The vision for improving America’s healthcare by including integrative providers in the insurance system is best expressed by its author, US Senator Tom Harkin, as here in remarks to naturopathic physicians in 2012:
“I’m very proud of the fact the law includes the first federal level, non-discrimination clause to protect (integrative providers) regarding participation in a health plan…and…to ensure that insurance companies cannot exclude allied health professionals from practicing under the capacity of their training and licensure.”
Frequently Asked Questions about 2706
Q 1: What exactly does Section 2706 do?
Effective January 1, 2014, Section 2706 requires commercial group health insurers to end discrimination against health care providers — with regard to their participation under a health plan or coverage — who are acting within the scope of that provider’s license or certification under applicable State law.
CoverMyCare supports an end to discrimination against many hundreds of thousands of licensed providers of complementary, integrative (or holistic) medicine, such as those listed in our section “The Professions.“
Q 2: What is the discrimination?
Health insurance companies frequently refuse to contract with integrative healthcare practitioners, thus keeping them out of the insurers’ provider networks.
This exclusion: a) prevents licensed providers from delivering their services on a reimbursable basis, and b) it prevents members of health plans (patients) from being reimbursed when they choose those providers.
This discrimination actually increases the total costs of care for individual patients who pay out-of-pocket for access to integrative health services. So while Section 2706 is designed to protect providers from being excluded from health care plans, it also provides for patients greater access to the providers of their choice.
Q 3: But my acupuncture has been covered for a year or so. How does Section 2706 apply to this?
Some integrative procedures have been covered by health insurance, acupuncture among them, but only on a very limited basis, and often not to the full extent of the provider’s training and scope of practice. Some insurance plans may also exclude from coverage entire classes of providers, such as naturopathic physicians or chiropractors. Others may limit the use of acupuncture to certain diagnoses, such as pain, or provide coverage only when the procedure is conducted (i.e.: acupuncture needles are used) by an MD.
Q 4: So how is 2706 new?
For many reasons, insurers historically have excluded specific types and groups of healthcare professionals from their provider networks and from out-of-network coverage. This exclusion happens even when those providers hold state licenses and even despite substantial, long-standing public preference for their services. Many thousands of licensed providers – and entire groups of “provider types,” such as acupuncturists — have long been excluded from these insurer networks.
Senator Tom Harkin, the author of Section 2706, recognized this discrimination as a serious imbalance in the health insurance marketplace.
In effect, Section 2706 asserts that more access to licensed care – from patient demand and selection — will result in better treatment outcomes and lower the costs of care when integrative health providers have equal standing in the healthcare financial system.
Q 5: How does it work?
When an integrative provider treats any health condition covered in an insurance plan, he or she should be eligible for reimbursement, so long as that provider is: a) licensed by his or her state, and 2) the treatment of that condition falls within that provider’s scope of practice.
Example: A patient has been experiencing chronic back pain and seeks treatment. Treatment of back pain is covered by her health insurance plan. Under Section 2706, she can choose an orthopedic surgeon, an osteopathic physician, a naturopathic physician, a chiropractor, an acupuncturist, or a massage therapist, again: so long as the provider is licensed in their state and back treatment is within his/her scope of practice. Insurance companies cannot discriminate in their coverage policies by refusing to pay providers whose license permits treating a given medical problem.
Although Section 2706 became effective January 1, 2014, most insurance companies have not been compliant in this regard and have not made these options available to patients.
Q 6. What type of health insurance plans does 2706 cover?
- All market-based healthcare plans: for individuals and families; for employee groups.
- Non-governmental plans selected on the “health insurance exchanges” created by the Affordable Care Act. Except: Section 2706 does NOT apply to Medicare or Medicaid plans, or Tricare (military health) plans.
- Plans that cover federal employees and their dependents.
- Self-insured plans (known as ERISA) that a large company such as Boeing, Microsoft, Safeway or Google administers itself for its own employees.
Q 7. Is the insurance company required to include integrative providers in their plans?
Not all providers and not in all plans.
But as with any provider “type” (family physician, RN, obstetrician, orthopedic surgeon, anesthesiologist), the plans must include an adequate number of providers and types of providers to serve the geographic region in which the insurance company itself is licensed to sell its plans.
This requirement is called “network adequacy,” and it has been a factor in healthcare regulation for many years before the Affordable Care Act was passed.
