NMSAAM Annual Meeting 9/15/2024 Report

NMSAAM Annual Meeting 9/15/2024 Report

Our patients: that’s who it’s all about!

First in-person annual meeting since before the pandemic

Attending in-person: Yvonne Walston, Yvette Arellano, Steven Malins, John Scott, Van Warren, Elene Gush, Glenn Wilcox, Eric Zhao
On Zoom: Brenda Petty (later came in-person), Caterina Di Palma, Mark Maynard, Brandon Taylor
Technical assistance: Roy Walston
Report assistance: Elene Gusch

Welcome by outgoing president Yvonne Walston:

• Yvonne strived to be a gan cao president, a harmonizer.
• She felt that it was an honor and privilege to serve as NMSAAM’s president for the last four years.
• She is proud of our board members.
• We all help each other achieve our individual and collective goals.
• We have come a long way since NMSAAM was founded in 2009!
• We are increasingly professional in our activities, especially considering having few resources.
• Our time is now, since so many MDs are leaving the state.
• SWAC died— do we want DOMs to die out too?
• We have to pull together even though we have a LOT of differences between each of us.
• We are like cats— different varieties, some social and some not.
• We are all healers.

We thrive when we learn and love to learn and collaborate.  NMSAAM membership benefits our patients.  NMSAAM needs to grow from slightly more than 10% of the DOMs in New Mexico in order to best serve our patients. ASA membership makes us stronger and gives more benefits.

Candidate statements and board reports:

Yvonne is stepping back from the presidency to bring in new talent, but plans to stay a board member. She listed some highlights in NMSAAM during her four years as president:

• Our website became stable through hard work, with information available to all who visit the site. We are working on having pertinent information in the Members Only section relatively soon.

• We continue pertinent communications to all NMDOMs through at least monthly e-blasts.

• We have held pertinent townhalls online and in-person as pandemic allowed.

• We have held pertinent educational events.

• We usually have a BOD member at the NMBAOM meetings to keep up with information, and we recommend that if you can, attend the next one on September 24, which will be an important rules hearing.

• We hired NMSAAM’s first lobbyists to protect our scope of practice and to legislatively move the profession forward. One seasoned DOM thought that the BAOM pays for our lobbyists – not so. That would be a conflict of interest. Palpable NMSAAM lobbyists achievements:
  • Repeal of the Sunset Act
  • No GRT on the insurance co-pays for DOMs who are on insurance panels
  • Protection from several groups who attempted to dilute the DOM practice act
  • Continued work on the rural tax credit bill
  • Protection of our valuable scope of practice
• Yvonne served as one of the two delegates for the ASA.
  • The ASA rallied acupuncturists across the country through the state members, including NMSAAM members, to successfully stop the removal of the current acupuncture insurance codes.
  • Medicare approved acupuncture for Medicare patients without first having acupuncturists as Medicare providers. Medicare does not have the authority to give acupuncturists that roll.
  • HR 3133 Acupuncture for Our Seniors act is supported by NM US Reps, and sponsored by NM US House Rep. Melanie Stansbury

Yvonne introduced and enthusiastically endorsed Yvette Arellano as the next president of NMSAAM.

Yvette has been very active at the legislature and as an insurance provider, and has done a lot of community outreach.

Yvette, current VP:

Thanked Yvonne for her hard work, dedication, and support, and gave her a gift of flowers.

We were fortunate to have lobbyists who gave us a great deal in the past few years.  Unfortunately, our main lobbyist, Michael Chavez, died last winter.  We have found a new lobbyist, Kim Legant, who we will meet today, and who has made herself affordable. She understands the steps needed to get us in the budget for Medicaid, which has complicated issues.  Lobbying has been a learning experience.  We will need to develop funding for a lobbyist, and the board has decided to start a GoFundMe. Although a 60-day session is coming up, she expects that there will be less of a burden on us this time and we will be better prepared.

We anticipate that our licensure is going to be challenged again by the proposal to have acupuncture-only licenses, as in the 2023 and 2024 sessions.  We have been dealing with that for the past 3 years and it has been time-consuming.  We need to work on other issues, including Medicaid, which could help a million New Mexicans.  She notes that DOMs would not be required to take Medicaid, but we could help fill the gap created by the lack of primary-care providers, especially since we can often be accessed more easily.  Our lobbyist is aware that we need to continue to educate people about this.

We will be meeting with the director of Medicaid soon.  John Scott pointed out that now, during the interim, is the time that budget issues need to be taken care of.  The governor’s advisory board agreed that Medicaid should cover acupuncture, but last year the chair was unwilling to add an amendment— one budget included Medicaid coverage and one did not, and we had not taken care of this beforehand— so we didn’t get in.

