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March 10, 2014 at 01:35 PM
A Senate committee has forced federal agencies to take another look at guidance that could let carriers and group health plans keep state-licensed chiropractors, acupuncture providers or midwives out of their provider networks.
The three agencies – the Internal Revenue Service, the Employee Benefits Security Administration and the Centers for Medicare & Medicaid Services – have put out a request for information about provider non-discrimination.
The agencies issued the request because the Senate Appropriations Committee objected to a batch of answers to frequently asked questions the agencies issued in April 2013.
The Patient Protection and Affordable Care Act created a federal law, Section 2706(a) of the Public Health Service Act, which forbids a carrier or group health plan from shutting entire classes of state-licensed health care providers out of its networks.
Health law specialists say the provision may prohibit a plan network from excluding midwives, nurse practitioners or social worker family therapists as well as providers who might be classified as complementary medicine practitioners, such as chiropractors, homeopaths or acupuncture providers.
When the federal agencies issued the PHSA Section 2706(a) FAQ answer, they declined to interpret the law, except to say that carriers and plans should use a “”good faith, reasonable” interpretation of the law.
The agencies said, “This provision does not require plans or issuers to accept all types of providers into a network.”
