5 Ways Affordable Care Act [aka Obamacare] Affects Massage Therapists
Healthcare and insurance law are definitely subjects best left to the experts! We've been really curious about the Affordable Care Act, also known as Obamacare, and we know that you as independent massage therapists have a lot of questions, too. Luckily, Julie Onofrio agreed to shed a little light on the subject. She also collaborated on a a great introduction to insurance billing, if you're interested in downloading it here for free. Enjoy her guest blog post below!
How will the Affordable Care Act (ACA) affect massage? That is the top question on everyone’s mind these days. The short answer: No one really knows. The ACA is a monstrous document but it does have a section that appears to make provisions so that massage may be covered by health insurance plans in every state (notice all the qualifiers in that sentence!).
Here's the section I'm talking about. Feel free to skim and read the bolded parts if reading policy jargon gives you a headache!
SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.
(a) Providers- 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. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.
(b) Individuals- The provisions of section 1558 of the Patient Protection and Affordable Care Act (relating to non-discrimination) shall apply with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage.
There are also other sections that apply to massage.
SEC. 3502. ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME.
SEC. 4001. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL
SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN.
SEC. 5101. NATIONAL HEALTH CARE WORKFORCE COMMISSION.
This FAQ posted on Health and Human Services website on 4/29/2013 helps to clarify things a bit as well:
To the extent service is covered, a plan shall not discriminate based on a provider’s license, to the extent provider acting within scope of license under state law. [42 U.S.C. §300gg-5(a)]
Insurance Exchange System
Each state is in charge of setting up what is called an Insurance Exchange System. States can choose whether or not they want to do it themselves or use the system the Federal Government is setting up. Insurance companies in each state apply to be a part of the exchange system.
Thankfully, the Integrative Healthcare Policy Consortium is working on it for us. They have hired Deborah Senn, the insurance commissioner in Washington state who brought Health Care Reform to the state in the mid 1990s. In Washington state we have something called the ‘Every Category Law” which mandates that insurance companies provide benefits that cover massage.
Here's what that law looks like:
Every category of health care providers
- To effectuate the requirement of RCW 48.43.045 that health plans provide coverage for treatments and services by every category of provider, health carriers shall not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for conditions covered by basic health plan (BHP) services as defined by RCW 48.43.005(4). If the BHP covers the condition, the carrier may not exclude a category of provider who is licensed to provide services for that condition, and is acting within the scope of practice, unless such services would not meet the carrier's standards pursuant to RCW 48.43.045
Essential Health Benefits
The ACA says that plans must cover these basic Essential Health Benefits:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management, and
- Pediatric services, including oral and vision care
We already are able to bill health insurance here in WA and have been able to since around 2000. AMTA-WA is very active in working with the Office of the Insurance Commissioner in WA to preserve the ability to bill insurance under the ACA. They had Diana Thomson, (former President of the Massage Therapy Foundation and author of Hands Heal) and a team of research aware people create a monumental document:
Summary of Evidence: Massage Therapy is an Integral Component in the Affordable Care Actʼs Essential Health Benefits
This 54 page document with 995 research citations shows what areas massage fits into in the Essential Health Benefits: (From the Document)
Of the 10 EHBs specified in the Affordable Care Act, MT has shown substantial benefit in four primary categories:
“1. Ambulatory Services”
“5. Mental health and substance use disorder services, including behavioral health treatment”
“7. Rehabilitative and habilitative services and devices”
“9. Preventive and wellness services and chronic disease management”
The 5 Things Every Massage Therapist Should Be Doing to Prepare for Obamacare:
- Work with the Office of Insurance Commissioner
Massage therapists across the country really need to be working with the Office of the Insurance Commissioner in their state to ensure that massage will be covered there under the ACA.
- Stay informed and involved
It will be a very long road to creating a place for massage in the exchange systems and implementing the plans. MT's have to stay current with what is going on, read everything you can to stay informed, and get involved with your organizations.
- Learn billing
We need to be prepared for clients who will expect massage therapists to bill insurance in the near future, if they don't already.
Along with learning how to bill insurance, we will need to educate ourselves on HIPAA, privacy, and security concerns.
- Be at the table
How will massage therapists fair working in health care on such a nationwide level? Will we be able to preserve the art and science of massage while working in a system that is constantly reducing allowable fees and benefits? That is part of the new unknown territory we are walking into. As I have heard a few times though from John Weeks of the Academic Consortium for Complementary & Alternative Health Care:
"If we are not at the table, we are what is on the menu."
You can find more information about the Affordable Care Act and it's impact on massage therapy here:
Integrative Healthcare Policy Consortium
IHPC – Massage Blog
IHPC - Facebook page