Section 2706(a): What It Means to You
Written by Editor   
Tuesday, October 14, 2014 10:37 AM

Section 2706 is a non-discrimination provision within the Public Health Service Act, as added by the Patient Protection and Affordable Care Act, which was designed to create a level playing field for providers. This provision states (in part):

''(a) PROVIDERS.-A group health plan and a health insurance issuer offering group or individual health insurance coverage 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 provider's license or certification under applicable State law. This section shall 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. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures." (Emphasis added)

It is the American Chiropractic Association's view that Sec. 2706(a) applies in the following situations, if there is evidence that:
  • doctors of chiropractic are being reimbursed at a different level than other providers for the same covered service, and such discrimination is not based on quality or performance measures, but is based in whole or in part upon licensure,
  • an insurer or group health plan is, for example, applying caps on specific services provided by doctors of chiropractic, and such caps are not being applied to other providers based in whole or in part upon licensure, 
  • the insurer or group health plan is denying specific forms of care otherwise covered under the plan on the basis that it is provided by a doctor of chiropractic, and the covered service is within the scope of practice of a doctor of chiropractic, and
  • doctors of chiropractic are being excluded as a group from participation in a network's plan.

Sec. 2706(a) applies to all group health plans, both insured and self-insured, and, it is not subject to ERISA preemption. The law provides that the state has the first responsibility to enforce Sec. 2706(a), and if the state does not provide enforcement, then it falls to the HHS Secretary to do so.

ACA has received numerous questions as to the applicability ofSec. 2706(a) in many scenarios.  While there has been some misperception by the federal Department of Health and Human Services on how the provision should be applied to certain specific payer policies and practices, ACA is steadfastly working to ensure that the law will be implemented as Congress intended: to improve patient choice and access to care; guarantee that the availability of essential services provided by a Doctor of Chiropractic is equal to the availability of traditional medical care in all federally established or regulated plans in the exchanges; and that any discriminatory policies adverse to patients and providers are eliminated. 
For more information on 2706, please click here.  If you believe that you have been discriminated against as a doctor of chiropractic by a health insurance plan, please contact ACA at [email protected].
Source:  ACA: In Touch, September 2014