Amidst the long-running debate over the Affordable Care Act (ACA) and the most recent congressional stalemate, one potentially groundbreaking piece of the law has evaded the limelight: Section 2706, titled “Nondiscrimination in Health Care.”
This largely overseen piece potentially paves the way for commercial insurance to pay for nontraditional types of caregivers; yet it has not hit the radar screen of many insurers, business associations, human resources professionals and even practitioners of complementary and alternative medicine (CAM).
Effective Jan. 1, commercial insurers, including employer-sponsored plans, are not to “discriminate against any health care provider who is acting within the scope of that provider”™s license or certification under applicable state law.”
Although most people realize that ACA, commonly referred to as Obamacare, will expand health care coverage to many previously uninsured citizens, what is less well known is that it will bring new types of practitioners into insurers”™ networks. Nontraditional, but licensed professional providers in New York such as acupuncturists, chiropractors and massage therapists, who are often not reimbursed through commercial insurance, soon may be.
For example, if you live in New York and suffer from low back pain and have commercial insurance, you might have the option to seek treatment from an acupuncturist, a chiropractor or a massage therapist, all of whom treat low back pain, and have that treatment covered (at least in part) by your insurance plan.
While Section 2706 is part of the law, the practical reality of how and when it will get implemented is still a bit of a mystery. There is general agreement among those in the know that little planning has yet taken place for providing access to nontraditional health care services. It”™s been pretty much just “wait and see.”
There is still a lot of nuance related to Section 2706. States have different licensure regulations that affect how service providers are included or excluded by the legislation (practitioners must be licensed in order to be included.) For example, naturopathic doctors are not licensed in New York state, whereas they are licensed in nearby Connecticut, as are homeopathic physicians. The legislation doesn”™t require insurers to contract with all of any type of specialty provider in a geographic area, and it doesn”™t set reimbursement rates.
Although the value of CAM services has some vocal naysayers, almost 30 percent of U.S. adults receive care from some type of CAM practitioner each year. In Westchester County, that equates to roughly 200,000 people. And reimbursement is largely through out-of-pocket patient payment.
Right now, a number of local hospitals offer nontraditional services, mostly on an inpatient basis. But, for the most part, nonhospital clinic or office-based practices in this geographic area are still pretty distinctly divided into separate worlds: traditional medical doctors and therapists and nontraditional or CAM practitioners where “never the twain shall meet.”
In order to be covered under Section 2706, licensed providers do not have to be part of a traditional medical practice; but in the new world of integrated health care delivery, increased communication among the various caregivers and patients will ideally be more closely coordinated instead of fragmented as it is today.
The legislation could motivate hospitals to add CAM services to their outpatient offerings. We might also see a greater number of outpatient practices with traditional and nontraditional service professionals working side by side to integrate patient care.
Insurers and employers could design innovative benefit packages and/or look at useful comparative outcomes. Returning to the example of low back pain, this frequently occurring condition is a big contributor to workplace absenteeism and lost productivity and to increased medical and disability costs. Insurers or large employers could evaluate the impact of medical costs and other factors based upon their members”™ use of various types of traditional and nontraditional treatment.
How Section 2706 will evolve or what it may mean in the bigger picture of health care is yet to be determined. For right now, it seems to be one of Obamacare”™s best-kept secrets.
For additional information, The Integrative Healthcare Policy Consortium”™s website has a list of frequently asked questions and a video from Deborah Senn, JD (former state of Washington insurance commissioner) about Section 2706 at: ihpc.info.
Sherrie Dulworth is a national health care management consultant working with organizations to identify, implement and/or communicate clinical and operational best practices. She is an R.N. and has a Master of Science degree from the Columbia University Graduate School of Journalism. She can be reached at sherriedulworth@gmail.com
Hi Sherrie,
The numerous “nontraditional” or “complimentary and alternative medical providers” (CAM) organizations strongly disagree with the notion that “This provision does not require plans or issuers to accept all types of providers into a network.”
This was one of two inaccurate informal statements/advice originally posted April 29, 2013, on the webpage of the “Center for Consumer Information & Insurance Oversight” (CCIIO). This statement can legally be characterized as only “interpretive rule,” which had not undergone the notice and comment provisions required under the “Administrative Procedure Act,” and as such do not have the weight of formal administrative rule or regulation and certainly to not have the weight of law.
More importantly this informal advice or interpretive rule conflicts with the plain language of the law (Section 2706) and Congressional intent noted in “Report 113-71, Calendar No. 128, pg 126 and if necessary will be legally challenged…ain’t life grand. Cheers, Vern Saboe, Albany, OR