As part of the Affordable Care Act’s implementation, states are defining the minimum level of coverage insurers must extend to millions of people starting in 2014. But if these essential health benefits are not carefully defined when states establish state health insurance exchanges, consumers could effectively lose access to affordable services provided by certain health professionals.
In Oregon, for example, the minimum coverage standards don’t include services like family and marital therapy, chiropractic care, naturopathic care and acupuncture. During public hearings, citizens raised concerns that these important services will not be reimbursed under the minimum coverage plan outlined by the state health insurance exchange.
“If insurance coverage doesn’t extend to the full range of certified and licensed healthcare professionals, patients may not be able to afford to see the providers who best meet their needs,” said Katherine C. Nordal, spokesperson for the Coalition for Patients’ RightsTM, a national coalition that represents more than three million licensed and certified healthcare professionals. “State policymakers need to carefully design health insurance exchanges so they preserve patient access.”
Access and coverage can vary from state to state. Sixteen states had established health insurance exchanges as of Sept. 14, according to the Kaiser Family Foundation (http://statehealthfacts.kff.org/
Some states have taken action or are considering measures to protect patient choice and access:
· In Nevada, the state health insurance mandates include a provision specifically allowing individuals to be reimbursed if they visit a “non-MD specialist” for a covered service.[ii]
· California legislators included acupuncture as an essential health benefit.[iv]
· A Virginia advisory board supported offering speech therapy and chiropractic care as essential health benefits. iii
· In Michigan, chiropractic care would be covered under the draft essential health benefits. iii
“The Coalition applauds states’ efforts to reimburse a broader range of care providers, but there is more work to be done,” said Nordal. “With an estimated 30 million people expected to gain insurance under healthcare reform, we will need all hands on deck to provide the care patients need. It is critical to protect affordable access to the full range of licensed, trained and certified professionals.”
In some states, the exchanges run the risk of perpetuating existing issues involving patient access to care and reimbursement. For example, experienced operating room nurses are utilized nationwide to serve as the first assistant during surgery, in part due to surgeon shortages and mandated reductions in surgical residents’ work hours. However, many health insurance policies do not reimburse registered nurse first assistants (RNFAs) who undergo specialized training to provide this care. In New York, the state’s health insurance exchange has not taken action to recognize RNFAs, although failing to reimburse these trained personnel could mean longer waits for patients who need surgical procedures.
Patients can play a role in determining essential health benefits and the professionals eligible to provide them by writing to state legislators and requesting that reimbursement for their preferred healthcare professionals be incorporated into the state health insurance exchange where they live. The Coalition has provided a template letter at http://www.patientsrightscoalition.org/
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About the Coalition for Patients’ Rights™
A national coalition of more than 35 professional membership organizations, the Coalition for Patients’ Rights (CPR) represents more than three million licensed and certified healthcare professionals and is committed to ensuring comprehensive healthcare choices for all patients. Formed in 2006, the Coalition supports a patient’s right to choose the healthcare professionals who best meet their health needs. To that end, the CPR advocates for the ability of all healthcare professionals to practice to the full extent of their ability, training, certification and licensure and works to ensure that transparent, patient-centered scope of practice guidelines promote consumer access to safe, high-quality and cost-effective healthcare.
The Coalition is comprised of a diverse array of healthcare professionals, including registered nurses, naturopathic doctors, psychologists, speech-language pathologists, audiologists, marriage and family therapists, occupational therapists, physical therapists, advanced practice registered nurses (certified registered nurse anesthetists, nurse practitioners, certified nurse-midwives and clinical nurse specialists)
State of Oregon, “Oregon’s Benchmark Selection Process for EHBs in the Commercial Market.” September 2012. Retrieved from http://www.oregon.gov/