After almost two years of correspondence and at least one in-person meeting with representatives from the integrative health and medicine community, the US Department of Health and Human Services (HHS) has acknowledged that instances of insurer discrimination in violation of Section 2706 submitted from the state have merit.

HHS responded this past April to a selection of documented cases of discrimination that the American Association of Naturopathic Physicians (AANP) assembled with its state member associations in Washington, Oregon, California, Hawaii, Maine, and Puerto Rico. (Such cases are similar to those you’ll find in our Stories Album involving other disciplines).

The HHS executive who has been leading the long conversation with AANP and the IHPC, said that the documentation showed clear examples of discrimination in violation of 2706 (those provisions are not yet known), and that their review process may lead HHS to reach out to the state insurance commissioners directly.

This acknowledgement could mark a sea change in the posture that HHS has adopted since its flawed guidance on 2706 was issued in 2013 and in an updated version in spring of 2015. Independent actions in the states, including those involving state insurance commissioners, combined with this HHS acknowledgement may also be welcome news for other professions whose providers have faced similar discriminations with little response from their state officials.

These are important parallel tracts that CoverMyCare will continue to track through 2016.

Last fall the then newly formed People for Acupuncture in Vermont carefully put together a coalition to create legislation that would mandate insurance coverage for acupuncture treatment for certain conditions. At the same time, lawmakers were intent on addressing the state’s overwhelming opioid addiction epidemic. As a result a kind of blended bill was produced and signed by Governor Peter Shumlin on June 10.

Vermont Gov. Peter Shamlin

The Opiate Bill, S.243, appropriates $200,000 to pay for implementation of a pilot project that requires the Dept. of Vermont Health Access to offer acupuncture to a cohort of Medicaid-eligible patients who have been a diagnosed with chronic pain. Outcomes will be assessed in terms of how treatments enable patients to return to social, occupational, and psychological function.

An implementation plan is due to the legislature on or before January 15, 2017.

In addition to the pilot and required studies, the committees also created the Controlled Substances and Pain Management Advisory Council and included representation by licensed acupuncturists.

This action mirrors other state Medicaid programs that have made a place for acupuncture, such as in Oregon, which now recommends acupuncture, massage and other integrative approaches for first treatments of low back pain.

(Thanks to People for Acupuncture President Kerry Jenni,L.Ac for this update.)

See the full Press Release on the law here.

A summary of the enacted law is here.

At its January meeting Minnesota’s multi-disciplinary provider coalition, MN Fair Care agreed to introduce a bill during the state’s shortened legislative session. In mid-March they did so.

The timing for introducing the bill (HF 3291 in the House; SF 3046 in the Senate) is thought to be challenging because the session runs only from early March to late May (due to capitol building construction.) But the importance of focusing on the subject of non-discrimination, promoting the bill and identifying supporters in the legislature prior to the November election were strong incentives to bring the bill forward.

MN Fair Care Coordinator Michele Maiers, DC

To see the sponsors for the bill in each chamber, a link to it — and to the MN Fair Care Facebook page! — see the Minnesota State Page.

Thanks to our colleagues at the American Sustainable Business Council, Ms. Maiers met recently with the chairperson of ASBC member Small Business Minnesota, which represents many of Minnesota’s 200,000 small businesses.

To get connected with the initiative, please see our Minnesota page.

The bill would “Require insurance coverage for certain medically necessary health care services when delivered by a licensed acupuncturist.”

PFA leaders Kerry Boyle Jenni, LAc and Joshua Singer LAc at right, with 2016 Lt. Gov. candidate Kesha Ram.

She said a similar discussion is taking place in the House Health Committee, whose chair is a main sponsor of their bill.

The PFA bill — available at the CMC Vermont State Page –addresses inequitable treatment between providers when treating identical conditions:

“Coverage for medically necessary diagnosis and treatment related to pain management, anxiety and post-traumatic stress disorder, substance use disorder, and nausea…shall not be denied reimbursement by the health insurer for providing those covered services if the health insurer would reimburse another health care provider for providing the services.”

The bill would take effect as early as Oct. 1 of 2016 and no later than Oct. 1 of 2017.

The group will be composed of community members, health care advocates, providers, agents and brokers, legislators, and other government officials. (For reasons not yet clear, OSI will also convene a separate group for insurance carriers and industry representatives.) The group will focus on provider directory accuracy, balance/surprise billing, specialist access, network sufficiency standards, and consumer notification/education.

Network adequacy requirements are seen as one path for state health insurers to comply with provisions of Section 2706 of the ACA, and/or with state non-discrimination statutes that are based on Section 2706, such as those enacted in Oregon and Rhode Island in 2015.

SUNM President
Patrick Nuzzo, DN

Assemblyman Ed Chau

Rep. Chau developed the bill in 2014 and introduced it in 2015. Although it passed through several committees, it was held over until the 2016 session. Since chiropractic care is also not included in the state’s ACA-mandated Essential Health Benefits (EHBs), further chiropractor involvement in this effort is thought to be very unlikely.

Registration in naturopathy

HOUSE
Number: MA HB 1992
Sponsor: Rep. Jay Kaufman (DEM-MA)
Title: An Act establishing a board of registration in naturopathy
Status: Hearing Scheduled JPH – 11/17/2015 10:00 am Gardner Auditorium

Summary: Establishes a board of registration in naturopathy and defines the practice of naturopathic health care.

