TALLAHASSEE, Fla. - Florida physical therapists cannot offer “dry needling” procedures to their patients, a state judge ruled Monday in a legal challenge filed by a group representing acupuncturists.
Administrative Law Judge Lawrence P. Stevenson issued an order rejecting a proposed rule by the Florida Board of Physical Therapy that set minimum standards for physical therapists to use dry needling. Stevenson said the proposal exceeded the Board of Physical Therapy’s “grant of rulemaking authority because it would expand the scope of physical therapy practice, not merely establish a standard of practice.”
The order can be appealed to the 1st District Court of Appeal in Tallahassee.
Tad Fisher, chief executive officer of the Florida Physical Therapy Association, said Monday he was still reviewing the order with his attorneys and that he wasn’t sure if the association, which formally intervened in the case, would appeal.
Dry needling is the name physical therapists use to describe a technique of inserting filiform needles into the skin at various “trigger points,” which causes certain responses. Filiform needles --- which are used for acupuncture --- are solid. They cannot be used to inject substances or medicine, hence the word “dry.”
Physical therapists in more than 30 states practice dry needling, but it is not authorized by law in Florida.
The Florida Board of Physical Therapy initially published the proposed rule last year. It was pushed in part by the Florida Physical Therapy Association, which touted dry needling as a possible alternative that patients could seek for chronic pain management.
The proposed rule called for allowing physical therapists to perform dry-needle techniques so long as they had taken courses recognized by the Commission on Accreditation in Physical Therapy Education, the American Physical Therapy Association, the Federation of State Boards of Physical Therapy or any branch of the United States Armed Forces.
The Florida State Oriental Medical Association, which represents acupuncturists, challenged the proposed rule in the state Division of Administrative Hearings arguing, among other things, that the proposal modified existing law and that it was vague and capricious.
Stevenson agreed with the Florida State Oriental Medical Association that the Board of Physical Therapy expanded state law by passing the rule.
Stevenson said that “dry needling meets the definition of acupuncture in Florida law because it involves the insertion of acupuncture needles” into specific areas of the body.
He noted that the law generally bans physical therapists from performing acupuncture, allowing it only when “no penetration of the skin occurs.”
The Florida State Oriental Medical Association had an announcement on its website Monday afternoon saying “WE WON!!! The Dry Needle Challenge.”
By Christine Sexton, The News Service of Florida
Posted: 5:22 PM, January 28, 2019
NOT-AT-19-005: Notice of Intent to Publish a Funding Opportunity Announcement for Pragmatic Randomized Controlled Trial of Acupuncture for Management of Chronic Low Back Pain in Older Adults (UG3/UH3, Clinical Trial Required) - grants.nih.gov
NIH Funding Opportunities and Notices in the NIH Guide for Grants and Contracts: Notice of Intent to Publish a Funding Opportunity Announcement for Pragmatic Randomized Controlled Trial of Acupuncture for Management of Chronic Low Back Pain in Older Adults (UG3/UH3, Clinical Trial Required) NOT-AT-19-005. NCCIH
2018 Acupuncturist Profession Landmarks in Focus
American Association of Acupuncture and Oriental Medicine - Public Policy Committee
· The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) implements a reciprocity process for individuals who have passed the California Acupuncture Licensing Exam (CALE).
· The SUPPORT for Patients and Communities Act contains budget provisions targeting populations harmed by the opioid epidemic, and is signed into law on October 24 by President Trump.
· Licensed acupuncturists register with System for Award Management (SAM) to submit capacity statements, bid for 2019 government contracts, and apply for small business grants.
· The profession is regulated in 47 states,with clearly defined educational, credentialing, and practice standards. Senator Rader introduces the Oklahoma Acupuncture Practice Act, national acupuncture special interest groups unify in support of this legislation, and the AAAOM formally endorses the bill in December. ,
· Self-payer access to acupuncture increases through utilization of incentives such as IRS medical expense deductions, Flex Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement arrangement (HRA).
· Acupuncture becomes available in some Medicare Advantage Plans while insurance companies increase beneficiary access to acupuncture, in alignment with the 9/2017 National Association of Attorneys General request that the American Health Insurance Plans prioritize member incentives for non-pharmacological pain management options.
