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Feds decline to clarify PPACA alternative provider provision

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The Center for Consumer Information & Insurance Oversight (CCIIO) and other federal agencies have called an alternative medicine provider provision in the Patient Protection and Affordable Care Act (PPACA) “self-implementing” and declined to issue regulations explaining it.

CCIIO (pronounced “Sih-Sigh-OH”), the arm of the U.S. Department of Health and Human Services (HHS) responsible for overseeing many HHS PPACA implementation efforts, has posted comments on the alternative medicine provider provision and other PPACA provisions in a new batch of answers to PPACA questions.

HHS developed the answers together with officials at the U.S. Treasury Department and the U.S. Labor Department, CCIIO officials said.

In addition to answering questions about alternative medicine providers, officials answered questions about topics such as the effects of a change in plan year on the annual limit waiver expiration date, coverage for individuals in clinical trials, and transparency reporting.

Officials considered alternative medicine providers in answers to questions about “provider non-discrimination.”

PPACA added a section to the Public Health Service Act, Section 2706(a), that states that an insurer “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.”

Alternative medicine groups say Section 2706(a) refers to their members.

The Integrative Healthcare Policy Consortium (IHPC), a group that supports providers and users of acupuncture, homeopathy, acupuncture, therapeutic massage, midwifery and other forms of care other than treatments provided by conventional medical doctors, has said that it is “launching a strategic state-by-state campaign to support the correct implementation of Section 2706.”

In the new batch of federal agency answers, officials said Section 2706(a) will apply to all non-grandfathered individual and group health plans starting with plan or policy years beginning on or after Jan. 1, 2014.

Insurers should implement Section 2706(a) “using a good faith, reasonable interpretation of the law,” officials said.

“For this purpose, to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider’s license or certification, to the extent the provider is acting within the scope of the provider’s license or certification under applicable state law,” officials said.

“This provision does not require plans or issuers to accept all types of providers into a network,” officials added.

Section 2706(a) does not affect reimbursement rates or quality standards, officials said. 

IHPC has said that Deborah Senn, a former Washington state insurance commissioner, is helping it shape Section 2706 implementation.

Because of Section 2706, “over the next 12 months, we have an unparalleled opportunity to incorporate integrative healthcare practitioners into the payor system and make patient access to those practitioners across the country a happy reality,” Senn said, according to a statement issued by IHPC. 

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