In short, insurance companies cannot summarily exclude naturopaths from reimbursement in states where naturopaths are licensed and operating within the scope of their license. The insurance companies can however limit how many ND's they include, and they can decide whether or not (and how much) to reimburse based on "quality or performance measures" which are not explicit.
I have received a series of wonderful questions relating to my summary of H.R.3590, the Patient Protection and Affordable Care Act, (health care reform). Here is the analysis of the section soliciting the most questions, the non-discrimination provision. Subsequent emails will address your questions on other portions of the law, so please feel free to continue to email us!
SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.
(a) Providers- 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 provider's 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.
Perhaps the most important question? "Will I, as a naturopathic physician, be required to be a part of an insurance offering?" All my research indicates that no - there is no requirement for you to take insurance, or be a part of an insurance panel. So what does this legislative language actually mean for you?
Effective in 2014, insurers, including those that cover major corporations who are not subject to state laws, will not be allowed to deny participation of naturopathic doctors in our licensed states. How many NDs are included in the plans, and what level of reimbursement is afforded to them will be determined by the insurers or the Secretary of HHS.
Implications? Plans will restrict the number of participating NDs and determine what services they will reimburse based on "quality or performance measures." This language, likely to be defined as part of a regulation, could very well restrict coverage to the most basic of naturopathic care. Rates, if history were to repeat itself, could be defined using Medicare reimbursement schedules.
Patients may still find themselves paying out-of-pocket for naturopathic services (especially in unlicensed jurisdictions) - and will be required to pay for insurance coverage as well. This could have an impact on access to naturopathic care.
Licensure for the profession remains central to our success. Careful monitoring of rule promulgation is essential to ensure that naturopathic medicine is covered to the extent possible.
What services will the new law actually cover? The Essential Health Benefits Package is defined in law as follows:
(1) IN GENERAL- Subject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
The Secretary will limit cost-sharing and establish levels of coverage to be defined as either the bronze, silver, gold, or platinum level of coverage, ranging from 60 to 90 percent of the full actuarial value of the plan benefits.
Karen E. Howard
American Association of Naturopathic Physicians
River of Health
Notes for a Future Naturopathic Practice
- What the Healthcare Reform Bill Means to Naturopathic physicians