July 2015 Edition

Feature Article

Mike Jawer, AANP Director of Government and Public Affairs

The Center for Medicare and Medicaid Services (CMS) has directed health insurance plans to accept pharmacy claims for prescriptions written by providers who are not physicians (defined as MD/DO by CMS) but are allowed by state law to prescribe drugs.

The goal of the regulation, issued May 1, is to avoid unintended interruptions in drug coverage caused by a regulation CMS published a year ago. At that time, CMS required plans to deny pharmacy claims written by providers who either aren’t enrolled in or have opted out of Medicare. That rule aimed to prevent fraud and abuse. Since then, however, CMS learned that some states allow drugs to be prescribed by certain pharmacists and other providers who do not meet the statutory definitions of “physician” or “eligible professional” eligible for Medicare. The amended rule clarifies that valid prescriptions from these providers will be accepted.

News From the Executive Director
Laura Culberson Farr l Executive Director, OANP

Two years ago, John Weeks (founder of the Integrator Blog and champion of integrative medicine) posed the question in The Huffington Post of whether we needed “A ‘Big Honking Lawsuit’ to Advance Integrative Medicine and Health?”

At the time, we were still working with various state insurance commissioners, including ours in Oregon, and we were hopeful that the non-discrimination provision of the Affordable Care Act would finally mean that insurance barriers to naturopathic doctors would come tumbling down.

While some of the insurance carriers did take demonstrable steps in the right direction, others chose to bury their heads in the sand regarding compliance with the law, and continued on their path of imposing severe restrictions, barriers, and grossly discriminatory reimbursement policies on NDs.

To answer your question, Mr. Weeks, “Yes!”

OANP decided that after a year and half of ongoing patient barriers to care with virtually no enforcement by government agencies, it was time to file that “Big Honking Lawsuit.”

On July 7, OANP became the first organization in the country to file a class action lawsuit in federal court to clarify enforcement of Section 2706 of the ACA which prohibits insurance plans from discriminating against provider types. The lawsuit specifically targets Health Net Health Plans of Oregon and their subcontractor American Specialty Health (ASH).

Click here to read more about the lawsuit.

OANP would also like to invite any of your Health Net patients to join the lawsuit who have had claims denied because they were done by you as an ND that Health Net would otherwise cover. Email Laura@oanp.org.
I’m proud of the OANP and our board for showing this leadership on an issue that will clearly have national ramifications not just for NDs, but for all provider types - from chiropractors to nurse anesthetists.

Please consider making a generous donation to OANP’s Legal Action Fund to support our effort to make sure patients have access to and insurance coverage for the provider of their choice!

Community News

Laura Culberson Farr l Executive Director, OANP

The Oregon Workers’ Compensation Division has extended an invitation to NDs to join them at their Workers' Compensation Educational Conference on Nov. 5 and 6, 2015, at the Salem Convention Center. This will be the 13th Oregon conference designed with the provider in mind.

They’ve made diligent efforts to be responsive to what you, as the workers’ compensation community, have told them you need in educational programs for this conference. The conference will offer educational and interactive workshops, informational booths, exhibits, and plenty of networking opportunities.

OANP believes that this is a great opportunity for NDs who already take Workers Comp patients, or who are interested in expanding their practices into this area of healthcare. For more information about this event or to sign up to receive a registration packet, please contact Kara Null, 503-947-7515 or kara.r.null@oregon.gov.

Brook Schales, ND, LMP l Physician Member Coordinator, OANP

The ReVitalization Retreat is a multi-day camping retreat held at The Eclectic Institute in Sandy, OR that focuses on hands-on and experiential learning opportunities in the modalities of traditional Nature Cure. During the retreat, you'll have the opportunity to participate in discussions, hydrotherapy, herbal walks, meditations, and other interactive workshops. This annual retreat is planned and coordinated by students attending NCNM. The retreat will be September 11-13th and the cost of the 2015 retreat is $115 for recent ND graduates (past 3 years) and $220 for all other NDs. CE credits are pending approval.

