November 2012 John Weeks Integrator Round-up covering the topics of:  Policy, Business, Integrative Centers, Academics, Natural Products, Professions, and People.

Do state-by-state Essential Health Benefits decisions violate the non-discrimination clause in the Affordable Care Act?

This critical question is raised by the American Chiropractic Association (ACA) in a letter October 19, 2012 to Health and Human Services Secretary Kathleen Sebelius. The ACA shares concerns “regarding the Department’s implementation of a key provider non-discrimination provision of the Patient Protection and Affordable Care Act (PPACA).” The provision is Section 2706 which requires non-discrimination against licensed providers: “The law enables patients to receive care from any provider who is licensed in a state to provide a specific benefit covered through an exchange health plan.” However, some states are choosing Essential Health Benefits (EHBs) in their “benchmark plan” that do not include chiropractic or other services. States Keith Overland, DC, ACA president: “We have reason to believe that several states have taken just such an action, having allowed little to no input from the chiropractic community during their deliberations.” In the letter, the ACA requests that HHS “communicate to states that adherence to Section 2706 is vital and implement a process to evaluate each state’s proposed benchmark plan to determine whether it is in compliance.”

Comment: No one thought that implementing 2706 would be easy. The first shot across the bow was the AMA’s House of Delegates’ resolution to strike the language from the law. While the ACA’s letter is framed around chiropractic, the answers will have meaning that will shape citizen access to a whole variety of integrative health services from licensed practitioners working in solo offices or in integrative medicine clinics and teams. It is unfortunate that this letter was not co-signed by a dozen organizations. The strategy here should be less legal than an organizing. A letter to Sibelius from a broader base, reaching from consumer groups to massage therapists to integrative medicine doctors and the philanthropists who support them, is what is in order. The Integrative Healthcare Policy Consortium should be partnered at the hip with the ACA here. Meantime, for some reason perhaps linked to chiropractic’s Achilles heel of going it alone, the ACA remains the only significant licensed “CAM” national, organization not at that table as part of IHPC’s Partners for Health. Get together you two! 

Oregon publishes useful report on navigators, wellness coaches and health workers in Coordinated Care Organizations

The Oregon Health Authority has published a draft report entitled The Role of Non-Traditional Health Workers in
Oregon’s Health Care System
. These are not licensed integrative healthcare practitioner, of which Oregon has a full complement. Rather, the report focuses on “DRAFT Recommendations for Core Competencies and Education and Training Requirements for Community Health Workers, Peer Wellness Specialists and Personal Health Navigators.” The report was engaged as part of the state’s legislated effort to clarify what exactly is a Coordinated Care Organization, and the roles of the various professionals and others in carrying out such a mission with a focus on “Oregon Health Plan enrollees and with special attention to coordinating care and services for Medicare beneficiaries who are also on the Oregon Health Plan.” The 94 page document includes a set of recommendations for competencies.

Comment: The roles of health workers, coaches, navigators, guides and connectors has been intertwined with the dialogue around the optimal integration of so called “CAM” services and providers with mainstream medicine since the work was formally engaged nearly two decades ago. Good for the state of Oregon to have taken this to a new level of recognition. (Thanks to Charles MacLean, PhD for giving me the heads up.)


New Hampshire mandates coverage of services of naturopathic doctors

In somewhat old news, the publication Seacoastonline recently featured a report that the state of New Hampshire now requires insurers to cover the services of that state’s licensed naturopathic doctors (New law levels playing field for naturopathic doctors). The change came via passage of New Hampshire House Bill 351. In the state Senate the bill as narrowly approved HB 351 in a 13-11 vote in early May and Gov. John Lynch signed it into law on June 20.