Continued work on the tax credit for practitioners in rural areas.  DOMs have worked in outlying areas and this is much needed.  Another issue is trying to open the insurance panels.

Saturday, October 26 1-4 pm for our fundraiser celebration of AOM Day and community outreach.

Thank you to Diane Polasky, who passed early this year and was her mentor and such an important part of our community.

Announcement from Van Warren:

Van worked for Public Health Acupuncture of NM as its program director, but has resigned and started his own acudetox program, which is awaiting approval by the BAOM. He would like for CADs to be able to join NMSAAM.

Note that CADs are indeed welcome to join NMSAAM as Associate Members.

Eric Zhao pointed out that the trend is that DOMs and other acupuncturists are doing more for public health over time, so it would make no sense to go backward and institute a lower level of licensure as others have requested in the recent past at the NM Legislative sessions.

Steve Malins, current treasurer, governance chair, and tech person:

We need to do brief annual reports to the IRS and NM to keep our nonprofit status, and these are done.

Prior to his tenure, budgets were not submitted, though finances were kept track of and the board was kept informed.  A budget is needed for future plans and nonprofits should always have them.

He added governance documents to the website, such as bylaws and committee charters.  He intends to add financial documents so that all members can see them.  There is a governance website, accessible from the website under Members Info.

We have a new membership management platform, Zeffy, which processes payments and keeps track.  This avoids PayPal fees and keeps us from being completely reliant on PayPal.  Steve plans to maintain our PayPal account as a fallback, though.

He will continue as an ASA delegate.

Governance:  All officers are also directors.
The state skills exam is “near and dear to his heart” and can be a contentious issue among DOMs.  It has been attacked at times.  During John Scott’s tenure as president, NMSAAM stated its position that the practical exam is necessary to protect our patients.  We are the only state which has a practical skills exam like this.  It has been found to be psychometrically sound— it tests what it is supposed to test.  Part of the reason we can justify our extensive scope of practice is the existence of this test.

A reason for a governance chair is to facilitate elections.  He has created an electronic ballot.  Nominations were received by email to governance@nmsaam.org, including self-nominations.  Candidates submitted letters of intent.  Floor nominations can also be made for open positions once votes for those candidates are taken.  The more people we have on our board, the more we can get done.  Explained e-ballot process and why it is better than Zoom polls— only members will receive the access code, and the e-ballot counts the votes, so no one running the election can see who voted for whom.  This can be done on a phone as well as a computer.  This process also keeps a record of results.

Election

Done by e-ballot.  Results:

President:  Yvette Arellano

Treasurer:  Steven Malins

Director, Immediate Past President: Yvonne Walston

Directors:  Caterina Di Palma, and Jake Wilcox (who is not here due to an emergency)

A VP and secretary are still needed.

Lobbyist presentation, Kim Legant and her assistant Skye Devore, and discussion:

Yvette summarized the past two legislative sessions re: acupuncture-only licensure bills.  In the 2024 session this was introduced as a dummy bill; it went nowhere largely because it was filed very late.  She reiterated that according to our practice act, we are primary care and can be covered by Medicaid, and that we can treat a wide variety of conditions, even potentially getting people back into the workforce.

Skye:  All members of the legislature are up for election this year.  There will be a vastly different composition of the legislature since so many members have retired.  As a group they are leaning more progressive.  So many members will be “drinking from a firehose.”  There is talk that if Harris is elected our governor may take a position in her administration.  We will need to educate new members and maybe a new governor.  A lot can only be done after the election, once we know who will be on which committees.

Human Services Department transformed into Health Care Authority this year, which changes how health care is administered.  Departments were consolidated into the HCA.  They will be meeting with Sec. Armijo of the HCA soon.

John asked what might happen with Health Security.  Kim replied, “It won’t happen all at once.”

Traditionally important bills tend to be pushed through at the end, with not that much happening for the first 30 days of a long session.

Bill tracking:  They have a system where they can plug in bills that are important to us and alert our point of contact, possibly a listserv, to actions that are needed.  This can be integrated with our website Members Only section if that looks like a good thing.  They need to know both what we are trying to stop as well as what we are advocating.

So far the issues they are aware of are the Medicaid budget inclusion and scope of practice/licensure; they ask whether there are other issues they should include.  Glenn asks for injectable lidocaine to be added back to our scope for expanded practice; John Ross has been working with NCCAOM on this. He offers to help with expanded practice issues, possibly a committee.  Yvonne summarized what expanded practice is for the lobbyists.  (Note: the upcoming BAOM rules hearing on 9/24 is intended to facilitate getting expanded practice classes going again.)  John said there is support for adding injection therapy back to the general (not expanded) scope with very basic training.