View More Information or Register

Brook Schales, ND, LMP l Physician Member Coordinator, OANP

The National College of Natural Medicine’s Helfgott Research Institute is looking for participants! Helfgott conducts research in the art and science of healing, and is dedicated to studying natural medicine therapies. At Helfgott, scientists from the fields of naturopathic medicine, Chinese medicine, immunology, and nutrition apply their expertise to the study of natural medicine.

There are currently two active studies available for participation:

The Herbal Salve Study: examines the ability of a topical skin salve containing plant extracts to increase oxygen delivery to the skin on the legs and feet of participants with type 2 diabetes.

The Heart Health Study: assesses the safety and tolerability of an over-the-counter dietary supplement for cardiovascular health in adults with borderline to mildly high blood pressure.

Community Supporter News

Laurie Morgan l Senior Consultant and Partner, Capko & Morgan

Collecting well from patients used to be a key to maximizing profitability. Now it’s essential just to maintain it. Patients now cover as much as 40% of their service costs through copays, coinsurance and deductibles.

What’s more, the trend towards greater patient financial responsibility has made plans more complex and confusing – making the collection challenge even more difficult.
Collecting from patients is not just a financial problem. Your practice must tread carefully to maintain positive relationships with patients. You must be able to help patients understand their health plans – because even though it’s not technically your job, it’s critical to patient perceptions of your practice, and their readiness to pay.

Success starts with tuning up your front-office workflow. Every staff member involved in the scheduling, check-in, and billing processes must understand their role in educating and accepting payment from patients. And they must have the right tools to verify eligibility, determine patient obligations, and calculate patient balances.

Happily, innovative front-office technology tools can now make the process easier. Many tasks that previously required calling a health plan can now be done within your practice management system. And tools that help patients better manage their payment obligations have emerged, too – with familiar interfaces via smartphone apps and user-friendly websites.
Best practices throughout your front office workflow will help your practice get paid reliably. Learn some easy, effective ways to update by accessing the free, on-demand webinar: “Patient Financial Responsibility: Tackling Your Practice’s Biggest Profitability Problem.”

Laura Culberson Farr l Executive Director, OANP

Many NDs share office space, as either independent contractors or renters. In these situations, it is tempting to use the same business card logo and template. Physicians should resist this temptation! Using the same business cards, logos, or letterheads when you are not owners or partners in the clinic may lead the public and patients to think that you are all co-owners, which leaves you open to liability if one of the other contractors, renters, or owners in the business run into legal problems. It also leaves the business that contracts space to you open to liability if YOU run into legal problems and a lawsuit names both you as the provider and the business entity where you provide services. Here are some tips to protect you from liability in shared office spaces:

For Clinic Owners Sharing Clinic Space with Independent Contractors:
• Carry a separate limit of liability for your business entity on your insurance policy.
• Require that each contractor name your business entity as an additional insured.
• Do not allow the use of your logo, letterhead, business cards, etc for independent contractors and renters.

For Independent Contractors and Renters Sharing Clinic Space:
• Carry your own liability insurance.
• Name the business entity that you contract space from as an additional insured on your individual policy. Note that some insurance plans will not allow you to do this, so shop carefully to ensure that you can get this coverage.
• Maintain your own logo, letterhead, business cards etc. to clarify that you are operating as a distinct and separate business entity.

Aegis Insurance Associates would be happy to answer any of your insurance questions for this type of exposure. We plan to offer a free seminar on this and other malpractice pitfalls in the future for all OANP members, and don’t forget that Aegis already offers OANP members a 10% discount on malpractice insurance! Contact Lyle Cheeney for more information.

Legislative News
Laura Culberson Farr l Executive Director, OANP
OANP staff, board leaders and lobbyists were exceptionally busy this year, with the legislative session culminating in three bills passed, two attempts to remove philosophical exemptions for vaccines killed, and discussion of including NDs in loan repayment programs will continue on during the interim. We’ll be catching our breath after this extra busy session. Please give a huge shout out to Dr. Jeff Clark, OANP’s Legislative Chair, and Dr. Hilary Andrews, esteemed advisor, for all the work and time they put into testifying and sitting on workgroups to make this session so successful!

