NMSAAM President Lindsay Meade, DOM and VP Steven Malins, DOM attended this meeting, which centered on the continuing efforts to create a new organization to represent acupuncturists on the national level.  They prepared the following report.

Delegates from 23 state associations met in Columbia, MD on March 13-14, 2015. Two major decisions were made at the meeting regarding the future direction of the profession. After brief discussion and a thorough review of the proposed bylaws, it was decided to move forward with the creation of a new corporate entity.

New National Organization
Following action taken at the 2014 AOML meeting and work done by the CSA executive committee, with input from state representatives, the CSA is on the verge of creating a new legal entity to represent our profession at the national level. The structure will be very similar to the consensus of the last meeting (March 2014) of the CSA: The proposal is a capitated per-member fee, as proposed in the Ideal Professional Association Vision from 2014. The fee is per organizational member, but it is up to each individual organization how they raise this money or distribute the cost to their members. This fee will be $500 per org and $5 per member for the first year.

A nominating committee for the new organization was also appointed. The nominating committee consists of:
1. Candance Sarges
2. Regina Walsh
3. Steven Malins
4. David Bock
5. Kimberley Benjamin
The CSA has requested a formal statement from each state society with their decision by May 1st.

Structure of National Organization
The proposed organization will have several key points regarding its organization. Only minor changes to the bylaws as presented to NMSAAM before the meeting are expected. The members of the organization will be state professional associations. The organization will have a “Council” which is composed of delegates from each member organization. The organization will also have a board of directors, which will handle the operations of the organization and decide how best to implement the policy decisions/directions made by the council.

Council of Delegates
As stated in the bylaws, the council shall be responsible for public policy and overall direction of the organization, providing guidance on strategic implementation of that policy to the board of directors, and have the authority to remove a board member by a formal vote. Also, the Council shall approve all fundamental transactions (amendments of the articles of incorporation or bylaws, mergers, membership exchanges, sales of all or substantially all of the assets, domestication, conversion, or dissolution of the Association) by the Board of Directors through a 2/3 vote of those present and voting at a properly-called meeting.

Board of Directors
The board of directors carries out the policy set by the council, and with advice and direction given by the council. One change to the bylaws was to increase the number of meetings required of the board. The proposed bylaws listed one in-person meeting per year; it was agreed to change this to meeting quarterly with one meeting per year required to be in person. The board of directors is appointed by the nominating committee, and approved by the council. This way of doing things, using a nominating committee and not having direct elections, is standard in association management. CSOMA, the California State Oriental Medical Association, uses a similar model. Jeff Glassie, the attorney that CSA hired to help draft the articles of incorporation, was very clear that this is a standard and accepted way for membership organizations to appoint a board of directors. A major consideration is that it prevents candidates, both incumbent and non-incumbent, from wasting time and effort on campaigning for votes.

Other Bylaws Discussions
Minor grammar and phrasing edits were proposed to the bylaws. An example  is rephrasing Article II Section 1 Subsection A to be inclusive of states that do not use the term “Licensed Acupuncturist.” There was some discussion of the membership requirements for member organizations. Several options were proposed:
● In order to qualify an organization must have the larger of 25 members or 10% of the licensed acupuncturists in their state.
○ This would disqualify some current members of the CSA, including NMSAAM.
○ It was proposed to allow current members of the CSA to be grandfathered in.
Discussion then centered around how to include current members of the CSA with this requirement. Options were:
● Include them by name, either directly or by a proviso to the bylaws.
● Include language to the effect of “all current members of the CSA will be considered founding members and automatic members of” the new organization.
● Leave it out, as Jeff assured us we could legally include members at the beginning that didn’t meet the requirements to join.
It was decided to leave the requirements as written. This means that to join, an organization needs 25 members OR 10% of the acupuncturists in their state. The other requirement to join is approval of ⅔ of the council at a proper meeting. This was deemed sufficient to prevent frivolous organizations joining.

