Dr. Larry Bridges, Executive Director

First of all a special thanks to our OSCIPA lobbyist Dennis Adkins for keeping us informed of both the content and status of bills of interest to the chiropractic profession. I will also acknowledge the efforts of Dr. Dan Post our legislative committee chairman in his efforts to follow each bill identified by Dennis as a bill that could impact the profession. The OK-Legislature stood adjourned as of May 27th. Governor Mary Fallin put an exclamation point on a successful legislative session by signing 8 bills that were major republican priorities this year.

WORKERS COMP BILL: SB 878 regarding worker’s compensation drew a lot of attention from chiropractors statewide. A lot of misinformation surfaced during the latter days of this bill going through the house and the senate. OSCIPA was very much involved in following this bill through the efforts of Dennis and Dr. Post as to whether or not we should have collectively opposed this bill.  According to OSCIPA Board Chairman Dr. Dan Post, “this bill passed the Senate 48-0 and the House 81 -8. In the final analysis it was decided that it did not adversely impact the majority of the chiropractors so the decision was made not to get overly involved without a common cause to do so.” Dr. Post’s summary of this bill is that “chiropractors can no longer be IME’s for the Work Comp Court and can no longer testify in the court on PPI (Permanent Partial Disability) cases. Only MD’s and DO’s are now allowed to do this.”

He also suggests that it does legislate that the Physician Advisory Committee (PAC) will begin following “Evidence Based Guidelines” for the treatment of cervical, thoracic, and lumbar spine injuries. It specifies the most common CPT codes used for these injuries. This may give the majority of the chiropractors a possible avenue to get back in the WC care arena, as we all know that virtually all the “evidence” shows manipulation to be one of the best treatments of choice for many of the referenced conditions. Even though chiropractic lost some of its status as physicians of the court there may be some hope of getting back into this arena of care. However we must always be on guard to prevent these types of restrictions in other areas of the law!

CHIROPRACTIC ASSISTANT CERTIFICATON: Another bill that we have been following that was signed by the governor is HB 1658 which specifically impacts Chiropractic Assistants by creating a CA certification requirement. This means that in the future unlicensed chiropractic assistants as we know them today will be required to be certified to continue to deliver health services to patients. Insurance companies have traditionally been struggling with this issue when paying claims that may have services on them that were not done by the chiropractor but by his/her CA. This effort will also improve the professionalism of the profession by having all CA’s certified.  As you may know, OSCIPA has partnered with Dr. Rosalind Canham, creator of Professional Online Education in Arizona. Not only has Dr. Canham written CA certification programs for several other states, but she also created one just for Oklahoma CA certification.  We are still waiting to find out whether or not this program will be accepted by the state of Oklahoma for use in educating CA’s for their certification requirement.  This bill requires the board of Chiropractic Examiners to promulgate rules regarding certified chiropractic assistants.

SB 0299 was also signed by the Governor and changes the authorization of the Board of Chiropractic Examiners to employ one or more investigators to the authority to contract with one or more investigators. It requires any investigator to be certified as a peace officer by the council on Law Enforcement and Training and have statewide jurisdiction to perform the authorized duties.  It requires an advisory committee to meet and determine whether a complaint merits further investigation after an initial complaint is received.

A final note on the work that this House and Senate did during the 2011 session is that SB 0772 creates a 15 member Business and Professional License Facilitation Task Force to study the existing governmental models in Florida, Ohio, and other states that have established a central contact point or agency for the facilitation of the majority of business and professional licenses and applications. This would be leaning toward creating a Healing Arts type board for all health care professionals.

COPAY EQUALITY: We at OSCIPA have encouraged our lobbyist to look into the new Co-Pay Equality law passed in South Dakota this year. This law says that no health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5 that is greater than the copayment or coinsurance amount imposed on the insured for the services of a primary care physician or practitioner for the same or similar diagnosed condition even if a different nomenclature is used to describe the condition. 