SENATE
Number: MA SB 1205
Sponsor: Sen. Marc Pacheco (DEM-MA)
Title: An Act establishing a board of registration in naturopathy
Status: Hearing Scheduled JPH – 11/17/2015 10:00 am Gardner Auditorium

 
Integrative Pain Management

Number: MA HB 2006
Sponsor: Rep. John Lawn (DEM-MA)
Title: An Act relative to the safe treatment of pain
Status: Hearing Scheduled JPH – 11/17/2015 2:00 pm Gardner Auditorium

Summary: The use of needles on trigger points, Ashi points, soft indurations, motor points and/or for intramuscular needling for the treatment of myofascial pain will be considered the practice of acupuncture.

 
Complementary and alternative health practitioner oversight

Number: MA HB 2033
Sponsor: Rep. William Pignatelli (DEM-MA)
Title: An Act providing for consumer access to and disclosure of complementary and alternative health services
Status: Hearing Scheduled JPH – 11/17/2015 2:00 pm Gardner Auditorium

Summary: Clarifies the circumstances under which a complementary and alternative health practitioner who is not licensed, registered or certified as a health care provider under the Commonwealth shall be in violation of Chapter 93A or any other health care practice act.

 
Team-based health care

Number: MA SB 1170
Sponsor: Sen. Thomas Kennedy (DEM-MA)
Title: An Act to promote team based health care
Status: Hearing Scheduled JPH – 11/17/2015 2:00 pm Gardner Auditorium


(Thanks to our colleagues at the State Pain Policy Advocacy Network, SPPAN, for the heads up on this event.)

The proof comes in compiled research that shows not only do integrative options often offer better health outcomes, they can often cost less than conventional options.

If you are a company’s HR or healthcare manager (or even an employee), you might want to know “Really? By how much?” The data (our numbers) have been out there, but not until recently pulled together as they are in this single sheet entitled “Wellness in the Workplace,” which summarizes the research into this very question, and presents compelling statistics.

Consider:

• A program in which naturopathic doctors educated patients on diet, exercise, stress reduction and dietary supplements resulted in an annual employer savings of more than $1,100 per participant.
• A similar program that taught health habits, activity, stress management and smoking cessation that included MDs trained in integrative medicine saw a 48% reduction in annual employer costs per participant.

These examples are excerpted from a longer, more substantial review of cost-comparative research that is available from our parent the Integrative Health Policy Consortium: “Integrative Health and Medicine: Today’s Answer to Affordable Healthcare: Health Creation Economics.”

Published in March of 2015, and written by the nation’s top researcher in the field, the report shows the advantages of acupuncture, massage therapy, naturopathic medicine and chiropractic when used to treat a variety of conditions and when in used in concert with conventional therapies, as in the examples above, which you see are heavily oriented to lifestyle improvement.

One of the reasons that CoverMyCare insists that Section 2706 be adopted across the country is that integrative therapies and approaches to care are not only great treatment options, they often cost less than standard care. For chronic illness that could require costly symptom management over many years, this can make a huge difference. “Wellness in the Workplace” shines a light on the numbers that reveal these facts of integrative life.

(By the way, they also apply outside the workplace.)

Download Wellness in the Workplace here

The Legislation

Oregon Governor Kate Brown signed a bill that would not only provide state-level provisions for ending discrimination against licensed health care providers, but would require insurance companies to include these providers in their networks and,

“…(1)(c) Annually report to the Department of Consumer and Business Services, … the insurer’s plan for ensuring that the network of providers for each health benefit plan meets the requirements of (Section II).”

Section II contains the non-discrimination language of Section 2706 of the Affordable Care Act.

The Lawsuit

Now in July, the Oregon Association of Naturopathic Physicians (OANP) has filed a class action lawsuit against Health Net Health Plan of Oregon and its contracted benefits provider American Specialty Health (ASH).

A press release describing the lawsuit used the example of a patient who saw an ND for her annual well-woman appointment in November 2014, but was not reimbursed for the service even though a similar preventive checkup by an MD would be covered. Several patients are included in the lawsuit. One of its purposes is to address the long-standing disparities between reimbursement accorded to NDs (and ultimately other licensed integrative providers) and that attained by MDs for exactly the same procedure.

This action appears to be oriented directly to the provisions of Section 2706. The OANP press release notes, “Advocates have been working directly with federal agencies and state insurance commissioners for the last two years to implement and enforce the provider non-discrimination provision, to little effect.”

The lawsuit comes a little more than a month after the Dept. of Health and Human Services released an updated version of an FAQ from April 2013 that was so poorly worded that the Senate Appropriations ordered it re-written. That took nearly two years. The re-write has been greeted as an improvement by some. Apparently the OANP feels its updated guidance still falls short when it comes to guaranteeing patients the kind of parity of coverage requested in the provisions of its lawsuit.

This action could potentially be of national consequence. As the press release notes:

“Plaintiffs believe this class action lawsuit will produce a much-needed judgment to clarify the ACA’s provider non-discrimination mandate for a variety of provider types in Oregon as well as nation-wide.”

Clarification has been badly needed since Section 2706 went into effect on Jan. 1 2014. Oregon is forcing the issue on two fronts, by passing legal non-discrimination language of the Affordable Care Act and by its naturopathic physicians demanding in addition to financial compensation:

• “Enforcement of non-discriminatory practices in the future
• A court order that clarifies for insurers which of their practices are unlawfully discriminatory”

A PDF of the OANP Press Release is here.