· Medicaid beneficiaries access acupuncture care in nine states: California, Maryland, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Rhode Island, and New Jersey. Medicaid pilot programs are underway.5 Medicaid directors urge use of nonpharmacological methods, such as acupuncture, to “bring about a reduction in prescription drug abuse and overdose, resulting in an overall reduction in healthcare expenses and an improvement in health outcomes of beneficiaries.”
· Designated as an Essential Health Benefit (EHB) since 2014 in six states (California, Alaska, Maryland, Massachusetts, New Mexico, Washington) and four territories (American Samoa, Guam, North Mariana Island, Virgin Islands), acupuncture meets at minimum five of the EHB criteria and service categories of care: ambulatory patient services, maternity/infertility, mental health and substance use disorders services, rehabilitative services, preventative wellness, and chronic disease management.21
 H.R.2839: Acupuncture for Heroes and Seniors Act of 2017. https://www.congress.gov/bill/115th-congress/house-bill/2839
 The Joint Commission. R3 Report. https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FINAL.pdf
 Gale M, Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP). Meridians. 2016; 3(4): 11-16.
 “Rx Pain Medications, Know the Facts, Managing Your Pain: Which Approach is Right for You?” DHSS, CDC, SAMHSA. https://store.samhsa.gov/system/files/sma17-5053-1.pdf
 Executive Office of the President of the United States. Standard Occupational Classification Manual. 2018. https://www.bls.gov/soc/2018/soc_2018_manual.pdf
 S 2372: The VA MISSION Act of 2018 https://www.congress.gov/bill/115th-congress/senate-bill/2372/text
 HR 6: SUPPORT for Patients and Communities Act https://www.congress.gov/bill/115th-congress/house-bill/6
  Department of the Treasury Internal Revenue Service. Publication 502 Medical and Dental Expenses. December 01, 2017: 5. https://www.irs.gov/pub/irs-pdf/p502.pdf
 Retrieved online [1/2/2019] https://fsastore.com/FSA-Eligibility-List/A/Acupuncture-E7.aspx
 Corbet, Michelle, “BlueCross removes Oxycontin, addes acupuncture amid opioid crisis,” Daily Memphian, 26 December 2018.
 Bathurst R, Valentine-Davis B, Williamson T, “Acupuncture and the Oklahoma Budget Crisis: Self Regulation and Workplace Inclusivity of Acupuncturists Relieves Healthcare Costs, Provides Recurrent Revenue, and Protects the Public.” OKAA. August 9, 2017. http://www.okacupunctureassociation.org/
 Marsh & McLennan Companies. State Medicaid Interventions for Preventing Prescription Drug Abuse Overdose: A Report for the National Association of Medicaid Directors. National Association of Medicaid Directors. 2014.
· In alignment with the profession’s 2009 Consensus Conference, Congresswoman Judy Chu champions the American Association of Acupuncture and Oriental Medicine (AAAOM) historic federal bills within the United States Congress as the “Acupuncture for Heroes and Seniors Act of 2017-2018” and the “Acupuncture for our Heroes Act of 2017-2018” with aim to expand qualified acupuncturist services to veterans, military, seniors, disabled, and more.
· Pain assessment/management standards for Joint Commission-accredited hospitals, implemented in January, include provisions for nonpharmacologic pain treatment provided by Licensed Independent Practitioners such as Licensed Acupuncturists.
· Acupuncture is promoted as a pain treatment in government agency patient education materials where it is described as “a practice that involves the stimulation of specific points on the body, usually through the insertion of thin needles into the skin.”
· The Veterans Health Administration (VHA) publishes occupational requirements in February for GS 9-13 licensed acupuncturist positions (supervised/independent/supervisory/administrative). Throughout the year, federal job openings are posted online.
· The Standard Occupation Classification Manual, containing the profession’s new and distinct standard occupation code (SOC) “29-1291 Acupuncturist,” is released in March by the Executive Office of the President, Office of Management and Budget.
· Terminally ill patients gain the “Right to Try” experimental treatments as S.204 is signed into law by President Trump in May.