The Patient Protection and Affordable Care Act (PPACA) will allow individuals and businesses to purchase Health Insurance directly through State Health Exchanges. In Oklahoma these Exchanges are called “Health Insurance Exchanges”. These exchanges will offer a choice of qualified health plans (QHPs) that will vary in coverage levels but meet certain standards in categories of care and limits on patient cost sharing. How will this affect chiropractic?

Essential Health Benefits Requirements must cover 10 general categories of service. Further details of the Essential Health Benefit packages will be defined by the Secretary of Health and Human Services (HHS) based on the scope of benefits offered by a typical employer plan. The Summit GR Committee fully believes that the services that doctors of chiropractic can perform could indeed fit in several of the 10 Essential Benefits named in the PPACA law. Remember, Doctor’s of Chiropractic are physician level providers of care.

Just so you know I have attended all 3 of the Oklahoma Health Insurance Exchange meetings on your behalf. I am also on a workgroup committee entitled Carrier and Plan Selection. Our first workgroup meeting is this Tuesday in OKC. This committee is co-chaired by Mike Rhoads, Deputy of Health Insurance and Laura Brookins, Executive Director of the Oklahoma Association of Health Plans; both of whom I have known for quite some time. Both COCSA and the ACA have encouraged chiropractic representatives to serve on these types of committees and workgroups. I selected this particular workgroup because one of its main issues is the Minimum Essential Benefits that an exchange must provide. COCSA and the ACA seek to ensure the full applicability of Section 2706 (Non-Discrimination) to insurance plans (including ERISA and State Exchange Plans) as the primary mechanism to ensure that doctors of chiropractic can provide services in the newly regulated environment created by PPACA – and to ensure no language is adopted at the federal level relative to “essential benefits” that would specifically exclude the inclusion of services provided by, or participation of DC’s. This involves making this position crystal clear at the highest levels of the HHS Department, via the Gephardt Group and Senator Tom Harkin, Chairmen of the Senate HELP Committee, the Committee of Jurisdiction over the key elements of PPACA about which chiropractors are concerned.

In addition to this involvement do not forget that OSCIPA has employed former House Member Dennis Adkins of A & A Advocates, Inc. as our lobbyist. Dennis and I both are involved in a group of non-MD/DO health care associations that have formed a legislative alliance in which we can help each other when appropriate. And as I have mentioned before if any of you have any legislative concerns or issues you may contact Dennis at dennis.adkins@ymail.com.      

Last week we introduced Dennis Adkins as our chiropractic lobbyist this year. Mr. Adkins routinely submits to us a current tracking report of all legislation that is relative to chiropractic and the health related field. He also submits a Chiropractic Monthly Lobbyist Update that we have attached to this week’s blog. The reason being, we want all of our chiropractic members and their staff to know that we are whole heartedly involved in the Oklahoma state legislative process on your behalf.

If you are a doctor reading this, please let your staff know what we are doing here. If you are a staff member please let your doctor know what we are doing as well. OSCIPA has over 350 doctors and when you combine that count to each doctor’s current employees, we have a grassroots program in its beginning stages. If any of you have any legislative concerns please feel free to contact Dennis Adkins at dennis.adkins@ymail.com. And please also copy me larry@oscipa.com and Dr. Dan Post at drpost@postclinic.com. Also, if any of you have a direct relationship to any legislator please let Dennis know right away! If each of you does get involved in this process (and if needed we could also involve your patients in our efforts) then we would have the potential for a huge “grassroots” base. Do not forget that Dennis and Dr. Post will be available to meet and greet all the February 26th CE seminar attendees in OKC after Saturday’s session at 5:00 PM in the lobby at a cash bar set up for this purpose. Please help us move forward on this effort as many of you listed “legislation” as a priority in our member’s survey. We can make a difference in a very positive and well organized way!     

