Unfortunately, nurse practitioner, physical therapy, marriage and family therapy, and other “conventional” health care practitioner organizations have allied with the IHPC, the American Association of Naturopathic Physicians, the American Chiropractic Association and the American Association of Acupuncture & Oriental Medicine to push for greater insurance coverage of their services, in an organization called the Coalition for Patients Rights (CPR).
The ACA requires insurers to cover certain “essential health benefits,” or “EHBs,” such as maternity care and an annual wellness exam.
Section 2706 was intended to prohibit exactly these types of discrimination.
[Emphasis added.] In other words, unless insurers could point to some performance or quality data allowing them to exclude reimbursement to chiropractors, naturopaths, acupuncturists or the like for services covered by a health plan, refusing reimbursement would violate the ACA.
As former American Association of Naturopathic Physicians Board member and Vermont naturopath Loirlee Schoenback, sunnily predicted: suggest[s] that if insurers cover a health condition, they must pay any providers are licensed to treat that condition.
If the insurer covers a service provided by medical doctors . ., for example, it must also cover that service when provided by another legal provider, such as NDs, acupuncturists or chiropractors.
Unfortunately, one of those is Section 2706 of the ACA (42 U. It adds that it is not an “any willing provider” law and that varying reimbursement rates can be based on quality or performance measures, a subject we’ll return to in a moment.
I have argued that forcing insurers to cover providers they would not otherwise choose to include is at odds with the ACA’s emphasis on cost-effectiveness and evidence-based practice.
The Affordable Care Act (ACA, or “Obamacare”) says “yes” and the American Health Care Act of 2017 (AHCA, but apparently not “Trumpcare”), recently passed in the U. House of Representatives by a narrow margin, agrees.Of course, “performance or quality” data is notoriously lacking on CAM practices, leaving insurers in a precarious predicament: If this hard performance or quality data justifying the exclusion of CAM practitioners from providing covered services didn’t exist, would they be forced to pay up just because some state legislature had foolishly passed a licensing bill giving chiropractors, naturopaths or acupuncturists a broad scope of practice?The Senate Committee’s rebuff led HHS to issue a request for public comment on “all aspects of interpretation” of Section 2706, which drew over 1,500 comments.Back in 2013, the Department of Health and Human Services (HHS) issued guidance on just what was to be expected of insurers under Section 2706. The goal of this provision is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State.According to HHS, insurers would be allowed to use: reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service . The Committee is therefore concerned that the FAQ document issued by HHS …