ACR chapters are often the only voice for radiology at the state and local level. One of the primary purposes of any chapter is to represent the interests of their members before government. OSRS membership provides the representation necessary to effect federal and state legislation and regulations. Almost all of the managed care legislation and healthcare reform issues are being dealt with at the state level. Much of the policy for Medicare and Medicaid reimbursement is also determined at the state level with direct input from the chapters. Through the ACR’s facilitation, chapters have Medicare Carrier Advisory Committee representatives that make sure that federal policy is implemented with radiology’s input. The ACR has also developed a managed care committee with each chapter to assure that each state learns from the experiences of others in this arena. Over half of the chapters have hired lobbyists to assist them with state legislation and regulations while almost all chapters have a government relations committee dedicated to monitoring state and local action affecting the practice of radiology.