FROM DENNIS ADKINS AND A & A ADVOCATES

Governor Fallin’s State of the State:

Fallin was introduced for the first time as governor to the House and Senate as it convened for its second joint session of the 53rd Legislature. In a point of personal privilege, she remarked on the fact that it was the first time for a woman to deliver the State of the State. “Twenty years ago, I sat in the back of this chamber as a freshman legislator,” she said. “For 16 years, I stood behind the governor, and I was the woman behind the man. Today, I get to wear the britches.” She said it was like Oklahoma singer Toby Keith’s song, “How Do You Like Me Now.”  In her formal remarks, Fallin asked for the Legislature’s help in addressing several areas of reform, including: workers’ compensation reform, lawsuit reform, state government reform, pension reform and education reform. Tax credits also remain a focus, with Fallin expressing her support for a review of those tax credits that has been initiated by Rep. David Dank, R-Oklahoma City, and Sen. Mike Mazzei, R-Tulsa.  “I’m looking forward to the results of that study, and our course of action will be real simple: only tax credits that create jobs will stay,” she said.                                                                                            

House:                                                                                                  

On its second day of work Tuesday, the House second read a number of bills and decided to adjourn due to impending weather.House Floor Leader Daniel Sullivan, R-Tulsa, asked that the House request the Senate’s permission to adjourn more than three days, an action that is requiredunder the Oklahoma Constitution. “In light of the great distances many House members have to travel when returning to their home districts, it is prudent to allow them to make those drives now before road conditions potentially became icy and dangerous,” said House Speaker Kris Steele, R-Shawnee, in a news release. “While this delay is inconvenient, it will not result in any major disruption of the legislative session, and we will resume regular activity next Monday.”

Senate:

An approaching winter storm led to the Senate adjourning early on Tuesday without discussing joint rules related to appropriation bills because of members expressing concern about the condition of roads and highways. The Senate also canceled all committee and subcommittee meetings for the week. The Senate will reconvene next Monday, Feb. 14, at 1:30 p.m.

OSCIPA recently hired former House member Dennis Adkins of A&A Advocates, Inc. as our new lobbyist.  We’d like to take the time to introduce Mr. Adkins to you. We have included in this week’s blog his past achievements as well as his pre-session legislative report.  Mr. Adkins will also be available to meet and greet our members at the upcoming relicesning seminar on February 26th after class ends at 5:00PM.

About Dennis Adkins and A&A Advocates

Government  affairs clients currently include; AT&T, AES Shady Point, ITC Great Plains, Newfield Exploration, Oklahoma Municipal League, Oklahoma State Chiropractic Independent Physicians Association, Oklahoma State Employees Association, Plains Pipeline, Sunoco Logistics, Tarrant Regional Water District.

Legislative Career Highlights:

Dennis Adkins elected to the House of Representatives in November of 2000 and served to November 2008. 

He is the past Chairman of the Energy, Utility, Aerospace, and Technology Committee for the Oklahoma House of Representatives.  Chairman Adkins’ responsibilities included jurisdiction and oversight of Oklahoma’s oil and gas industry, telecommunications and technology, mining, aerospace industry, as well as, all electric and water utilities. 

Representative Adkins was also served as a member of the Public Health Committee for six year.  Adkins was named to the Leaders on Public Health Policy shortly after being elected in 2000. 

Chairman Adkins has testified before the Environment and Public Works Committee of the United States Senate with respect to the energy industry and its relation to carbon emissions and climate change.  

In addition, Adkins served on the Executive Committee of the International Energy Council, a leading organization of energy producing states, Venezuela, Canada, and China. 

Adkins was selected by the International Republican Institute to serve as an official observer of the first democratic Presidential elections in Macedonia. 

Representative Adkins was also chosen by the American Council of Young Political Leaders to participate in a United States mission to Tanzania and Uganda to study emerging issues with regional African leaders. 

Representative Adkins’ legislative career was highlighted by being twice named Oklahoma Independent Petroleum Association legislator of the year. 

