medicare Services: Decision Memo for Acupuncture for Chronic Low Back Pain – January 2020 https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295

Acupuncture for Chronic Low Back Pain Approved for Medicare Beneficiaries – With Caveats

Advocacy & Legislation, Open Letters

In a press release dated January 21, 2020, the Centers for Medicare & Medicaid Services (CMS) announced its decision to cover acupuncture for Medicare patients with chronic low back pain.

While this is welcome news, CSOMA would like to clarify some areas of potential confusion.

California licensed acupuncturists (LAcs), including those with doctoral titles, may not furnish acupuncture under the Medicare program, unless under the appropriate level of supervision (physician, physician assistant, or nurse practitioner/clinical nurse specialist).

Why? Per the Decision Summary, acupuncturists are not recognized by CMS as Medicare providers, and are not eligible to bill for acupuncture services.

This fact could be overlooked, given that the same document outlines the following:

“Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:

A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
Current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.”

Despite fitting this criteria to furnish acupuncture under the Medicare program, licensed acupuncturists are considered auxiliary personnel, and as such –

“Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.”

Mike Morgan, CSOMA President remarked, “This decision by CMS brings us one step closer to getting acupuncture approved for licensed acupuncturists in California and nationally, so that we can deliver this medicine to all populations in need, regardless of healthcare coverage.”

In a joint letter from the ASA and NCCAOM, it was noted, “This is a monumental step towards improving access to acupuncture and licensed acupuncturists for all Americans, and we should take a moment to enjoy this evolution, which was many years in the making.”

For complete details, see the Decision Memo for Acupuncture for Chronic Low Back Pain.

CSOMA will provide updates on the topic as they become available.

Letter to the CAB: Athletic Bill AB1592

Official Letter (PDF, 2 pages)

April 16th, 2019

California Acupuncture Board
1747 North Market Blvd., Suite 180
Sacramento, CA 95834

Dear California Acupuncture Board:

The California State Oriental Medical Association (CSOMA), is writing to inform you of our concerns and objections to the Athletic Trainers Bill (AB 1592), as amended in assembly March 28, 2019.

Our first objection is to the omission of the practice of Acupuncture in section 2697.14 which outlines the exclusions of practice to Athletic Trainers in the state of California. We believe this permits the proposed Athletic Training Practice Act to permit, at a later date and through future amendment, the practice of Acupuncture by Athletic Trainers of California under the guise of “Dry Needling” techniques.

Our second objection is in regards to the wording of section 2697.12 (a) which outlines the Scope of Practice for Athletic Trainers. Within these sections 2697.12(a)(3) and 2697.12(a)(4) states that an Athletic Trainer can provide “ immediate care of an injury ” and “ rehabilitation and reconditioning from an injury sustained or exacerbated while participating in athletic activity…. ” CSOMA believes that along with the previous stated omission of the Practice of Acupuncture in the exclusion section of the Bill AB1592, 2697.12a Scope of Practice section will permit Athletic Trainers to practice Acupuncture directly on patients without referral to a Licensed Acupuncturist.

Our third objection regards the section of the proposed amended bill 2697.12(d): (d) An athletic trainer shall not provide, offer to provide, or represent that they are qualified to provide any treatment that they are not qualified to perform by their professional education or advanced post professional study or does not fall within the scope of practice of athletic training. CSOMA strongly believes that this section does not go far enough to protect the safe practice of Acupuncture in California. With the aforementioned exclusion of the Practice of Acupuncture in the section 2697.14, we believe this current wording will permit the future practice of Acupuncture by Athletic Trainers.

CSOMA strongly objects to AB 1592 as currently written and amended on March 28, 2019, as it represents a potential public safety danger to Californians by persons practicing Acupuncture (aka Dry Needling), which are grossly undertrained to administer Acupuncture safely and effectively. As you know, Licensed Acupuncturists are required to spend up to 950 hours of direct and supervised training under accredited educational programs for the safe and effective administration of Acupuncture to patients.

