Healthcare Reform & Chiropractic

Now that the dust has settled. The healthcare reform bill signed by President Obama is now law. How does it affect your chiropractic care? Some things like increased taxes take affect immediately but other things like requiring everyone to have insurance will take affect years later. Medicare funding has also been cut by hundreds of billions so it will most likely affect Medicare Advantage coverage eventually. I did not find any wording to that effect so far. It does not make sense to keep the pay rates the same or increase them when you are increasing the people covered and cutting the funding. Currently, basic Medicare only covers chiropractic adjustment and no physiotherapy modalities like heat, ice and therapeutic techniques. However, "increases the Part D initial coverage limit by $500 for 2010 to reduce the size of the coverage gap(Effective January 1, 2010) (Section 10328.)" A few things specifically relating to chiropractic are:

Non-discrimination in health care; Sec. 2706:
"No health plan or insurer may discriminate against any health provider acting within the scope of that provider’s license or
certification under applicable State law." Insurances cannot discriminate against chiropractors from practicing from their training and licensure on a federal level.

Community Health Teams; Sec. 3502:
"DCs named as potential members of Community Health Teams to support the development of 'medical homes.'" Chiropractors can now be included as a discipline in community homes.

National Health Care Workforce Commission; Sec. 5101:
"DCs are specifically included as part of the National Health Care Workforce Commission defined as “Health Care Professionals,” and schools of chiropractic are also included in the health professional training schools definition." Chiropractic will be address as a part of any federal healthcare workforce program.

All the above will take effect as of January 1, 2014.


Here are other things that I found thanks to information provided by the American Chiropractic Association (ACA):

Within the first year
• Young adults will be able stay on their parents' insurance until their 26th birthday.
• Insurers will be barred from imposing exclusions on children with pre-existing conditions. Pools will cover those with pre-existing health conditions until health care coverage exchanges are operational.
• Insurers will not be able to rescind policies to avoid paying medical bills when a person becomes ill.
• Lifetime limits on benefits and restrictive annual limits will be prohibited.
• New plans must provide coverage for preventive services without co-pays. All plans must comply by 2018.
• A temporary reinsurance program will help offset costs of coverage for companies that provide early retiree health benefits for those ages 55 to 64.
• New plans will be required to implement an appeals process for coverage determinations and claims.
• Adoption tax credit and assistance exclusion will increase by $1,000. The bill makes the credit refundable and extends it through 2011.
• Businesses with fewer than 50 employees will get tax credits covering 35 percent of their health care premiums, increasing to 50 percent by 2014.

January 1, 2011
• Medicare will provide free annual wellness visits and personalized prevention plans. New plans will be required to cover preventive services with no co-pay.
• A plan to provide a vehicle for small businesses to offer tax-free benefits will be
created. This would ease the small employer's administrative burden of sponsoring a cafeteria plan.
• The Medicare payroll tax will increase from 1.45 percent to 2.35 percent for individuals earning more than $200,000 and married filing jointly above $250,000.

January 1, 2013
• Health plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.
• Contributions to flexible savings accounts will be limited to $2,500 per year, indexed by the Consumer Price Index in subsequent years.
• There will be increases to the income threshold from 7.5 percent to 10 percent of adjusted gross income. Those older than 65 can claim the 7.5 percent deduction through 2016.

A 2.9 percent excise tax on the first sale of medical devices will be established. Excepted are eyeglasses, contact lenses, hearing aids or other items for individual use.

January 1, 2018
• Taxing "Cadillac" plans: An excise tax will be imposed on high-cost, employer-provided health plans beyond $27,500 for family coverage and $10,200 for single coverage; it will increase to $30,950 for families and $11,850 for individuals, retirees and employees in high-risk professions.

FAQs: How Health Care Reform Will
Affect You and Your Patients
On Tuesday, March 23, 2010, President Obama signed H.R. 3590, the Patient Protection and Affordable Care Act into law.
Here are answers to some frequently asked questions about what reform will mean
to doctors of chiropractic and your patients.

What provisions begin soon?
Starting this year, children up to age 26 would be allowed to remain on their parents' health plan. People with pre-existing medical conditions would be eligible for a new federally funded "high-risk" insurance program.
Small businesses could qualify for tax credits of up to 35% of the cost of premiums. Insurance plans would be barred from setting lifetime caps on coverage and would no longer be able to cancel policies when a patient gets sick. Health plans would also be prohibited from excluding pre-existing conditions from coverage for children.