· President Trump signs the VA MISSION Act of 2018into law in June to “consolidate the VA’s community care programs into a new Veterans Community Care Program.” Qualified acupuncturists credential as vendors with local VA facilities.
· The Federal Student Aid office implements the Public Service Loan Forgiveness (PSLF) tool available for individuals working for qualified employers: government organizations (federal, state, local, tribal) and certain 501(c)(3) organizations.
· Professional non-degree and post-graduate degree programs, accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) include: Certificate, Master, and Doctoral levels.
H.R.2839: Acupuncture for Heroes and Seniors Act of 2017. https://www.congress.gov/bill/115th-congress/house-bill/2839
The Joint Commission. R3 Report. https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FINAL.pdf
The AAAOM visited with the legislature in Washington D.C. on September 27th-28th, 2018.
AAAOM president Carlos Chapa and others joined the American Alliance of Acupuncture (AAOA) to support the federal bill of H.R. 6110, Dr. Todd Graham Pain Management, Treatment, and Recovery Act of 2018. This was introduced by Reps. Judy Chu (CA-27) and Jackie Walorski (IN-02), and has been combined with H.R.6. It was then added to H.R.1099 which had been approved by both House and Senate and then signed by the President. The bill directs the Centers for Medicare and Medicaid Services to study barriers to accessing non-drug alternatives to opioids. Acupuncture as a safe and effective alternative treatment is included.
A sincere thank you to those who helped make this happen.
The AAAOM attended AOMA's annual Symposium in Austin, TX.
A special thanks to the president of AOMA and to the teachers, faculty and students who spoke with us and expressed their concerns and ideas about the profession.
The AAAOM will be at the 2018 AOMA Southwest Symposium. The event will take place September 21-23, 2018.
Southwest Symposium is an annual event held in Austin, TX, which provides informative and educational seminars for people in the health care profession. This conference brings together the diverse community of health care providers from fields across the spectrum. We are proud to provide acupuncturists, Asian bodywork therapists, naturopaths, herbalists, and nurses with educational seminars from qualified and fascinating educators. Our presenters provide a truly engaging experience, which help our attendees deepen their knowledge of health and patient care, taking their practice to an even higher level of excellence. The presentations we offer for Southwest Symposium are always accredited through NCCAOM for continuing education credits.
Come talk to the acupunturists of the AAAOM who represent the profession. Learn firsthand about our upcoming events and legislative activity.
For more information:
2017 Acupuncturist Profession Landmarks in Focus
American Association of Acupuncture and Oriental Medicine Public Policy Committee
· The Wyoming Acupuncture Practice Act is signed into law by Governor Matthew Mead in March.
· The profession is regulated in forty-seven states, with clearly defined educational, credentialing, and practice standards. Acupuncturists prepare for introduction of legislation in the three states without practice acts: Alabama, Oklahoma, and South Dakota.
· Clean Needle Technique Manual 7th Edition 2017 Revision is released by the Council of Colleges of Acupuncture and Oriental Medicine. The manual defines “safety standards and best practices applicable to any healthcare practitioner who uses a filiform needle or related techniques.” 
· The Kansas Acupuncture Practice Act of 2016, effective July 1, 2017, statutorily defines acupuncture as “needle insertion…for the…correction of any abnormal physiology” and the “practice of acupuncture” to be inclusive of techniques called “dry needling…and similar terms,” in alignment with national association dry needling position statements.[5,6,7,8,9,10,11]
· Medicaid beneficiaries have access to acupuncture care in nine states: California, Maryland, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Rhode Island, and New Jersey. Medicaid pilot programs are implemented in other states and Medicaid directors urge use of non-pharmacological methods, such as acupuncture, to “bring about a reduction in prescription drug abuse and overdose, resulting in an overall reduction in healthcare expenses and an improvement in health outcomes of Medicaid beneficiaries.”
· Acupuncture is designated as an Essential Health Benefit (EHB) in six states (California, Alaska, Maryland, Massachusetts, New Mexico, Washington) and four territories (American Samoa, Guam, North Mariana Island, Virgin Islands) since 2014. Acupuncture meets, at minimum, five of the EHB criteria and service categories of care: ambulatory patient services, maternity/infertility, mental health and substance use disorders services, rehabilitative services, preventative wellness, and chronic disease management.