Business Plan
Prior to the meeting, Lindsay and Steve received the business plan that was produced with the money NMSAAM and other organizations pledged, as outlined in the proposal we approved at our phone meeting in February.  After this meeting there will be updates to the business plan. Some input was given at the meeting, and further will be given over email to the executive committee of the CSA.

Funding the New Association
The business plan as presented called for $500/yr per organization member and $50/professional member of the organization. For example, NMSAAM would pay $2,300 ($50/member x 36 members + $500). Many of the larger state associations, specifically ASNY and CSOMA, objected that they would not be able to afford that. Each of these organizations has over 300 members. In light of this, it was decided that the CSA would ask each organization for $500 + $5 for each professional member. This is initial startup money, and the fees are expected to increase as needed to fill the budget of a national association. The business plan is going to be revised to reflect this funding for the first year.

Name of the New Organization
Many issues surrounding the name of a new organization were discussed. No definite name was decided upon, but the following guidelines had broad, if not unanimous, consensus:
● The name should include the words “United States.”
○ This designates a region for dealing with other international organizations.
○ It also reflects the fact that it is a organization of united state associations.
● The name should not include the words “Oriental” or “Chinese.”
○ These words are offensive to large portions of the Asian population of the US. Further, many of these individuals are practitioners of our medicine.
○ Some states, notably NY, forbid registering businesses with the word “Oriental” in them. Jordan Barber, from NY, is going to put the CSA executive committee in touch with a professor of Asian studies who is active in Asian communities. Jordan assures us that if we can pick an appropriate name, we can gain the support of several ethnic communities.

Relations with the AAAOM
During the past year since the 2014 CSA meeting, the CSA executive committee has been in negotiations with the AAAOM leadership. Some of these discussions were mediated by a group of past AAAOM presidents and leaders in the profession. David Miller, CSA chair, reported that these negotiations ultimately broke down. A question was raised about how much more effort should be spent trying to dialogue with the AAAOM. It was a unanimous vote of those present that further discussion with the AAAOM will be at the Executive Committee’s discretion, with the understanding that the CSA will proceed with its plans to form a new legal entity. (See more about this in David Miller’s report, which includes some discussions at the AOML).

CPT Codes
The AMA, American Medical Association, is the owner of the CPT codes. Up until now, acupuncturists have not been included in the discussion of adding/changing CPT codes. PTs and other professions interested in dry needling or acupuncture are involved in the process. The AAAOM was asked to participate in 2011, but nothing of substance happened and no acupuncturists were included on committees. Past NMSAAM president and current CSA vice-chair Eric Buckley has been working to get acupuncturists on the committee for changing/adding CPT codes. He has been doing this through NCCAOM. The reason is that AAAOM has not acted in a timely manner and that in order to be included an organization must represent >= 50% of professional members. The main issue is third-party verification of the number of acupuncturists in the US. One effort that will help with this is the addition of “Acupuncturist” as a job designation with the Bureau of Labor Statistics (BLS).

BLS Designation
The NCCAOM has been working to get “Acupuncturist” as an official job title designation with the BLS. This will have several benefits:
● Allow third party tracking of income/jobs/etc.
○ This would satisfy requirements of the AMA to get us on the sub-committee for CPT codes
● May help with other legislative efforts on the state and national level in the future.
The status of the NCCAOM effort can be found at the NCCAOM BLS page.

Dry Needling
There was much discussion on March 13th about dry needling and the best way for our profession to respond. Over the past year CSA leadership, Eric Buckley, David Miller, and the CSA allied health committee, have been working with NCCAOM to develop minimum standards for training for other professions doing filiform needling.
NCCAOM thinks the first step is a job task analysis to determine what tasks other professions, e.g. PTs, are performing in relation to filiform needling and what they need to be capable of. The PTs are not convinced that they need to work with acupuncture associations at all. This is an area where a strong national association would be very helpful.
Many states are dealing with dry needling on a state level. Some states have had success defeating dry needling efforts via court action. Others have had success blocking rule changes by the PT board, though this avenue seems to be less effective. Several states have had decisions against dry needling, but PTs and others continue to practice it. Regulation and health departments have been reluctant to get involved despite clear decisions against dry needling.
To emphasize that a national organization is needed in this fight: the PT national organization has been sending threats of lawsuits to acupuncture regulatory boards should they take action against PTs doing dry needling.

