Section 2706(a) of the Public Health Service Act establishes federal non-discrimination protections for providers acting within the scope of their licensure in terms of participation and reimbursement under health insurance and group health plans, specifically group health plans and health insurance issuers offering group or individual health insurance coverage.
A group health plan is any employee welfare benefit plan to the extent that the plan provides medical care to employees or their dependents directly or through insurance, reimbursement, or otherwise including both insured and self-insured plans. A health insurance issuer is any insurance company, insurance service, or insurance organization (including a health maintenance organization) that is licensed to engage in the business of insurance in a state.
The federal government, under several administrations, both Republican and Democrat, has thus far failed to issue rules and regulations pertaining to Sec. 2706(a), as amended by the Affordable Care Act, despite pressure from Congress and non-MD provider groups, including ACA. The law provides that states may enforce the provisions of 2706(a); however, individual states, for the large part, have not enforced the law. That’s where Oregon stepped in.
I sat down recently with Vern Saboe, DC, a member of the ACA Legislative Committee, who is also the lobbyist for the Oregon Chiropractic Association. Dr. Saboe has dedicated several years to ensure that chiropractors in the Beaver State are reimbursed fairly for services rendered.
Watch my interview with Dr. Saboe here.
John Falardeau is senior vice president of public policy and advocacy at the American Chiropractic Association.