· Veteran access to temporary acupuncture care increases[14,15] as President Donald Trump, Congress, and the United States Department of Veteran Affairs take action to replenish VA Choice Program funds.[16,17,18]
· Congresswoman Judy Chu re-introduces the American Association of Acupuncture and Oriental Medicine (AAAOM) historic federal bills to the United States Congress in June as the “Acupuncture for Heroes and Seniors Act of 2017-2018” and the “Acupuncture for our Heroes Act of 2017-2018” with aim to permanently open access to qualified acupuncturists to veterans, military, seniors, disabled, and more (beneficiaries of VHA, TriCare, Medicare), in alignment with the profession’s consensus conference of 2009.
· The Joint Commission releases the R3 Report detailing new and revised pain assessment and management standards applicable to Joint Commission-accredited hospitals, effective 1/1/18. Standards include the provision of non-pharmacologic pain treatment by Licensed Independent Practitioners, such as Licensed Acupuncturists.[20,2]
· The National Association of Attorneys General request in September that the American Health Insurance Plans prioritize member incentives for non-pharmacological pain management options, such as acupuncture,21 in response to President Donald Trump’s opioid emergency declaration in August.
· Clinically relevant real-world acupuncture efficacy studies increase.
· The IRS provides detailed instructions to self-payers in December for deducting acupuncture as a medical expense on 2017 income tax forms.
1 Wyoming Acupuncture Practice Act 2017 http://legisweb.state.wy.us/2017/Enroll/HB0165.pdf
2 Gale M, Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP). Meridians. 2016; 3(4): 11-16.
3 CCAOM. Clean Needle Technique Manual 7th Edition. http://www.ccaom.org/downloads/7th_Edition_Manual_English_June_2017.pdf
4 Kansas Statutes Annotated and Administrative Regulations Pertaining to those Professions Licensed and Regulated by the Kansas State Board of Healing Arts. January 2017: 282.
5 AAAOM Position Statement on Trigger Point Dry Needling and Intramuscular Manual Therapy. 2013. http://aaaom.wildapricot.org/resources/Documents/AAAOM-Dry-Needling-Position-paper%20(1).pdf
6 American Academy of Medical Acupuncture.® AAMA Policy on Dry-Needling. 2017. http://www.medicalacupuncture.org/Portals/2/PDFs/DryNeedlingPolicyMar2017.pdf
7 American Academy of Physical Medicine and Rehabilitation. AAPM&R Position on Dry Needling. 2012.
8 American Medical Association. Dry Needling is an Invasive Procedure. 2016. https://policysearch.ama-assn.org/policyfinder/detail/dry%20needling?uri=%2FAMADoc%2FHOD-410.949.xml
9 National Certification Commission of Acupuncture and Oriental Medicine. NCCAOM® and the NCCAOM® Academy of Diplomates Dry Needling Position. 2017. http://www.nccaom.org/wp-content/uploads/pdf/NCCAOM%20Dry%20Needling%20Position%20Statement.pdf
10 Council of Colleges of Acupuncture and Oriental Medicine. Position Paper on Dry Needling. 2011.
11 Fan AY, Xu J. Li YM. Evidence and expert opinions: Dry needling versus acupuncture (III) – The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med. 2017 Mar 23(e):163-165. https://www.ncbi.nlm.nih.gov/pubmed/28243825
12Bathurst R, Valentine-Davis B, Williamson T. Acupuncture and the Oklahoma Budget Crisis: Self Regulation and Workplace Inclusivity of Acupuncturists Relieves Healthcare Costs, Provides Recurrent Revenue, and Protects the Public. OKAA. August 9, 2017. http://www.okacupunctureassociation.org/
13Marsh & McLennan Companies. State Medicaid Interventions for Preventing Prescription Drug Abuse Overdose: A Report for the National Association of Medicaid Directors. National Association of Medicaid Directors. 2014.
