Chiropractors (and other licensed disciplines) make gains under Federal Employee Health Benefits via BCBS on Section 2706 “Non-Discrimination in Health Care”

In a December 20, 2013 release (ACA advocacy results in DC’s expansion of coverage under BCBS Federal Employees Program), The American Chiropractic Association shared that “doctors of chiropractic will be listed equally with other types of physicians and will no longer have any limitations attached to their definition of physician under the 2014 Blue Cross and Blue Shield (BCBS) Service Benefit Plan, as authorized by the Federal Employees Health Benefits (FEHB) law.” The release noted that effective Jan. 1, 2014, BCBS Federal Employee Program (FEP) will “now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA).” In addition:  “Benefits for chiropractic care are no longer limited to one office visit and one set of X-rays per year.” Coverage for those services will be based upon “the benefits we provide for office visits and … for our coverage of radiological services performed by covered professional.”

Comment
: That this is based on Section 2706, Non-Discrimination in Health Care, of the Affordable Care Act suggests that there are similar implications for other licensed disciplines that have not, in the past, been included. Mor

by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Chiropractors (and other licensed disciplines) make gains under Federal Employee Health Benefits via BCBS on Section 2706 “Non-Discrimination in Health Care”

In a December 20, 2013 release (ACA advocacy results in DC’s expansion of coverage under BCBS Federal Employees Program), The American Chiropractic Association shared that “doctors of chiropractic will be listed equally with other types of physicians and will no longer have any limitations attached to their definition of physician under the 2014 Blue Cross and Blue Shield (BCBS) Service Benefit Plan, as authorized by the Federal Employees Health Benefits (FEHB) law.” The release noted that effective Jan. 1, 2014, BCBS Federal Employee Program (FEP) will “now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA).” In addition:  “Benefits for chiropractic care are no longer limited to one office visit and one set of X-rays per year.” Coverage for those services will be based upon “the benefits we provide for office visits and … for our coverage of radiological services performed by covered professional.”

Comment
: That this is based on Section 2706, Non-Discrimination in Health Care, of the Affordable Care Act suggests that there are similar implications for other licensed disciplines that have not, in the past, been included. More on responses from these disciplines as I learn more.

Jud Richland, MPH on the impact on the naturopathic medical profession of the BCBS FEHB decision

On reading of the Blue Cross Blue Shield association direction regarding Federal Employee Health Benefits and Section 2706 (Non-Discrimination in Health Care), I invited comments, for the record, from leading policy figures from the other licensed integrative health and medicine disciplines. Jud Richland, MPH, is the CEO of the American Association of Naturopathic Physicians. This was his useful reply: “Thanks for sharing this.  We’ve actually been discussing this for a while and trying to figure out what it means.  I have a couple of thoughts. My overall reaction is that, in general, this helps establish a great precedent for other plans to follow.  The flip side, like so much, is that the devil is in the details.”

Richland continued: “In defining physicians, BCBS basically stuck with the Medicare definition of physician, which doesn’t include naturopathic physicians.  The plan also refers to ‘Other Covered Health Care Professionals.’  It says “Professionals such as the medical practitioners listed below, when they provide covered services and meet the state’s applicable licensing or certification requirements…’ It includes a long list of other professionals, but not NDs or, for that matter, acupuncturists or massage therapists.  It does include certified midwives.  It looks like the key is ‘such as.”  I certainly don’t see any reason CAM practitioners wouldn’t be included.

In addition: “Having said that, we’ve searched the plan’s provider directory and haven’t been able to find any NDs.  Maybe at some point they’ll add NDs to their network of preferred providers.  Possibly (hopefully), they’ll immediately be covering services delivered by all types of out of network, licensed providers.”

Richland concluded: “One last thought… it’s interesting that this is included in the federal BCBS plan.  It’s not clear to me that FEHBP plans are required to comply with Section 2706 (I could be wrong about this), so I’m not sure if BCBS is doing this because they think they have to or for other reasons.”

Comment: While the platitude is that healthcare is local, and regulated by states, Richland’s comment on Medicare’s definition of “physician” – which excludes “naturopathic physicians” – is an example of federal intrusion over-throwing this frequently repeated fiction.  As is clear in this paper on naturopathic physicians and primary care, they are not only typically considered “physicians” in states where they are licensed. They are also explicitly considered primary care in more than half.


The Integrator
Top 10 for Policy and Action in Integrative Health and Medicine for 2013

Since 2006, on or about each winter Solstice, I have saluted the coming of the light with publication of The Integrator Top 10 for the previous year. The 2013 iteration begins with the battle over civilizing US health care through “non discrimination” and ends with a salute to the end of year emergence of something operating under the working title of “The Academy.” (See The Coming of the Light: The Integrator Top 10 for Policy and Action in Integrative Health and Medicine for 2013.) Between these, research surprises, some sterling appointments by individuals, advances of select professions, and some ways that individuals associated with these movements are shaping the mainstream dialogue via the values, practices and disciplines associated with integrative health and medicine. Since 2011, these have also been published via the Huffington Post. Links to past lists are here and at the bottom of this posting. Together these chronicle eight years of policy and action in this popular movement. This column was first published here at the Huffington Post.

Related end of 2013 lists: Here are the Top 5 Articles for 2013 via Integrative Practitioner, a list of 11 stories for the naturopathic profession from the American Association on Naturopathic Physicians, plus a Reiki Year-End Report from Pamela Miles and the Top 10 American Public Health Association via Public Health Newswire.

Is PCORI meeting its “CAM” mandate? Only one integrative health and medicine grant in recent funding announcements

In a recent electronic exchange with Integrator advisers and fellow writers on integrative health topics Taylor Walsh and Glenn Sabin, we explored a key question relative to the Patient Centered Outcomes Research Institute (PCORI). Sabin wondered whether “anyone is writing on what’s been earmarked to integrative health investigators and designs in recent award announcements … and if the early promise of PCORI to support IM whole systems based designs looking at outcomes of effectiveness and cost has been realized at some level?” Walsh engaged a review and reported: “I find only this, on page 37, under ‘Addressing Disparities’ in the Sept. 10 announcement: Paula Gardiner MPH, MD, BOSTON MEDICAL CENTER, Integrative Medicine Group Visits: A Patient-Centered Approach to Reducing Chronic Pain and Depression in a Disparate Urban Population. I find nothing in the Dec. 17 awards.”

Comment: Of course, an unanswered question here is: are researchers in integrative health and medicine fields applying and being turned down, or are they simply not applying? The initial PCORI announcement included two awards in the integrative health area but, other than Gardiner, we appear to have seen pretty much of a shut-out since. At least one terrific proposal turned down by PCORI: a follow-up to the NCCAM-funded diabetes study, referenced below, led by Ryan Bradley, ND, MPH, Dan Cherkin, PhD and others. One possible factor: because NCCAM has mainly funded reductive, efficacy trials in its 15 years of existence, the agency has not created a workforce that is optimal for the “real world” comparative research focus in the PCORI environment. Any additional intelligence on what may be going on here would be welcome. PCORI, under the leadership of Joe Selby, MD, MPH, has presented itself as quite open to proposals from the integrative community. (Thanks Taylor.)