Federal Agency Clarifies PPACA Language on Access to Non-MD/DO Providers
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Wednesday, June 17, 2015 04:58 PM
Quick Brief:  New CMS FAQ guidelines correct previous language that led some states to limit patient access based solely on the type of a provider’s licenseThis language has been rectified.

 

At the urging of the American Chiropractic Association (ACA), the Centers for Medicare & Medicaid Services (CMS) has clarified a section of the Patient Protection and Affordable Care Act (PPACA) that led some states to improperly limit patient access to chiropractic physicians and other qualified non-MD/DO health care providers.

On May 26, CMS withdrew and replaced a Frequently Asked Questions (FAQs) document on Section 2706(a) of the 2010 Patient Protection and Affordable Care Act (PPACA) with one containing a more realistic approach to the issue of provider non-discrimination. The new FAQs establish a more reasonable standard for Section 2706(a) enforcement and are more in line with ACA's understanding of the issue.

"This clarification signifies a remarkable achievement for ACA and its health care association partners in ensuring that all patients have free and fair access to the providers of their choice," said ACA President Anthony Hamm, DC, noting that the previous FAQs had served as a "severe impediment to quality patient care and genuine reform in the nation's health care system."Proper implementation of the law had been hampered in part by flawed information distributed in 2013 by the HHS Center for Consumer Information and Insurance Oversight (CCIIO), which led some states to limit patient access to qualified health care providers, including chiropractic physicians, based solely on the providers' licenses -- in direct contradiction to the intent of Congress.

The new FAQs were issued in response to the Dec. 11, 2014 explanatory statement issued by the U.S. House of Representatives Committee on Appropriations, directing CMS to "provide a corrected FAQ or provide an explanation." The new FAQs take a position very close to the approach originally advocated by ACA and other provider groups. The agencies now state that they "will not take any enforcement action" with respect to 2706(a) "as long as the plan or issuer is using a good faith, reasonable interpretation of the statutory provision..."

"We would suggest that this new language strengthens the point that singling out chiropractic care for special discriminatory treatment is a clear violation of Section 2706(a). The new FAQs reflect ACA's impact on this issue, as we were instrumental in all points that the new document referenced," added Dr. Hamm. A key dimension to Section 2706(a) is patient access to covered services from licensed doctors of chiropractic (DCs), and other non-MD/DO providers. ACA works on an ongoing basis with states and other stakeholders to ensure the proper enforcement and aggressive implementation of that section of the health reform law aimed at curbing discriminatory abuses against the chiropractic profession and other health care disciplines.

The FAQs were prepared jointly by the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury. Like previously issued FAQs, these answer questions from stakeholders to help people understand the PPACA and benefit from it, as intended.