19 H.R.2839: Acupuncture for Heroes and Seniors Act of 2017. https://www.congress.gov/bill/115th-congress/house-bill/2839
20 The Joint Commission. R3 Report. https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FINAL.pdf
22 Oliphant J. Trump Declares National Emergency on Opioid Abuse. Reuters. Accessed August 10, 2017.
23 Carter K, Olshan-Perlmutter M, Martini J, Cairns S. NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment. Behavioral Sciences. 2017. 7(2); 37. https://doi.org/10.3390/bs7020037
24 Department of the Treasury Internal Revenue Service. Publication 502 Medical and Dental Expenses. December 01, 2017: 5. https://www.irs.gov/pub/irs-pdf/p502.pdf
We were deeply saddened to hear of the passing of Dr. Deke Kendall. While most of our generation of practitioners were not aware of his contributions to the field, we would do well to be informed and grateful for the work of Dr. Kendall. He was primarily a leader in the modernization of how Chinese Medicine was viewed through a biomedical lens. He was controversial to most, but introduced important ways of thinking and seeing that didn't exist in literature in any substantive way before. Rest in peace Dr. Kendall. You will be remembered and honored.
Donald "Deke" Kendall 1930-2017.
A legend in the field of Chinese Medicine passed away on September 22, 2017, after a lifetime of contributing to the field. Donald "Deke" Kendall lived a full life and was loved and admired by many. Below is the eulogy of his friend and colleague, Steven Stumpf, honoring the legacy Deke left behind. For more information about Deke, his life, and/or to leave a message to the family, a memorial will be held on October 21, 2017; follow this link for more details: http://www.never-gone.com/Memorials/Default.aspx?m=DpDswusIT6U0ie4nEr2A%2bQ%3d%3d
Honoring Deke Kendall, by Steven Stumpf:
"Donald “Deke” Kendall was an aerospace engineer. When I suggested he was a rocket scientist he laughed. Like so many healthcare providers he entered the world of medicine looking for a solution to his own health concerns. This is a common phenomenon. We are often inspired by events – frequently unexpected – that change our lives. Deke found health in Chinese medicine. He decided to look further. He learned to speak and read Chinese so he would be able to read the "classics." He looked at TCM from the perspective of a scientist. He assumed nothing. He vetted everything. He concluded that this ancient approach to diagnosis, treatment and mechanism of action was profoundly misrepresented in the popular TCM literature. He wrote a book - The Dao of Chinese Medicine - that to this day is one of a kind; a treatise on Chinese medicine and especially acupuncture that places the practice squarely in the medical mainstream. He accomplished two of his principal goals: (1) establishing that acupuncture efficacy was the result of an interaction between the cardiovascular and neurological systems, and (2) that the ancient Chinese physicians discovered this principle along with the longitudinal organization of the body, the function of blood flow, and much more.
Deke was a fighter. His theories and his book were considered heretical. As a scientist, Deke chose to fight for his views on the basis of observable anatomy and theory driven medical mechanisms. His book was roundly ignored. However, Deke could not be ignored. He found an excited group of acupuncture providers who understood he had provided evidence and practical theory to understanding what these practitioners practiced. For this group of students and licensed practitioners Deke provided answers to their questions and a path towards intelligent practice.
More than ten years ago I hired Deke to lecture to a group of doctorate students at Emperors College. I did not know him; I only knew of him. My doctorate students told me his book was banned and his theories were blasphemous. I suggested these notions were hardly in tradition of educational inquiry. Deke agreed to lecture under the condition that I understand the risk I was taking. Huh? “Steve – you know you will be fired for this.” I laughed. He was right. We continued our relationship which became a friendship. We published two academic papers together; both about topics that ran against the grain for the acustablishment. On this point we absolutely stood together: acupuncture belongs in the medical mainstream. It is a modality that needs to be recognized. It fits with modern medical theory and should be utilized as the first – not the last - option in numerous illnesses and injuries. In recent years Deke finally grew weary of fighting for this cause. Fortunately, he inspired too many students and associates who continue to follow his lead."
Steven H. Stumpf, Ed.D. email@example.com 818-571-3930 http://stevenstumpf.com
Deke Kendall, you will be missed!! With love, AAAOM
"American Association of Acupuncture and Oriental Medicine" is a 501(c)6 non-profit organization.
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