CSOMA is requesting that the California Acupuncture Board strongly object to the current wording and omissions contained within AB 1592 on the basis of the lack of protections to the public safety in regard to the Licensed Practice of Acupuncture in California. In addition, CSOMA is requesting that the California Acupuncture Board, as a Professional Board under the Department of Consumer Affairs, Business and Professional Committee make these concerns known to the Business & Professional Committee as it undergoes the Amending of the Business and Professional Code of California.

Sincerely,

The California State Oriental Medical Association

CSOMA Official Statement on China’s Legalization of Domestic Trade in Tiger Bone and Rhino Horn

November 5, 2018

The Chinese government recently lifted a 25-year ban on the trade of tiger bone and rhino horn from captive-bred animals for use in traditional medicine.

The decision has been condemned by wildlife conservation groups that warn that allowing such legal trade will have devastating consequences globally for the two critically endangered species. The California State Oriental Medical Association (CSOMA) is unequivocally opposed to the use of all substances derived from any endangered species in the practice of traditional Chinese herbal medicine and condemns China’s reversal of the 1993 ban that significantly curbed the demand for tiger and rhino parts and has been instrumental in conserving these iconic species in the wild.

With tiger and rhino populations facing numerous threats in the wild, the reality is that with their already perilously dwindling numbers, this decision may very well seal the fate of these two species and propel them towards extinction. This result would be a tragedy to the global community as well as a black stain on the practice of traditional Chinese medicine worldwide.

We would like to underscore that these substances are in no way necessary to the effective practice of herbal medicine. We acknowledge that there is no scientific, medical or otherwise justifiable reason to use these products medicinally in any capacity. We make no distinction between captive-raised endangered animals and those born in the wild, as both equally deserve protection. Any compromise of the protections for these animals is unconscionable and misguided. CSOMA supports the prosecution of any practitioner in the U.S. found to be trafficking or dispensing any products derived from endangered species.

We call on the Chinese government to reverse this short-sighted decision and urge all members of the Chinese medical community to maintain the integrity of traditional Chinese medicine by using only ethically sourced and humanely treated, non-endangered animal products.

Acupuncture Profession Joint-Position Statement on Dry Needling in California

Advocacy & Legislation, Open Letters

September 12, 2018

This statement is presented by the two largest acupuncture professional associations in California. The American Association of Chinese Medicine and Acupuncture (AACMA) is the largest Chinese-language association and California State Oriental Medical Association (CSOMA) is the largest English-language association. They share a combined membership of more than 700 professionals and 30 years each in representing the profession.

The AACMA and CSOMA formally oppose the practice of “dry needling” by physical therapists in the state of California due to the following public safety and regulatory reasons:

“Dry needling,” as defined by the American Physical Therapy Association (APTA)¹, follows the same definition as “acupuncture” in the state of California.
Current practice in states that allow “dry needling” by physical therapists do not meet the standards adopted by the AMA on Regulating Dry Needling.²
Current practice in states that allow “dry needling” by physical therapists violate the FDA’s statement regarding the sale of acupuncture needles.³
The State of California maintains that it is unlawful for any person other than a licensed acupuncturist, physician, surgeon, dentist, or podiatrist to practice acupuncture or use any acupuncture technique that involves the application of a needle to the human body.⁴
“Dry needling” as it is currently practiced by physical therapists in other states, poses a hazard to public safety due to inherent risks of under-trained and unregulated practitioners.⁵

The AACMA and CSOMA oppose any health practice that threatens the safety of California consumers. Because the modality in question (acupuncture) falls within the unique scope of licensed acupuncturists, allowing the practice of “dry needling” by physical therapists may result in significant increases of pneumothorax and other health risks, as well as public confusion over the safety of acupuncture as it is currently defined and regulated by the State of California.⁶

While the AACMA and CSOMA oppose the practice of “dry needling” by physical therapists in the state of California, we are willing to advise interested parties regarding acupuncture training requirements in California to maintain the highest standards for public safety.