The intent of Section 2706 is that integrative providers must be included when insurance companies determine the composition of their networks of care providers. Instead it remains a source of confusion and varied interpretation, in part because of this passage in the 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.”
Section 2706 was not intended to be a mandate for every provider: forcing insurers to include all providers in their networks. But it is intended to ensure that an adequate number of licensed integrative providers are available in their plans, thus adhering to the legal requirements of “network adequacy” and ensuring patient rights of access to providers of their choice. As this has not happened since Section 2706 became active, insurers may be violating the law on both the state and federal level.
Q8. Does that mean that every procedure will be covered?
Not every procedure. But those defined as covered benefits in a health plan and included in a licensed provider’s scope of practice should be reimbursed.
In practice, however, and before Section 2706 became law, insurers often denied or limited coverage based on their own self-defined rules. For instance:
- The insurer considers the procedure not medically necessary,
- The treatment will be declared “not clinically efficacious” (i.e., it doesn’t work) or
- The treatment is deemed “experimental” (even if some like herbal therapies, have been effective for 2,000 years)
- An insurer gives preference to one type of provider over another, even if the services of the second provider are equally effective but less costly.
Section 2706 defines such exclusionary practices as discriminatory, as distortions of the market’s historically high demand for access to licensed integrative health providers.
Q 9. What are insurer objections to covering these providers in the first place?
Many health care insurance plans maintain that Section 2706 will increase the number of services needed to treat a condition, which will in turn lead to increases in the total cost of care for that condition. The belief is that adding a series of acupuncture treatments, for example, to a regimen of pharmaceutical painkillers would just add to the total cost of treatment.
This is simply not true. In fact, clinical experience and research show us that the overall costs for treating a condition with integrative options is often less costly than “standard” care alone. In the example above not only is the overall cost reduced but so too is the likelihood that the patient develops a dependency on the painkillers which itself increases costs. (See #1 in FAQ Footnotes below.)
This is not always the case, of course, but we know that integrative options can make a significant difference in the cost of treating certain kinds of conditions. Research compiled in 2014 and published in the booklet, “Integrative Health and Medicine: Today’s Answer to Affordable Healthcare | Health Creation Economics,” shows how full implementation of Section 2706 could have a substantial impact on reducing the costs of care. (A link to the study is #2 in FAQ Footnotes below.)
Related exclusionary practices.
Some states have previously passed non-discrimination provisions on their books that are similar to Section 2706. They focus on correcting insurer practices that:
- Cap the number of visits a patient can make to a provider
- Lower reimbursement rates
- Remove a service from a plan altogether
It is also important to note that denying or inhibiting access to a licensed integrative provider (for example: requiring referral by an MD), violates the letter and spirit of such existing non-discrimination provisions.
Most importantly, non-discrimination provisions are about expanding patient choice in the selection of health care providers.
Q 10. Will reimbursement for my massage therapy be the same as if I see a physical therapist?
Section 2706 does not dictate levels of monetary reimbursement, since the underlying costs of all kinds of treatments vary across the country, and sometimes from one part of a city to another. The provisions state:
“Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary (of HHS) from establishing varying reimbursement rates based on quality or performance measures.”
Once reimbursement is available for all licensed procedures, true marketplace forces will determine the rates.
Q 11. Why hasn’t the law been complied with so far?
Like most provisions of the Affordable Care Act, the implementation of Section 2706 depends on state insurance commissioners to direct compliance by health insurance companies that are licensed to sell and service policies in the state. We have found that implementation has been delayed because:
- Most insurance regulators are unfamiliar with Section 2706.
- The guidance provided by Health and Human Services in early 2013 was contrary to the intent of the law, and
- Regulators and elected officials are often not aware of the extent of the demand for integrative health services in their states.
CoverMyCare was created to help close this information gap at the state regulatory and policy level. See our 2706 Toolkit for ways you can help, including sharing stories of insurer denial of coverage for your care.
1 – In the case of pain management, the advantages of acupuncture, massage and chiropractic options have expanded recommended procedures by US military healthcare and by the Joint Commission, the national medical standards body that recommends treatment options to hospitals and healthcare facilities.
Also see, Complementary and Alternative Medicine Survey, 2011, Healthcare Analysis and Information Group (HAIG), Dept. of Veteran Affairs; Veterans Health Administration.
2 – Integrative Health and Medicine: Today’s Answer to Affordable Healthcare | Health Creation Economics, March 2015, The Integrative Healthcare Policy Consortium. For a PDF version of the booklet click here.