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NDs and affordable care act - Jan 2014

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Aug 6th, 2014
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  1.  
  2. NDs and the affordable health care act
  3.  
  4. James Prego, ND
  5.  
  6. Message 1 of 4 , Jan 21[-- Image: Frame1 --]
  7.  
  8.  
  9.  
  10. View Source
  11.  
  12. I just got a reply from the white house on this topic.  I put it
  13. below.  It confuses me though.  I can't tell if this means they
  14. WILL cover NDs or if they WON'T cover NDs.  
  15.  
  16. Jim Prego ND
  17.  
  18. Islip NY
  19.  
  20. Naturopathic Physicians and the Affordable Care Act
  21.  
  22. By Jonathan Blum, Principal Deputy Administrator at the Centers
  23. for Medicare & Medicaid Services.
  24.  
  25. Thank you for your petition regarding licensed Naturopathic
  26. physicians. Licensed Naturopathic physicians provide services
  27. that are important to millions of Americans, and nothing in the
  28. Affordable Care Act prevents insurance companies from including
  29. licensed Naturopathic physicians in their network of providers,
  30. or from covering services that licensed Naturopathic physicians
  31. provide.
  32.  
  33. The Affordable Care Act requires non-grandfathered health plans
  34. in the individual and small group markets to cover the
  35. essential health benefits package, which includes 10 general
  36. categories of items and services described in the statute that
  37. are equal in scope to a typical employer health plan. The
  38. benefits must be substantially equal to the essential health
  39. benefits covered by the state benchmark plan. Information on
  40. states' benchmark plans is available here.
  41.  
  42. Plans may also offer additional benefits. Therefore, even if the
  43. state benchmark plan does not cover services provided by a
  44. licensed Naturopathic physician, qualified health plans may
  45. choose to cover those services.
  46.  
  47. The law also provides that a health plan or health insurance
  48. issuer shall not discriminate with respect to participation
  49. under the plan or coverage against any health care provider who
  50. is acting within the scope of that provider's license or
  51. certification under applicable state law. The law does "not
  52. require that a group health plan or health insurance issuer
  53. contract with any health care provider willing to abide by the
  54. terms and conditions for participation established by the plan
  55. or issuer," and does not prevent "a group health plan, a health
  56. insurance issuer, or the Secretary from establishing varying
  57. reimbursement rates based on quality or performance measures."
  58. We also note that this requirement addresses the types of
  59. providers included in a network, not which services are
  60. covered. Questions about the provider nondiscrimination
  61. provision, including complaints regarding compliance, can be
  62. submitted to:
  63.  
  64. the State's Department of Insurance for complaints relating to
  65. health insurance issuers;
  66.  
  67. the Centers for Medicare and Medicaid Services (CMS)
  68. at 1-888-393-2789 for complaints relating to non-Federal
  69. governmental plans and health insurance issuers in states in
  70. which CMS is directly enforcing the market reform requirements
  71. of title XXVII of the Public Health Service Act; and
  72.  
  73. the Department of Labor
  74. at www.askebsa.dol.gov or 1-866-444-3272 for complaints
  75. involving employment-based group health plan coverage.
  76.  
  77. Tell us what you think about this response and We the People.
  78.  
  79. Stay Connected
  80.  
  81. Stay connected to the White House by signing up for periodic
  82. email updates from President Obama and other senior
  83. administration officials.
  84.  
  85. t.dallmann
  86.  
  87. Message 2 of 4 , Jan 21[-- Image: Frame2 --]
  88.  
  89.  
  90.  
  91. View Source
  92.  
  93. My mom got this same email at work yesterday (she live in MN)
  94. and forwarded it to me. Any translating anyone might give would
  95. be appreciated!
  96.  
  97. Terra Dallmann NMD
  98.  
  99. Scottsdale AZ
  100.  
  101. sherri jacobs
  102.  
  103. Message 3 of 4 , Jan 21[-- Image: Frame3 --]
  104.  
  105.  
  106.  
  107. View Source
  108.  
  109. I sent it over to my lawyer for translation....will let you know
  110. what he comes up with!
  111.  
  112.  
  113.  
  114. Sherri Jacobs, ND, CNS
  115. Chas SC
  116. www.HealthECoaching.com
  117.  
  118. keri.larocque
  119.  
  120. Message 4 of 4 , Jan 22[-- Image: Frame4 --]
  121.  
  122.  
  123.  
  124. View Source
  125.  
  126. My husband is in the home stretch of law school, and his two
  127. cents is that it is stating that the ACA (Affordable Care Act)
  128. itself does not prevent NDs from being covered, but sends that
  129. decision to the states.  All states have 10 areas of care that
  130. must be covered (ambulatory, prescription drugs, mental health
  131. services, emergency, hospitalization, rehab, labs, peds,
  132. maternity and Preventative Wellness care).  Each state then has
  133. "extra" coverage sections that will vary.  We don't necessarily
  134. fall under Prevention- depends on how the states define the
  135. services.  We might be covered there or under "extra coverage".
  136.  So, it feels confusing, because it is intentionally vague.
  137.  
  138. Under a growing blanket of snow…
  139.  
  140. Keri Layton, ND
  141.  
  142. Providence and Wakefield, RI
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