Resources

“Dry needling” as defined by the American Physical Therapy Association (APTA) is “an intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying points.” In California, this is the same definition as acupuncture. http://www.apta.org/StateIssues/DryNeedling/ClinicalPracticeResourcePaper/
In the name of patient safety, the American Medical Association (AMA) adopted the following policy on June 15, 2016, stating that dry needling must be regulated with the same standards as acupuncture. “Regulating Dry Needling: The AMA adopted a policy that said physical therapists and other non-physicians practicing dry needling should – at a minimum – have standards that are similar to the ones for training, certification and continuing education that exist for acupuncture. Lax regulation and nonexistent standards surround this invasive practice. For patients’ safety, practitioners should meet standards required for licensed acupuncturists and physicians,” AMA Board Member Russell W. H. Kridel, M.D. https://www.ama-assn.org/ama-adopts-new-policies-final-day-annual-meeting

“Dry needling” uses the same FDA-regulated Class II medical device specifically defined as an “acupuncture needle.” The FDA has explicitly stated that the sale of acupuncture needles “must be clearly restricted to qualified practitioners of acupuncture as determined by the States.” https://www.gpo.gov/fdsys/pkg/FR-1996-12-06/pdf/96-31047.pdf
CA Business and Professions Code – Acupuncture License Act, Division 2, Healing Arts. Chapter 12. Acupuncture. § 4935. Unlawful practice of acupuncture (b) Notwithstanding any other law, any person, other than a physician and surgeon, a dentist, or a podiatrist, who is not licensed under this article but is licensed under Division 2 (commencing with Section 500), who practices acupuncture involving the application of a needle to the human body, performs any acupuncture technique or method involving the application of a needle to the human body, or directs, manages, or supervises another person in performing acupuncture involving the application of a needle to the human body is guilty of a misdemeanor. https://www.acupuncture.ca.gov/pubs_forms/laws_regs/laws_and_regs.pdf
Because “dry needling” is, in fact, acupuncture, it presents the same inherent risks as acupuncture (i.e. perforation of the lungs and other internal organs, nerve damage, and infection) and requires the same education, supervised clinical training and independent competency examinations as required for the practice of lawful, licensed acupuncture. https://www.acupuncturesafety.org/
CA Business and Professions Code – Acupuncture License Act, Division 2, Healing Arts. Chapter 12. Acupuncture. § 4927. Definitions (d) “Acupuncture” means the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping, and moxibustion.” https://www.acupuncture.ca.gov/pubs_forms/laws_regs/laws_and_regs.pdf

Blue Shield of California Grievance Letter

Official Grievance Letter (PDF, 25 pages)

August 30th, 2018

Appeals & Grievance Department
Blue Shield of California
P.O Box 927
Woodland Hills, CA 91365-9856

Dear Blue Shield of California:

The undersigned California and national acupuncture associations are writing to express concerns about recent directives by Blue Shield of California (BSC). These directives are having profoundly detrimental effects on the ability of our practitioners to practice, and on the opportunity for patients to receive care. We represent the largest licensed group of practitioners offering acupuncture, which is one of the most widely recognized, non-pharmacologic pain management strategies discussed in current times, especially in relation to the opioid epidemic. We feel that it is of immediate importance that BSC rescind the destructive policies which stand in the way of patients receiving acupuncture care, and which fuel the opioid crisis rather than help to solve it.

KEY POLICY CONCERN:
The key policy of concern is Policy # 0055: Acupuncture When Billed with Evaluation and Management. This policy states, “[it] will be effective for claims processed on and after [January 1, 2018]. E&M services performed by a physician or other health care professional and billed with Acupuncture services will not be eligible for reimbursement. This policy followed another announcement: Adjustments to Fee Allowance Schedule for Acupuncturists, effective December, 1, 2017. This policy downgraded or eliminated the reimbursement for all E/M codes for acupuncture and acupuncture treatment related services. This policy change was sent on Sept. 21, 2017. A copy of that letter is attached hereto. “Attachment A1 and A2.”

