UPDATE: Insurance Coverage for Integrative Healthcare Services in 2014

Section 2706 of the Affordable Care Act prevents health insurance plans from capriciously excluding a range of integrative health practitioners from coverage, based solely on licensure. The law empowers patients to obtain care from any licensed provider in a state for a specific benefit covered through an exchange health plan. Specifically, this includes licensed naturopathic doctors, acupuncture and Oriental medicine practitioners, midwives, chiropractic doctors and massage therapists.

Recently Integrator Blog publisher-editor John Weeks wrote a post that included the following news and commentary. Weeks, a writer, organizer, executive and consultant in the field of integrative healthcare for 29 years, is also executive director of ACCAHC. He approved this re-posting.

HHS Secretary Sebelius Pushes to Enforce Integrative Health Practitioner Non-Discrimination Language in Affordable Care Act

In his useful Health Insights Today, educator and journalist Dan Redwood, DC recently published a useful review entitled Provider Nondiscrimination Update. The most significant segment is this: “In December 2012, we saw the first HHS regulatory language specifically referencing the nondiscrimination policy of Section 2706. Included in its extensive rule-making on requirements for coverage in ‘multi-state’ health insurance policies that will be available on the new healthcare exchanges starting in 2014, HHS unambiguously noted that all such insurance policies must be in compliance with Section 2706.

Redwood adds: “While this marks a key milestone regarding regulation of multi-state plans (which are just one of many types of insurance plans that will be sold through the exchanges), it more importantly demonstrates that 2706 is on the HHS radar screen and that Secretary Kathleen Sebelius and her department intend to follow the law and require states to do so as well.” The newsletter is published through Cleveland Chiropractic College. The Non-discrimination language of the Affordable Care Act is here.

Guild Urged to Fight for Prejudice: AMA House of Delegates Reiterates Interest in Continuing to Foster Discrimination and Prejudice Against Certain Healthcare Providers

During its interim meeting in Honolulu, Hawaii on November 9-11, 2012, the AMA House of Delegates re-affirmed its opposition to the non-discrimination clause, Section 2706, of the Patient Protection and Affordable Care Act. No current lobbying effort is apparently underway: “At this time, no specific lobbying effort to repeal Section 2706 has been initiated. This is due to the lack of willingness by Congress to enact necessary improvements in the ACA at this time. The AMA will continue to closely monitor this issue and work to identify opportunities to repeal Section 2706.” The AMA’s House enacted amendments to their policy H-35.968 that opposes the section. These include recommendations to “create and actively pursue legislative and regulatory opportunities to repeal the so called ‘Non-discrimination in Health Care’ clause” and “lead a specific lobbying effort and grassroots campaign in cooperation with members of the federation of medicine and other interested components of organized medicine to repeal the provider portion of PPACA’s ‘Non-Discrimination in Health Care’ language”. They asked the AMA Board of Trustees to report back at the 2013 AMA Annual Meeting.

Weeks’ Commentary

Redwood’s report is good news. However, the reading of the HHS memo by some others is a message that this issue will remain in low profile, perhaps because the section continues to be a subject of discussion at the American Medical Association’s House of Delegates.

And the war, as the singer Donovan sang it in the mid-1960s, drags on … I wonder which grassroots they are referring to. Will it be a patient-centered campaign for a march on Washington to demand that fellow citizens be denied the right to services? No, likely they are talking about an effort in which the grassroots will not be patient-centered but MD-centered, focusing on the 17% of medical doctors that are still AMA members. I picture the tendrils of those “grassroots” reaching down into a hydroponic mix that has been starved of connection with patients for two decades.

Sabin’s Commentary

With the hopeful assumption that the provider portion of PPACA’s “Non-Discrimination in Health Care‟ language stays intact, it will be interesting to see what practitioner reimbursements will actually look like through payers. Insurance coverage is spotty across the country for some of these services, and many practitioners work under a direct pay model. Some provide super bills for patients to submit to payers to get some level of reimbursement, though typically not enough to cover the full costs.

Consumers in theory should have more access to integrative services through their health insurance plans, but the economic impact on providers—hospital-based and small private practices alike—is yet to be known.