• HB 2468 – Defines network adequacy for insurance carriers. But most importantly for NDs, the bill codifies the ACA’s non-discrimination law into state statute, giving state regulators more ability to enforce the law. Insurers originally opposed inclusion of this language, but advocacy from OANP and strong support from the Insurance Commission ensured that the language was included.

• HB 3301 – Requires insurers to give NDs the choice of applying to be credentialed as PCP or Specialist. Introduced at OANP’s request, we worked with insurers to amend the original bill with language that any ND applying to be a PCP would need to meet the insurer’s credentialing requirements for PCPs.

• SB 231 - This bill deals with assessing and creating innovative payment methods for primary care. It includes "Naturopathic Physician" in the definition of "primary care provider," an important codification of the scope, training and licensure of NDs.

• SB 442 and SB 895 – Attempt to remove religious and philosophical exemptions to vaccines and to remove the ability of NDs to sign off on medical and non- medical exemptions. OANP issued a letter to the Senate Health Care Committee with our concerns about the bill. Parent rights advocates heavily opposed the bill and ultimately won in getting SB 442 retracted. SB 892 was an attempt to restrict who could sign off on exemptions to just MDs and DOs. OANP made clear that this would constitute restriction of scope for NDs and our legislative supporters indicated they would not move the bill unless NDs retained the right to sign off on exemptions. The author of the bill publicly conceded that she would amend the language to include ND, however this bill is still pending.

• HB 3396 – Rural/underseved loan reimbursement programs – OANP amended this bill to enumerate Naturopathic Doctors on the list of eligible provider types for the Primary Care Loan Repayment Program – a program for providers who work in rural or large low-income populations. An attempt was made to remove NDs from the list in the last days of session, and OANP lobbyists worked with legislators to give power to the Oregon Health Authority to research which providers should be enumerated as eligible for loan repayment. OANP will be working with OHA staff during the interim to continue trying to get NDs eligible for this loan repayment program. 
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Continuing Education
& Community Events

2015 NDI Brigades
August 29th - Sept 7th
Location: The island of Ometepe, Nicaragua

Free Webinar Ayurveda & Liver Health
Date: July 15
Location: Webinar

Primary Care for Women: Enhancing Your Skills
Date: July 17-19
Location: Portland, OR

Labrix Core Training
Date: August 1
Location: Portland, OR

AANP 30th Anniversary Convention
Date: August 5
Location: Oakland, CA

August MedTalk ND Lecture

Date: August 25
Location: Portland, OR

Career Center

Join Our Multidisciplinary Wellness Center
Location: Portland, OR

Space for Rent in Gorgeous Naturopathic Office
Location: Bend, OR

ND Space For Rent
Location: Eugene, OR

Equipment for Sale

Location: Portland, OR 

Part Time Insurance Biller Needed
Location: Lake Oswego, OR


Forrest Beck

Kelsey Becker

Jessica Brandes

Bryce Healy

Lara Martin

Morgan Peterson

Maureen Robinson

Alicia Rogers

Haley Smith

Please visit our website at 
www.oanp.org for more information about becoming a member of the OANP.



Laura Culberson Farr
Executive Director

Brook Schales, ND, LMP
Physician Member Services Coordinator

Audra Bates
Director of Membership & Development

2015 Board Members

Carrie Baldwin-Sayre - President

Sheryl Estlund - Past President

Wendy Abraham - Vice President

Kaley Bourgeois, Secretary

Rebecca Principe - Treasurer

Jeff Clark - At-Large

Bridghid McMonagle - At-Large

Martin Milner - At-Large

Wendy Vannoy - At-Large

Jennifer Karon-Flores - At-Large

Clair Hamilton Araujo - Student Rep