These policies highlight a failure on the part of BSC to revise payment coverage policies which would encourage healthcare providers to prioritize non-opioid pain management treatments. The recent downgrading of E/M Codes for acupuncture services has dramatically gone against the National Association of Attorney General’s recommendation, being emblematic of policy that forces providers Out-of-Network with BSC due to insurance reimbursements that are insufficient to cover the cost of providing care for patients. “Attachment B.” The non-allowance of E&M codes in conjunction with acupuncture codes is arbitrary and does not reflect the care that may commonly be provided in clinics.

For more than 30 years, CSOMA and its members have served as a consistent voice of the profession. During that same time, dozens of different associations, many of which are language-specific to their particular constituency, have been created in an effort to support the scale and diversity of the acupuncture profession in California.

BACKGROUND:
On September 18th, 2017 the National Association of Attorneys General (NAAG) sent a correspondence to Marilyn Tavenner, President and CEO of America’s Health Insurance Plans regarding the Prescription Opioid Epidemic, specifically recommending, “that AHIP take proactive steps in revising their payment and coverage policies to encourage healthcare providers to prioritize non-opioid pain management options over opioids. A copy of that letter is attached hereto signed by California’s Attorney General, Xavier Becerra. Shortly thereafter, BSC sent a correspondence dated September 21, 2017 dramatically reducing reimbursement rates for all E/M codes for acupuncture services.

The AG letter was quite specific in its understanding of the opioid epidemic and included, “We have witnessed firsthand the devastation that the opioid epidemic has wrought on our States in terms of lives lost and the costs it has imposed on our healthcare system and the broader economy.” They then present the importance of non-opioid care for chronic pain, “When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.”

The NAAG then presented the most sobering argument related to insurance company social responsibility for such non-opioid alternatives, “Insurance companies can play an important role in reducing opioid prescriptions and making it easier for patients to access other forms of pain management treatment. Indeed, simply asking providers to consider providing alternative treatments is impractical in the absence of a supporting incentive structure. All else being equal, providers will often favor those treatment options that are most likely to be compensated, either by the government, an insurance provider, or a patient paying out-of-pocket. Insurance companies thus are in a position to make a very positive impact in the way that providers treat patients with chronic pain.”

They conclude with a call to action for our nationwide insurance providers highlighting, “Adopting an incentive structure that rewards the use of non-opioid pain management techniques for chronic, non-cancer pain will have many benefits. Given the correlation between increased supply and opioid abuse, the societal benefits speak for themselves. Beyond that, incentivizing opioid alternatives promotes evidence-based techniques that are more effective at mitigating this type of pain, and, over the long-run, more cost-efficient. Thus, adopting such policies benefits patients, society, and insurers alike.”

Not only the NAAG is making a strong case to insurance providers to increase the opportunity for their insureds to be treated for the myriad conditions that cause chronic pain, and with a citation that such treatments are more cost effective. This is further supported by the Consortium Task Force White Paper, “Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care” as well as many other published studies and journal articles related to acupuncture treatment in the opioid epidemic. “Attachment C.”

The Dec. 1, 2017 rate reductions have already significantly hindered the ability of our providers to offer care, and are having a destructive impact on the abilities of your insureds’ to receive needed treatments. These policies affect numerous acupuncture specialists and a significant number of patients. Our organizations are deeply concerned with BSC’s trend in policy regarding acupuncture coverage, and hence its trend to work against the public health community and Attorney’s General in recommendations to meaningfully support non-pharmacologic pain solutions. Our nation is in an opioid crisis, and BSC is taking deliberate steps to make that crisis worse. These policies create obstacles for Licensed Acupuncturists to practice medicine in California and other states in which they are licensed, and to be paid commensurate with the services they provide.

Given that the combination of these policies are already affecting numerous Licensed Acupuncturists and countless patients with varying clinical conditions that can lead to chronic pain, we urge Blue Shield of California to rescind these policies and consider engaging the provider community in a concerted, serious dialogue on how to best deliver “alternative” medical care (which is no longer alternative) in a cost effective and efficient manner.These issues are important priorities for our respective organizations, and we will continue to work collectively to accomplish a mutually agreeable solution that addresses our concerns. We, thereby, request a formal response to our concerns within 30 days of receipt of this letter. We are certain BSC did not intend to be the stand-out company working against national opioid crisis efforts, and together we can certainly find a way to make it instead a leader in solutions.