Brandon pointed out that all this is up to the legislature and BAOM has no control over it, and that very few DOMs have expanded licensure so that may not be a good use of NMSAAM’s limited resources.  Skye said they have worked with other industries where some minority of the membership had particular needs that weren’t true of the majority.  They would keep expanded practice issues in mind but not prioritize them at this time.

Brandon also noted for the lobbyists that any health insurance plan sold on the exchange must include at least 20 acupuncture visits per year, and this is true of most employer-based plans as well.  We are the only health profession where 900,000+ New Mexicans have no access.  He gave a brief history of what has happened in past years with our efforts to get Medicaid coverage.  In NM, the state only pays 20% of Medicaid costs and the feds pay 80%.  He explained the role of the governor’s advisory council in unanimously advocating for DOMs to be included as providers.  Acupuncture reduces opioid use.  HSD came to him and another DOM to say that DOMs are needed as Medicaid providers because of the lack of PCPs.  They ran a feasibility study and found that it would only cost about $7 million to provide acupuncture for all enrollees, a tiny portion of the budget, 0.035%.  Because of the discrepancies in different budget iterations, plus the death of our lobbyist, this did not move forward.

They are working on a legislative toolkit to give out to legislators.  This could use a QR code that legislators could use to access our website, but also quick bullet points to make it easy for them.  Legislators are bombarded by so many industries so we need to make it easy for them.  They would also like to tweak our website to make it easier for legislators to find the relevant information.

John noted the importance of reaching out to legislators’ staff.  Starting this year, all legislators will have one full-time staff person who will be in the districts doing constituent work.

Skye said they talk to analysts for both sides.

Budget process:  The agencies put together their budgets, then submit them to the governor.  The governor has her own budget.  The Legislative Finance Committee has yet another budget which may not include these.  Then House Appropriations does its work, then Senate Finance, then the Senate Floor.  A concurrence committee between the two houses hashes out a final deal.  They tell clients that it is necessary to be part of two of the above budgets and/or have House Appropriations member that want your thing to go through.

Kim and Skye agree that the state of NM is not in compliance with its own laws regarding inclusion of acupuncture in Medicaid (they may not understand the statutory language*).  But even if we are included in the 2025 budget and the governor signs, it would take at least a year to get a program going (as it has with the DCs).  An 1115 waiver must be submitted to CMS, which can take a year.

Glenn said that 30 years ago the DCs got wind of DOMs’ efforts and got themselves written into the bill, and the legislature balked at a mandate, *so that we have the language “may” fund instead of “shall” in the NMSA, which has allowed the state to keep us out.

Skye said that using language about being equitable has been effective.

Kim asked for Brandon to send them the documents relating to the governor’s advisory council.

Will it be possible to treat people at the Roundhouse again?  Kim and Skye will help facilitate that.  Raul Burciaga retired so we will be working with someone new.

There are 200 DOMs in Albuquerque on Tri-West and 63 in Santa Fe.  Caterina di Palma is the only one in Silver City and has had to turn away patients.

Herb update:

John reported that wealthy Chinese investors have been buying up herbs and driving up prices to where some herbs are almost impossible to access.  Drought and flooding have affected herb-growing areas.  Climate change has also been affecting herbs.  Xi Jin Ping has supported herbal medicine and put more land into cultivation, but some herbs will take years to mature.

We have herbs growing in NM but it’s a much smaller amount and won’t make up for the lack, and they can also be different because of different growing conditions.

CEU class given by Steve Malins
Distal Acupuncture Theory and Practice

• Steve sent out certificates to attendees and data to NCCAOM within a few days.
• Yvonne Walston notes that the 2 pda credits are now included in her NCCAOM transcript as of 9/22/2024.
• Yvonne said that several attendees reported that they will be trying some of the new-to-them point combinations.
• The class was stimulation for all, with good interaction.

Bylaws:

Addition of a vision statement and new wording for the mission statements were approved. The mission statement was shortened and the word “Oriental” was removed; “acupuncture and herbal medicine” used to harmonize with ASA and others at the national level.

Eric Zhao noted that “acupuncture and herbal medicine” will be more relatable to the world of biomedicine at UNM.

Voting: Currently bylaws do not allow for voting other than in-person, and some things can only be voted for at annual meetings.  Steve proposes that e-ballots could be used securely, limiting voting to those who are paid members, with voting running for perhaps 72 hours before the annual meeting.  Motion: The board may establish a procedure for electronic voting.

Meeting ended with the passing of the torch to NMSAAM’s new president, Yvette Arellano.

Note: Yvonne gives a massive thank you to Elene Gusch, who shared her thorough notes, thus supplying many details while Yvonne was presiding the meeting.