When do the main reform changes kick in?
In 2014. That’s when insurance marketplaces, or exchanges, would be set up in states to offer competitive pricing on health policies for individuals and small businesses that don’t have coverage. People with a pre-existing condition would no longer be denied coverage, and all lifetime and annual limits on coverage
would be eliminated. Medicaid would be expanded to cover more low-income Americans.

What are the requirements for individuals to buy insurance?
Starting in 2014, a person who did not obtain coverage would pay a penalty of $95 or 1% of income, whichever is greater. That penalty would rise to $695 or 2.5% of income by 2016. The bill would exempt the lowest-income people from that insurance requirement. Medicaid would be expanded to cover those under age 65 with an income of up to 133% of the federal poverty level (below $29,327 for a family of four). To make coverage more affordable, the legislation would offer premium subsidies for people with incomes more than 133% but less than 400% of the federal poverty level ($29,327 to $88, 200 for a family of four). In addition, people in their 20s would have the option to buy a lower-cost "catastrophic" health plan.

How will small employers be affected by the changes?
Employers with 50 or more workers would face fines for not providing insurance coverage. Businesses with smaller workforces, though, would be exempt. Companies would get tax credits to help buy insurance if they have 25 or fewer employees and
a workforce with an average wage of up to $50,000.

Does the bill affect the Medicare chiropractic benefit?
There is no inclusion of an expansion of services DCs may be reimbursed for by Medicare. Full chiropractic parity in Medicare remains a signature issue for the ACA and we continue to work with the Congress and the Administration in achieving this goal.

What changes will occur in Medicaid?
Individuals and families with incomes up to 133% of the federal poverty level (below $29,327 for a family of four) will gain coverage. The federal government will pay all the states’ costs for the newly eligible Medicaid beneficiaries for three years. And primary-care doctors treating Medicaid patients will get an increase in their fees. Chiropractic availability is determined by the state and will remain a state by
state issue.

Will reform reduce health insurance costs?
Many health care experts say that while it contains some cost-cutting provisions and pilot programs, the legislation doesn’t go far enough to tame rising costs. People
with chronic medical problems, though, generally would see their premiums
decrease because of the new ban on pre-existing conditions.

How will the $940 billion price tag (over 10 years) be paid for?
Wealthier families will pay more in taxes. Starting in 2013, families with annual incomes above $250,000 (and individuals earning more than $200,000) would pay an additional 3.8% tax on investment income, and also face a higher Medicare payroll tax. Expensive, "Cadillac" insurance plans would draw a new tax starting in 2018.
And the Medicare program would receive substantial cuts, including a $132 billion
reduction in funding for Advantage plans run by private insurers.

How was provider discrimination in health care addressed?
This was one of the premier issues for ACA. Section 2706 of the bill states that, “No health plan or insurer may discriminate against any health provider acting within
the scope of that provider’s license or certification under applicable State
law.” This is the first federal level non-discrimination clause to protect doctors of chiropractic regarding participation in a health plan. This will ensure that insurance
companies cannot unfairly exclude doctors of chiropractic from practicing under the capacity of their training and licensure on a federal level. This provision is also applicable to ERISA plans and other plans established or regulated under the bill.

What are Community Health Teams and how do chiropractors benefit?
“Community Health Teams” were created to support the development of medical homes by increasing access to comprehensive, community based, coordinated care. These teams are integrated provider groups including primary care providers, specialists, and other clinicians and licensed integrative health professionals as well
as community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill specifically lists DCs as potential members of Community Health Teams to support the development of “medical homes” and ensures that doctors of chiropractic can be included in these patient-centered and holistic teams.

How does the law address the national health care workforce shortage?
The legislation calls for the creation of a “National Health Care Workforce Commission,” tasked with providing comprehensive information to Congress and the Administration about how to align federal health care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. DCs specifically included as part of the National Health Care Workforce Commission; included in the definition of “Health Care Professionals.” Also, chiropractic colleges are also included in the health professional training schools definition. The language in the bill guarantees that the need for doctors of chiropractic will be addressed
when considering federal health care workforce programs.

ChiroWorks Care Center
Anthony Tsai, D.C.
Chiropractor in San Jose, CA
ChiroWorksCareCenter.com
Graston Technique Certified
FAKTR-PM Completed

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References:
ACA Today
Medicare Official Website
Centers for Medicare & Medicaid Services