IHPC Response to HHS RFI on Section 2706

IHPC is making available here its June 5 response to the Request for Information Regarding Provider Non-Discrimination issued in March by the Centers for Medicare and Medicaid Services (CMS). The response enumerates examples of ongoing insurer discrimination since Section 2706 went into effect on January 1, and describes the results of a large survey IHPC conducted among the nation’s practitioners.

This RFI was ordered by the Senate Appropriations Committee a year ago to rectify what the committee determined was a very misguided FAQ that the department of Health and Human Services, Treasury and Labor issued in the spring of 2013 as guidance on the implementation of Section 2706.

The survey of more than 5,300 practitioners includes members of IHPC’s Partners for Health — naturopathic physicians, licensed acupuncturists, chiropractors, licensed massage therapists, licensed midwives — as well as medical doctors, osteopathic physicians, optometrists, clinical psychologists, registered nurses, physician assistants, advanced practice registered nurses, homeopaths, physical therapists, and occupational therapists.

Among the key findings of the survey: Despite efforts to assist patients with reimbursement documentation requirements, practitioners reported:

• 85% (more than 3,600 respondents) said their patients were rarely,
  irregularly, or incompletely successful in obtaining reimbursement for the healthcare
  services they provided and coded on a superbill.
• Problems also exist among providers who contract with a third-party payer. Twenty one percent
  report that patient access to healthcare services has been denied since January 1st, 2014.

Among the seven primary recommendations in the IHPC response:

“Clearly provide, in the newly-issued guidance, that commercial insurers must allow all types of licensed providers to participate in their networks and to clearly define terms such as network adequacy.”