CoveredCA FAQs

Chiropractic and the Patient Protection and Affordable Care Act – Covered California

Frequently Asked Questions

 

I heard that chiropractic isn’t included in the Essential Health Benefits (EHB) and chiropractors are not on the new provider panels. What are the facts?

Doctors of chiropractic are included on the new qualified health plan panels as providers. For 2014, chiropractic manipulative therapy is not a covered benefit and CMT codes will not be accepted by Exchange plans on the individual market. However, doctors of chiropractic wishing to provide services to those patients in the California Exchange may bill for all other services covered within our scope of practice. These services may include office visits, rehabilitative/habilitative services and wellness/preventive services that are covered by the EHB.

What is the Exchange and what are these Qualified Health Plans (QHPs)?

California’s Exchange is called Covered California and can be accessed at www.coveredca.com.


The Covered California board has required insurers of the Exchange to only offer EHB on individual plans. 

For a health plan to be qualified for the Exchange, it must meet the EHB minimum benchmark. In 2012, the California Legislature chose the Kaiser 30 EHB plan. The Kaiser 30 EHB plan is regulated by the Department of Managed Health Care. There are 11 Qualified Health Plans on the individual market on the Exchange. California has been divided into 19 regions however, not all plans are available in all regions.


When does this all go into effect?


January 1, 2014. Initial patient plan enrollment began October 1, 2013 and will continue through March 31, 2014.  Open plan enrollment will occur from October through December on an annual basis.


How do I find out if I am on the panels?


You can call the qualified health plans in your area or can check online at www.coveredca.com.


CCA has provided detailed instructions on how to determine if you are on the Exchange provider panels. To view the Covered California and Essential Health Benefit Provider Panel fact sheet: click here.

I thought the federal statute stated that they couldn’t discriminate against chiropractors. What about provider non-discrimination and Section 2706?

Section 2706 of the federal Affordable Care Act defines provider non-discrimination and states that a provider cannot be discriminated against providing covered benefits within their scope of practice based upon licensure. 

However, Section 2706 does not mandate that all services and benefits be part of any state’s essential health benefits. EHB are intended to be the minimum that an insurer can offer in a plan.

The Department of Health and Human Services has not issued regulations regarding implementation and enforcement of Section 2706, but has stated that insurers should exercise a “good faith” attempt at implementation of non-discrimination. CCA will be aggressively pursuing legislation in 2014 that will clearly define provider non-discrimination in California.

What is going to happen in the future with EHB and provider non-discrimination? And what is CCA doing about it?

CCA is not happy that chiropractic manipulative services are not a covered benefit and continues to work for inclusion at every opportunity. Chiropractic Manipulative Therapy is the most important service we provide for our patients and CCA will not stop advocating for that coverage.

Insurers have already submitted their plans and premiums to the Department of Insurance (DOI) and the Department of Managed Health Care (DMHC) for 2014 and those cannot be changed at this time.

CoveredCA has stated that it will consider allowing all plans to offer additional benefits beyond the EHB in 2015. Additionally, the California legislature is allowed to consider choosing a different benchmark for EHB in 2016. CCA will be advocating strongly for any new benchmark to include full chiropractic benefits.

Regarding the implementation and enforcement of Section 2706, CCA has been meeting with regulators at the DOI, the DMHC and representatives from the Exchange board and will continue to do so. Additionally, CCA will be strongly encouraging the Exchange board to allow additional benefits to be offered in 2015. CCA will also be pursuing legislation in 2014 that will clearly define provider non-discrimination in California. 

What do I need to be telling my patients?

Doctors of chiropractic can be a resource for their patients whose individual plans notify them that their insurance plan is no longer available beginning January 1, 2014. 

Direct your patients to www.coveredca.com. On this site, patients will be able to determine if they are eligible for a subsidy for an Exchange plan. If they are eligible, they can sign up for coverage through CoveredCa.  If they do not qualify based upon their income, they can purchase a plan off of the Exchange. All individual plans will offer identical coverage for 2014. 

Inform your patients that even if their insurance plan does not include chiropractic manipulative treatment, you are still able to perform many of the covered services included in their plan.

What happens in January when I have a patient that has one of those new health plans? Can I bill for services?

For 2014, chiropractic manipulative therapy (CMT) is not a covered benefit and CMT codes will not be accepted by Exchange plans on the individual market. CMT will be reimbursed within group plans and grandfathered individual plans (plans purchased prior to March 23, 2010). However, doctors of chiropractic wishing to provide services to those patients in the California Exchange may bill for all other services covered within our scope of practice. These services may include office visits, rehabilitative/habilitative services and wellness/preventive services that are covered by the EHB.

Do the Exchange plans affect my regular insurance and cash patients?

No. Doctors of chiropractic must continue to practice in the same manner whether treating patients within the Exchange, cash basis or regular insurance. That means that the treatment plan must contain chiropractic manipulative care as part of the overall treatment and that such care must be documented in your patient files regardless of coverage.

I have two employees. What do I have to do regarding notification of the new healthcare exchange?

Under the Affordable Care Act, employers covered by the Fair Labor Standards Act (FSLA) must provide notification to their employees about the new health insurance marketplace. Eligible employers are required to notify current employees by October, 1 2013, and new employees who start after October 1, 2013 within 14 days of the employee’s start date.

CCA recommends that chiropractic offices that have one or more employees provide notice to your employees and any future hires. For the CCA Chiropractic Offices and PPACA – Notice Fact Sheet, click here.

I think it is totally unacceptable that chiropractic benefit isn’t included on the Exchange panels and I want to do something about it! What can I do?

Stay informed! CCA will be providing continual updates on our website and via email to our members regarding the Exchange panels and other developments. Become familiar with and utilize our new 24/7 Grassroots Action center – click here.

As stated previously, Insurers have already submitted their plans and premiums to the Department of Insurance (DOI) and the Department of Managed Health Care (DMHC) for 2014 and those cannot be changed at this time. Therefore, any grassroots efforts to try and change these plans would not be fruitful. However, we encourage you to contact your state representatives to let them know of your concerns.

Where can I get more information?

CCA has dedicated a section of the CCA website to Chiropractic and the Patient Protection and Affordable Care Act – Covered California. This section is updated on a regular basis. To view this page - click here.

Questions?

Contact Dr. Kassie Donoghue, CCA Governmental Affairs Director at (916) 648-2727, ext 130 or kdonoghue@calchiro.org.

Please note: The information contained herein is current as of December 2013. CCA will keep you informed of any changes or additional information regarding Covered California as we become aware. For the latest updates, please refer to the Patient Protection and Affordable Care Act – Covered California section of the CCA website. To view this page - click here.