Breaking: Acupuncture Added As Essential Health Benefit in
By Brenda Duran, Senior Associate Editor
Acupuncture will be considered an "essential health
benefit" in California and will be covered by individual and small group
health plans starting in 2014.
On Sept. 30, Gov. Jerry Brown signed measures SB 951 and AB 1453,
which included acupuncture to be covered under the federal health reform also
known as the Patient Protection and Affordable Care Act (PPACA) that was signed
into law on March 23, 2010.
The health care law will require all insurance plans to cover a
specific set of benefits. The health law includes 10 broad categories that must
be included, leaving the specifics to every state. The legislation establishes
the minimum health benefits that must be offered to consumers.
The two measures included acupuncture as an essential health
benefit that the state can begin to offer through federally subsidized plans
for individuals and families as well as unsubsidized plans.
U.S. Supreme Court Upholds Key Health Care Reform
What it all means for California licensed
In a 5–4 split decision, the Supreme Court upheld almost all of
the Obama administration’s heath care reform legislation—the Patient
Protection and Affordable Care Act (PPACA)—including
the law’s individual mandate requirements.
In short, this ruling, coupled with legislation currently under
consideration in the California legislature, will likely mean that the vast
majority of California’s 38 million residents will have a basic level of
acupuncture coverage starting in 2014. In all likelihood, this base acupuncture
coverage will be equivalent to the coverage currently provided under the Kaiser
Small Group HMO plan, which provides for up to 20 covered acupuncture visits
It is important to understand that each insurance plan will
still establish its own reimbursement rate for acupuncture services as they
currently do. The adoption of the Kaiser Small Group HMO plan as a benchmark
does not mean that Kaiser’s reimbursement rates will be adopted. It simply
means that the acupuncture coverage value to the consumer must
be as high or higher than the coverage provided by the Kaiser Small Group HMO
for almost all insurance plans.
Another key provision of the health care reform law is the
"Non-discrimination in Health Care” language. This language will, starting
in 2014, prohibit health plans from discriminating against providers who are
providing services within their state-defined scope of practice. In other
words, plans could no longer require that acupuncture services be rendered only
by a medical doctor. There are a few exceptions detailed below.
EHB in California
California became the first state to enact a health benefit
exchange under PPACA. In 2011, the state created the California Health Benefit Exchange (HBEX), an
independent public entity within state government with a five-member board
appointed by the Governor and the Legislature. On January 30, 2012, the HBEX submitted formal
comments to HHS regarding the HHS Essential Health Benefits