Harkin pushes back on HHS for broader interpretation of “non discrimination in healthcare” Section 2706US Senator Tom Harkin has used the appropriations bill for the U.S. Department of Health and Human Services (HHS) to refute an extremely limiting HHS interpretation

Harkin pushes back on HHS for broader interpretation of “non-discrimination in healthcare” – Section 2706

US Senator Tom Harkin has used the appropriations bill for the U.S. Department of Health and Human Services (HHS) to refute an extremely limiting HHS interpretation of the application of the “non-discrimination in healthcare” provision (Section 2706) of the Affordable Care Act. Harkin’s language, injected into page 126 of this committee report from the Senate Health Education Labor and Pensions (HELP) Committee, restates his intent in placing Section 2706 in the Affordable Care Act. This important rebuke to HHS’s position, which gutted the law, follows:

“Provider Nondiscrimination.-Section 2706 of the ACA prohibits certain types of health plans and issuers from discriminating against any healthcare provider who is acting within the scope of that provider’s license or certification under applicable State law, when determining networks of care eligible for reimbursement. The goal of this provision is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State. The Committee is therefore concerned that the FAQ document issued by HHS, DOL, and the Department of Treasury on April 29, 2013, advises insurers that this nondiscrimination provision allows them to exclude from participation whole categories of providers operating under a State license or certification. In addition, the FAQ advises insurers that section 2706 allows discrimination in reimbursement rates based on broad ‘‘market considerations” rather than the more limited exception cited in the law for performance and quality measures. Section 2706 was intended to prohibit exactly these types of discrimination. The Committee believes that insurers should be made aware of their obligation under section 2706 before their health plans begin operating in 2014. The Committee directs HHS to work with DOL and the Department of Treasury to correct the FAQ to reflect the law and congressional intent within 30 days of enactment of this act.”

Harkin chairs the US Senate HELP Committee. The Committee Report will only have weight if the HHS appropriations bill is passed. In recent years, gridlock has left the agency operating via continuing resolution, at the previous level of funding, without passage a funding bill. A close observer with a long-time Washington, D.C. presence, Jud Richland, MPH, CEO of the American Association of Naturopathic Physicians, states that we “can point to this language as the clearest available expression yet of Congress’ intent.”

:  Many have been hoping that Harkin would weigh in on Congressional intent, given the lack of consideration, not to mention inclusion, of licensed integrative healthcare professions in essential health benefits and the development of insurance exchanges in many states. This is a good sign. Now it needs to be trumpeted.

IHPC posts briefing by former Washington insurance commissioner Deborah Senn on Section 2706
The Integrative Healthcare Policy Consortium (IHPC) has posted a two minute comment from former Washington State insurance commissioner Deborah Senn, JD, on the meaning of the “non-discrimination in healthcare” provision (Section 2706) of the Affordable Care Act. Senn calls the law, which goes into effect in January 2014, “groundbreaking for patients and providers in this country.” She notes that the development of insurance exchanges will substantially shape compliance. The posting was made available via the video department of Bastyr University, an IHPC Partner for Health. The IHPC also includes an FAQ on Section 2706. The useful 4-page document, developed in consultation with Senn, includes information on 14 questions. Federal policy leader in integrative health Janet Kahn, PhD, LMT, calls the video a “clear, brief and yet comprehensive on the meaning, expanse and limits of that section of the law.”

Kaiser Health News feature on Obamacare and alternative medicine stirs significant media interest

The feature by Ankita Rao for Kaiser Health News, a major resource for health policy leaders, was entitled Health Law Boosts Status of Alternative Medicine – At Least on Paper. The article focuses on Section 2706 of the Affordable Care Act and some of the poor implementation, for instance in California where chiropractors are excluded. Former Washington State Insurance Commissioner Deborah Senn is quoted as saying: “That’s just an outright violation of the law.” The article was very widely picked up, linked and re-posted.

Comment: I had a chance to be a resource for Rao and was briefly quoted. In an otherwise solid piece, I must say that I would never suggest that supportive research for integration does not yet exist, which my quote suggests. It was an interesting editorial choice to run with “alternative medicine” as the focus, rather than “integrative.” Harkin’s interpretation (see above) of 2706 would substantially support integrative care, whether through on individual’s choices or health system offerings. The value of this overall favorable piece was its location, in Kaiser Health News, which hasn’t historically shown much interest in the topic. The most recent integrative medicine-related article was coverage of the Health Affairs piece on cost savings in January 2013.

Chiropractors announce positive steps toward VA residency, expansion of VA services, and an opening with Medicare

On July 25, 2013, the American Chiropractic Association (ACA) informed members that the U.S. Senate Veterans Affairs Committee included provisions of the Chiropractic Care Available to All Veterans Act (S.422) in an omnibus bill. This new language would expand the availability of chiropractic services to more U.S. Department of Veterans Affairs (VA) medical centers. The next day the organization notified members that the VA “has released a request for proposals to establish a chiropractic residency program at VA medical facilities.” According to the notice, the program will support up to six residencies for chiropractic physicians at VA medical centers around the country. It will also expand partnerships between VA centers and local chiropractic schools.

In addition, the chiropractic organization announced on July 12, 2013 a long-sought opening by Medicare of consideration of potential coverage of evaluation and management (E&M) by chiropractors. The agency covers chiropractic care for limited conditions, but only for the procedure rather than the E&M that are routine care provided by doctors of chiropractic. The organization plans to work with seniors and the Chiropractic Summit to respond to Medicare’s related queries.

Comment: Each are terrific steps for that profession, its academic organizations, and the health of the Veterans, many of whom suffer from pain conditions. Credit the ACA and the Association of Chiropractic Colleges for their perseverance in informing Congress about the benefits of inclusion. Here’s hoping that S.422 stays in the omnibus bill. Meantime, good for the ACA to have found a way to get Medicare to begin to appreciate that chiropractors are not merely mechanical modalities but rather professionals with broader value to human health, including E&M services that are important to patient care. It’s a step toward interprofessional respect for the agency.