Chiropractors and other ancillary health care providers are breathing a sigh of relief following an about-face by federal regulators with respect to Affordable Care Acts coverage of their services. The new unified stance by the Department of Health and Human Services, Department of Labor and Department of the Treasury was spelled out in Part XXVII of its FAQs about Affordable Care Act implementation.
At issue is care provided by any state-licensed or state-certified health care provider, including not only MDs but chiropractors, naturopathic physicians, acupuncturists, massage therapists, osteopaths, optometrists, nurse practitioners and licensed or direct entry midwives and podiatrists, as long as they are licensed or certified by the state, according to the Integrative Health Policy Consortium.
A set of FAQs issued by the federal departments in 2013 cast doubt on the extent to which such services were reimbursable. One statement that set off alarm bells was that the provider nondiscrimination provision does not require plans or issuers to accept all types of providers into a network. This provision also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.
Lobbying organizations, including the American Chiropractic Association, brought their concerns to Congress, which in turn asked the agencies to go back to the drawing board.
Proper implementation of the law had been hampered in part by flawed information distributed in 2013 which led some states to limit patient access to qualified health care providers, including chiropractic physicians, based solely on the providers' licenses in direct contradiction to the intent of Congress, according to Anthony Hamm, a chiropractor and president of his industrys professional association.
In March, 2014, the government solicited industry comments on how Section 2706(a) should be interpreted, and received more than 1,500 responses. The result in the new FAQs is a more realistic approach to the issue of provider nondiscrimination and a more realistic standard for Section 2706(a) enforcement, says Hamm.
The departments lay out their new position in response to this question: What is the Departments approach to PHS Act section 2706(a)?
Good faith interpretation
In light of the breadth of issues identified in the comments to the RFI, the Departments are re-stating their current enforcement approach to PHS Act section 2706(a). Until further guidance is issued, the Departments will not take any enforcement action against a group health plan, or health insurance issuer offering group or individual coverage, with respect to implementing the requirements of PHS Act section 2706(a) as long as the plan or issuer is using a good faith, reasonable interpretation of the statutory provision.
The key language in the law reads as follows: A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that providers license or certification under applicable State law.
This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
The FAQ also states that the Departments will continue to work together with employers, plans, issuers, states, providers, and other stakeholders to help them comply with the provider nondiscrimination provision and will work with families and individuals to help them understand the law and benefit from it as intended.
Richard Stolz is a freelance writer based in Rockville, Maryland.
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