Naturopathic Physicians and the Affordable Care Act By Jonathan Blum, Principal Deputy Administrator at the Centers for Medicare & Medicaid Services. Thank you for your petition regarding licensed Naturopathic physicians. Licensed Naturopathic physicians provide services that are important to millions of Americans, and nothing in the Affordable Care Act prevents insurance companies from including licensed Naturopathic physicians in their network of providers, or from covering services that licensed Naturopathic physicians provide. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover the essential health benefits package, which includes 10 general categories of items and services described in the statute that are equal in scope to a typical employer health plan. The benefits must be substantially equal to the essential health benefits covered by the state benchmark plan. Information on states benchmark plans is available here. Plans may also offer additional benefits. Therefore, even if the state benchmark plan does not cover services provided by a licensed Naturopathic physician, qualified health plans may choose to cover those services. The law also provides that a health plan or health insurance issuer 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 providers license or certification under applicable state law. The law does not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer, and does not prevent a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. We also note that this requirement addresses the types of providers included in a network, not which services are covered. Questions about the provider nondiscrimination provision, including complaints regarding compliance, can be submitted to: the States Department of Insurance for complaints relating to health insurance issuers; the Centers for Medicare and Medicaid Services (CMS) at 1-888-393-2789 for complaints relating to non-Federal governmental plans and health insurance issuers in states in which CMS is directly enforcing the market reform requirements of title XXVII of the Public Health Service Act; and the Department of Labor at askebsa.dol.gov or 1-866-444-3272 for complaints involving employment-based group health plan coverage. Tell us what you think about this response and We the People.
Posted on: Sat, 18 Jan 2014 00:26:00 +0000
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