Presentations by Other National Organizations
The CSA heard presentations by other national organizations, some which address other professions besides acupuncturists.

Acupuncture Now Foundation
The Acupuncture Now Foundation is a 501(c)3 organization that exists to “elevate acupuncture’s impact on easing suffering and enhancing health through accurate information about its best practices.”
● Cannot lobby because it is a 501(c)3.
● International organization that works to promote safe acupuncture in all countries.
● Promotes acupuncture by any appropriately trained individual, but acknowledges acupuncturists in the US as having the most training in acupuncture of any profession.
● Is looking to raise significant capital in the near and long term to promote advocacy and education.

Integrative Healthcare Policy Consortium
The Integrative Healthcare Policy Consortium is a national organization with the mission to “advocate for an integrative healthcare system with equal access to the full range of health-oriented person-centered regulated healthcare professionals.”
● Not just for acupuncturists; also includes chiropractors, naturopaths, massage therapists, and others.
● NCCAOM has recently joined IHPC as a “Partner in Health.”
● Advocacy campaigns regarding clause 2706 of the ACA which requires insurance to pay any provider for a service that is covered.
○ For example, if they cover acupuncture done by an MD then they have to cover it when done by an LAc as well.
○ Has been somewhat successful with postcard campaigns to insurance commissioners.
● Is producing a booklet on cost effectiveness of various therapies to be used for marketing to insurance companies.
○ Will include acupuncture and Oriental medicine, with good data on cost effectiveness.

National Center for Acupuncture Safety and Integrity
The National Center for Acupuncture Safety and Integrity is a volunteer-run national project focused on protecting the public and promoting the safe and effective use of acupuncture through education.
● Has produced a “Fact Sheet” with 10 facts, which is very critical of dry needling.
○ CSA PR committee chair Lindy Camardella spoke with one of the leaders of NCASI. Responding to questions, she brought up the following takeaway points about the fact sheet:
■ Acupuncture should be defined as surgery. It does penetrate the skin and the underlying structures. Training and education for this should be higher than for simple “procedures” or “techniques.”
● It is described as such in China.
● Most PT practice acts prohibit the practice of surgery explicitly.
■ In China acupuncture is one part of the practice of medicine.
● Most PTs are prohibited from practicing medicine (i.e. diagnosing and deciding on appropriate treatment).
■ PTs claim that wearing gloves makes them safer/cleaner.
● CNT is more than sufficient to ensure safe, surgical insertion of a filiform needle.
● Many PTs wear gloves, but do not establish a clean field, nor change gloves between patients.
■ PTs claim that acupuncture is affecting qi and not designed to affect physical structures of the body. This is simply incorrect. Many classical texts show an understanding of anatomy and underlying structures. Many points are located via landmarks of gross anatomy.

NCCAOM gave a short presentation and update of their organization and standards. NCCAOM does a lot to help state associations, and they have recently updated their mission to include more support for diplomates. Highlights of the presentation included:
● NCCAOM’s mission is to provide certification of entry-level competence for the practice of acupuncture and oriental medicine.
○ All NCCAOM certification programs for the AOM profession are accredited by the Institute for Credentialing Excellence’s (ICE) National Commission for Certifying Agencies (NCCA).
● NCCAOM has several national policy initiatives.
○ The main one is BLS inclusion.
○ Others include letters of support for national legislation and providing demographic and clinical practice information to other national organizations and insurance providers.
● Changes are coming to standards for re-certification/CEUs.
○ Can now gain 4 PDAs for self-directed learning
■ Helping with efforts to increase research literacy among acupuncturists.
○ 2015 will require CPR
○ 2016 will now require:
■ 2 PDAs in safety
■ 2 PDAs in ethics
● Unlicensed states:
○ ND, SD, WY, KS, OK, AL do not have licensure or certification for acupuncturists/acupuncture.