Congress Poised to Address Provider Nondiscrimination Before End of Year

Tuesday, December 15, 2020

Congress Poised to Address Provider Nondiscrimination Before End of Year

By John Falardeau

In 2009-2010, the American Chiropractic Association (ACA) was heavily involved in procuring a provision in the Patient Protection and Affordable Care Act (PPACA) that would end the blatant discrimination doctors of chiropractic and other providers encountered from insurance companies and plans just because of their doctoral degree.  Chiropractors, especially, faced, and continue to experience, discriminatory practices from payors that ultimately harm patient choice, access, and affordability.

The provider nondiscrimination provision in the Public Health Service Act, section 2706 (a) reads in part, “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.” It was achieved primarily due to ACA and other provider group collaboration with then-Sen. Tom Harkin (D-Iowa) and help from other key players such as then-Sen. Chris Dodd (D-Conn.). Although he did not support the final bill overall, then-Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the nondiscrimination provision.

Since that time, ACA has fought for proper implementation during the regulatory process, with little success. While enforcement of Sec. 2706 (a) falls primarily to the states, and some states, such as Oregon and Connecticut have implementation or enforcement language in place, the federal government is the final arbiter and the current Administration and many states have little interest in seeing the PPACA and its provisions succeed. 

Congressional interest in addressing this issue has been tepid...until this week.  As part of a larger bill to address surprise billing practices, a vital provision involving provider discrimination will ensure that patients have access to care, no matter where they live, by requiring insurers to treat providers fairly.  Specifically, the provision requires the Secretaries of Health and Human Services, Labor, and Treasury to promulgate a rule within six months of enactment, implementing protections against provider discrimination.

The non-MD/DO coalition that ACA belongs to, the Patient Access to Responsible Care Alliance (PARCA), worked to advance this language and we believe that the federal government must help ensure the appropriate implementation of provider nondiscrimination protections under section 2706(a) of the Public Health Service Act (42 U.S.C. 300gg-5(a)). By prohibiting the exclusion of non-MD/DO providers from insurance networks based solely on the provider’s licensure, this consumer-friendly provision promotes competition, consumer choice and high-quality healthcare.

The coalition believes that this provision is a necessary part of striking an important balance between patients, providers, and insurers. The critical language around provider nondiscrimination is an important part of ensuring that patients have access to care, no matter where they live, by requiring insurers to treat providers fairly.  It can also be said that the far reach of Sec. 2706, which affects ERISA, group and self-insured plans, and plans available on state exchanges, may have a greater impact than other programs, including Medicare.

For more on Sec. 2706 of the Public Health Service Act, click here

John Falardeau is ACA senior vice president of public policy and advocacy.

 

 

 

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