We look forward to working with you on these issues. Please do not hesitate to contact Tiffany Tuftee, President, CSOMA (president@csomaonline.org); 831-515-6049), or Ra Adcock, Executive Director, CSOMA(ra@csomaonline.org, 1800-477-4564) with any questions or concerns.

Respectfully yours,

Tiffany Tuftee
CSOMA President
president@csomaonline.org

Ra Adcock
CSOMA Executive Director
ra@csomaonline.org

The California State Oriental Medical Association

CC: California Governor, Governor Jerry Brown California Attorney General, Xavier Becerra California Insurance Commissioner, Dave Jones Department of Managed Care

CSOMA’s Position on CalATMA

July 31, 2018

As one of the leading medical associations in California, CSOMA is committed to supporting the acupuncture profession through public policy work, networking, continuing education, publishing, and community outreach.

Earlier this year, State Representative Evan Low, of Assembly District 28, and his team organized several stakeholder meetings to encourage the formation of a single statewide acupuncture association through the unification of the 25+ acupuncture associations that currently operate within the state of California. As of May 2018, a Steering Committee charged with leading this unification effort was organized and it was decided that the name for the new association would be the California Acupuncture & Traditional Medicine Association (CalATMA). CSOMA attended the initial meetings of the steering committee.

CalATMA is in the initial stages of becoming an organization and currently has no member benefits for you. In order to participate on the steering committee, CALATMA required that CSOMA dissolve and close its corporation and disband its membership. Because we value your membership and commitment to CSOMA, we will continue to support you and the profession by following our stated strategic plan.

There is still uncertainty regarding if and how some of the individual associations will merge into one association, and if the new associations’ prevailing mission and values will be in alignment with CSOMA’s mission, or how long this process will take to accomplish. After much thought and deliberation, our Board of Directors at CSOMA made the unanimous decision to respectfully resign from our seat on the steering committee.

We believe that our resources are best spent continuing to advocate on behalf of our membership, and we are committed to keeping the tremendous momentum going that our organization has reignited over the past couple of years. CSOMA is currently working on numerous state and national legislative priorities as well as providing continuing education opportunities for our membership.

At CSOMA, we recognize the importance of and need for consensus among the state associations in order to achieve common goals and objectives for the profession on a state and national level. We are committed to professional communication, working together on statewide legislative priorities and joint lobbying efforts.

We hope to have the opportunity to collaborate with CalATMA in the near future, and we would like to extend a heartfelt thank you to Representative Evan Low and his team for bringing the various statewide stakeholders to the table in the spirit of unification.

If you have further questions or concerns or would like more information regarding this decision, please feel free to contact CSOMA President Tiffany Tuftee at president@csomaonline.org.

We thank you for your loyalty to our association over the last 30 years and look forward to continue to represent your best interests and advance the acupuncture profession.

Sincerely,

CSOMA Board of Directors

ASA 3rd Annual Congress

The American Society of Acupuncturists (ASA) held its annual meeting March 16-18, 2018 in Denver, Colorado.

Sunset Review Hearing 2018

On Monday, February 26, 2018, the California Acupuncture Board faced its Joint Sunset Review Hearing by the Senate Committee on Business, Professions & Economic Development and the Assembly Committee on Business and Professions. The public event was held at the State Capitol in Sacramento.

CSOMA UPDATE: February Stakeholder Meeting #3

February 27th marked the third meeting of California Acupuncture Stakeholders, orchestrated by Assemblymember Evan Low at the State Capitol in Sacramento.

CSOMA Update: February Stakeholder Meeting

February 2nd and 4th marked a historical day for the acupuncture profession in California.

CSOMA President, Tiffany Tuftee and Board of Director Representative, Bruce Gustafson were in attendance to discuss unification of the profession. Assemblymember Evan Low and his colleagues helped organize the meeting to open the dialogue about why it is important to unite our profession in California. The takeaway message from our meeting:

To be heard on legislative initiatives that move our profession forward, we must have a clear and consistent message from the acupuncture profession as a whole.