What is the future of Complementary and Alternative Medicine under the Affordable Care Act?

The Complementary and Alternative Medicine Law Blog  is pleased to published the following guest article on integrative medicine and healthcare reform:

 

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What is the future of Complementary and Alternative Medicine under the Affordable Care Act?

Complementary and Alternative Medicine is a growing segment of the U.S. healthcare system. According to a 2011 survey from Consumer Reports, every year 38 million Americans receive more than 300 million CAM treatments. Since most insurance plans have limited coverage for CAM, patients are usually paying for them out-of-pocket.

On average insurance coverage for CAM treatment depends on several factors like state mandates, your health insurance company, and the local licensure or certification of CAM practitioners. Most plans at the moment limit coverage to specific conditions as well as the number of visits you can make to a practitioner each year.

Historically, health insurers have preferred to cover only low-risk, proven medical practices. Before even considering coverage for a CAM treatment most insurers will require proof of its effectiveness and safety from peer reviewed medical literature.

Sadly though, that research can be hard to come by. It’s no secret that research in many areas of CAM lags far behind so-called "evidence-based" medicine. Still, an increasing number of people choose to seek out CAM practitioners for treatment each year.

Now with the upcoming full implementation of the Affordable Care Act on Jan. 1, 2014, we will finally see some changes in the way CAM treatments are covered by insurance.

Inside the Obama administration's landmark law is Section 2706, the Non-Discrimination in Health Care clause which states: “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.”

The wording may be a little confusing but what this means essentially is that if a CAM practitioner is licensed within a state to perform certain procedures then insurance companies must give them the same consideration as they would a medical doctor.

So because of this clause, insurers could cover your visits to licensed CAM practitioners like acupuncturists, chiropractors, massage therapists, and naturopathic doctors. Now the question is, how will this change complementary and alternative medicine in the future?

There are a couple of different views regarding the future of CAM and the Care Act. Some believe that this will help promote integration among different practitioners that will improve the delivery of quality care to consumers. Others think it will lead to a more philosophical shift in health care moving the U.S. from focusing on just medical interventions to more health promotion and maintenance.

Allowing CAM practitioners to participate in the direct care of patients sits right in line with what the Consortium of Academic Health Centers for Integrative Medicine envisions: “a comprehensive and compassionate health care system offering seamless integration of effective complementary and conventional approaches to promote healing and health in every individual and community.”

However, changes might not be as significant as some people expect. Before a CAM procedure can be approved for coverage, it must be proven safe, effective, as well as cost-effective.

The situation might be a little harder if you are enrolled in Medicaid. Only medically necessary care that falls into the ten “essential health benefits” categories of the Care Act will be included for coverage under the government-sponsored program.

Still, the Non-Discrimination clause will be helpful to those who wish to seek options outside of conventional medicine. Some people would like to deal with pain through natural means and want to avoid unnecessary surgeries. Removing payment barriers can help doctors and other medical practitioners refer their patients to CAM practitioners without worrying too much about limited insurance coverage.

Admittedly the Affordable Care Act has a lot of work ahead of it with more than 45 million Americans currently without any form of health insurance. For public officials getting ready for the implementation of the health care law, wider access to CAM treatments is probably not a priority. But giving patients coverage for even limited access to nontraditional medicine is certainly a step toward the right direction toward solving America’s worsening health problems.

Michael Cahill is Editor of the Vista Health Solutions blog. He has a degree in Journalism from SUNY New Paltz and previously worked as a reporter for the Poughkeepsie Journal and an editor for the Rockland County Times. Follow him on Twitter at @VistaHealth and @ElectronicMike

 

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The Michael H. Cohen Law Group in Los Angeles, California provides healthcare regulatory, corporate, and litigation legal counsel.  We do not offer healthcare insurance services, and express no opinion regarding the foregoing guest editorial.

 

For more information, contact the Michael H. Cohen Law Group.

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