 He was also named the Higher Education legislative newcomer of the year, American Royalty Council legislator of the year, and Industrial Electric Consumers legislator of the year. 

 He was selected to participate in Leadership Oklahoma and is now a lifetime member of the organization. 

 In addition to the Energy and Public Health Committees, Dennis served on the powerful Appropriations and Budget Committee, the Revenue and Tax, and the Environment and Natural Resources committee in the House of Representatives. 

Previous Employment and Education:

Prior to the legislator, Adkins served the State of Oklahoma in professional positions within the Department of Corrections, Department of Human Services and the Department of Rehabilitative Services.

He graduated from Northeastern State University in Tahlequah, Oklahoma with a Bachelor of Arts in Political Science.

2011 Pre-Session Legislative Report

The 2011 legislative session opened on Monday, February 7 and the face of Oklahoma’s government will be significantly different than at any time in our history.  Both houses of the legislature are now solidly controlled by Republicans.  Of the 101 members in the House of Representatives, 70 are Republican―32 of the 48 members of the State Senate are Republican.  But that is only the beginning of the story.  Mary Fallin, the state’s first female Governor, is a Republican, as is the Lieutenant Governor, State Treasurer, State Auditor and Inspector, State Insurance Commissioner, State Labor Commissioner, and the State Superintendent of Public Instruction.  This dominance by the Republican Party is sure to change the philosophy and direction of the state for years to come. 

What can be expected from the new legislature and executive branch?  The most pronounced change from past governments will be a much more conservative approach to the issues facing the state.  That conservative approach should manifest itself in a downsizing of state government (fewer agencies, departments and state employees), a rejection of any new tax increases, better financial management of state assets, and a much more conservative approach to social issues.  While it will take time for the new government to hit its stride, there is little doubt that change is coming.  The only question left to answer is how quickly the changes will occur.

As is always the case when a legislative session begins, the dominate issue will be the state budget.  Questions that must first be answered relate to the state’s revenue picture.  How much money will the legislature have to spend?  Once that question is answered, the legislature will turn its attention to balancing the budget by making cuts to various agencies and programs.  As it moves toward writing the FY2012 budget, legislators want to hear from state agency heads relating to ideas they may have about how budget cuts can be handled within their agencies.  Legislative leaders have already directed the various agency heads to develop plans that show how they could operate with as much as a 10% cut from their current budget level.  With little Federal Stimulus money left to help soften the blow, and with no reasonable prospect of additional revenues from tax increases, agency directors will be hard pressed to meet their budgetary requirements without additional layoffs of employees.  Every agency will be given an opportunity to make its budget case to both the House and Senate early in February.  Then the job of writing the FY’2012 budget will begin.

Before looking at the revenue projections for the state, here are a few facts about the Oklahoma economy.

• The state’s jobless rate remains flat at 6.9%, while total employment fell by 3,100 jobs in November.
• The state’s personal income grew in the third quarter of 2010 by 1%, down from 1.8% in the second quarter.
• December revenue collections were up 13% from the year before.  Thus far, FY2011 revenue collections are up 7.5% over the previous year, but that is still 23% less than revenue collections in FY2009.
• After 30 months of growth, the number of Oklahomans receiving SNAP (formerly food stamps) benefits declined in October, but Medicaid enrollment rose 2.1% in October, reaching the historically high level of 726,960 persons.

As the data above indicate, Oklahoma’s economy is improving but is still far from fully recovered.  Most estimates show that it will be FY2014 or beyond until state revenues return to pre-downturn levels.  By that time agency cuts will have trimmed the size of state government.  So a return to pre-downturn levels of revenue could result in sizable surpluses for the state.  However, there will be pressure to use much of the increased revenue to offset further cuts in the state’s income tax.  Reducing the state income tax continues to be a goal of the Republican majority.  The ultimate goal is to completely eliminate the tax in order for the state to compete with Texas when trying to entice out-of-state companies to relocate here.

