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Breaking: Acupuncture Added As Essential Health Benefit in California

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 Elements 

What it all means for California licensed acupuncturists…

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 per year.

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 Bulletin (12/16/2012)