Section 2706

Section 2706 is the Affordable Care Act’s note on non-discrimination. It’s been held up as the main section that guarantees equal insurance coverage for CAM providers. Let’s take a look at what it actually says!

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.

[There is a (b) to section 2706, but it’s related to employee non-discrimination laws, which isn’t relevant to this conversation.]

I know that that law is a whole lot of jargon, but let me break it down:

  • [H]ealth insurance… 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… This means that insurance can’t say that one group of licensed providers (eg, medical doctors) is covered under someone’s policy while another group of licensed providers (eg, massage therapists) are not.

That sentence, in and of itself, is the key to all of IHPC’s efforts. All providers must be covered. Simple as that.

  • 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. This means that licensed providers who want to work with specific insurance companies will still have to fill out the necessary paperwork and be accepted by the specific insurance company in order to work with its customers. They don’t have to allow all providers of every type to be contracted.

Note: This is already the case in states that allow health insurance to cover massages – for example, every time I’ve tried to contract with Kaiser/CHP, I’ve been told that they aren’t currently accepting new LMTs.

  • 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. This says that insurers still have the right to vary reimbursement rates among providers.

I’ll be honest, I really don’t like that last section. How does one define or measure “quality” and “performance”? Will the reimbursement rates vary within professions (will some LMTs get reimbursed less?), or between different types of providers giving the same treatment? (iwill chiropractors and LMTs get paid at different rates if they both bill for a massage?) Will reimbursement rates be tied to research? Patients’ self-report? Healing time?

I’ve skimmed over sections of the ACA, and from what I can tell, these performance and quality measures have yet to actually be defined. Because there’s still a year before section 2706 goes into effect, there’s still time to for IHPC and other groups to discuss this and influence the decision.

Nevertheless, this is a solid ground for changing the rules and implementing for systematic coverage of CAM and massage.

There are a few other sections of the ACA that talk about integrative healthcare, and I’ll discuss them here in the upcoming weeks. Stay tuned!

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