Revenue projections for the next fiscal year indicate that the legislature will have between $200 million and $600 million less to spend than it did in the current fiscal year, a figure that is about $800 million less than in FY2009.  It is estimated that the total appropriated state budget will be around $6.3 billion, as opposed to $7.125 billion in FY2009.  Federal Stimulus dollars have largely been used, so the state will not have those funds to help offset its budget shortfall.  Almost every state in the country is facing similar, if not greater, deficit.  Due to its budget-balancing requirement, Oklahoma is better positioned to address its needs than other states―a few who are even facing the possibility of bankruptcy.  But that does not mean Oklahoma is without pressing problems.  Unfunded liability levels in our pension systems continue to be a concern and most counties and school districts are also facing financial pressures.

So the members of the legislature and new Governor Mary Fallin return to the Capitol with a significant challenge.  The revenue shortfall must be accounted for.  The state constitution prohibits deficit spending.  There is no desire to raise general taxes to help make up for the shortfall.  Specific fees, such as fees on health care providers, will be discussed.  But even those targeted fees will face stiff opposition, and their passage will probably require a three-fourths vote by both houses of the legislature to become law.  That means that further budget cuts seems almost a certainty.  Those cuts will come in the form of across-the board reductions or through targeted cuts to specific agencies.  The budgetary process over the next four months will determine that.

In addition to budget discussions, the legislature will be taking up many non-budget issues.  Look for the State Chamber of Commerce to play a bigger role in shaping those issues than it ever has.  Conversely, organized labor and attorney groups have lost supporters inside the House and Senate chambers.  Their influence has been diminished.  Because Oklahoma is one of the most conservative states in the Union, there will be an aggressive conservative social agenda as well. 

As of the writing of this report, a total of 2137 bills and 85 JR’s have been introduced for consideration during the 2011 session. House members filed 1,168 and 41 joint resolutions, compared to 1,153 bills and 31 JR’s in 2010.  There were a total of 969 Senate bills and 44 JR’s filed as opposed to the 1082 bills and 82 JR’s filed in 2010. A new Senate rule exempts appropriation bills from the deadline, an effort to improve efficiency and increase transparency in the legislative process. Over the next four months A&A Advocates will report on all the important issues that are before the legislature and Governor.  Some of the issue areas that will receive scrutiny in our legislative updates will include:

Insurance:  General insurance changes; health insurance bills; uninsured motorist

General Business:  Workers Comp changes; Tort Reform efforts; Quality Jobs  issues;  Aeronautical issues

Medical/Health:  Health Care Reform; Medicaid funding and changes; Chiropractic proposals, local control tobacco regulation

State Government:  Procurement legislation; Tribal issues; Ethics and Elections discussions; Privatization efforts; State employee reductions

Corrections: Private Prison efforts; Prisoner reduction efforts

Energy: Incentives for oil and gas exploration; Pipeline Issues; Electric Transmission; Electric Generation; Recycling efforts; Water transfer and development legislation

Tax and Revenue: Income Tax reductions; Miscellaneous tax incentives; Tax Credit changes

Education: Overall funding; consolidation proposals; Property tax changes; Private college legislation

Communications: Telecommunications legislation; Changes regarding 911 laws; Mobile phone/Hand held device restrictions

Local Government: Municipal bond law changes

Politics:  Majority party and minority party issues inside the House and Senate; State elected office politics 

In addition, the A&A Advocates’ updates will pass along any credible tips and rumors that we believe may impact coming actions in the legislature.  We will tell you what we’re hearing behind the scenes, so you can make sense of what you’re reading in the daily newspapers.  Each week we will also provide links to other internet sites that we feel might provide additional useful information.  The 2011 session promises to be interesting.  We look forward to working with you and will do our best to keep you fully informed.

Thank you to those of you who took the time to read this information we have posted for you here.