A Michigan Q&A on marketplace coverage reminds us that there is a nondiscrimination rule for providers in health reform. Many plans are taking a wait and see approach for this rule but not all...
Question Can a carrier refuse to cover a required service based on who provides the service?
Answer No, a carrier may not refuse to cover a service as long as the service is provided by a health care provider who is acting under the scope of his or her license or certification. Under Section 2706(a) of the Public Health Service Act (PHSA), issuers may 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.
HHS, IRS, and DOL declined to provide more insight into this rule, stating that the rule is self implementing.
Officials said Section 2706(a) will apply to all non-grandfathered individual and group health plans starting with plan or policy years beginning on or after Jan. 1, 2014.
Insurers should implement Section 2706(a) "using a good faith, reasonable interpretation of the law," officials said.
Some groups that support providers and users of acupuncture, homeopathy, acupuncture, therapeutic massage, midwifery and other forms of care other than treatments provided by conventional medical doctors, stated they intend to do strategic state-by-state campaigns to support the correct implementation of Section 2706.
It appears various groups will have enforcement authority including state insurance departments and CCIIO for issuers and the DOL for employment based group health plan coverage.