APA Practice Organization addresses provider non-discrimination issue

Current guidelines could restrict provider participation and limit beneficiary access to services.

On June 9, the APA Practice Organization called on the Departments of Labor, Health and Human Services, and the Treasury (PDF, 117KB) to revoke and revise a Frequently Asked Question (FAQ) released by the Departments in April 2013 on the provider non-discrimination section (2706(a)) of the Public Health Service Act. As written, the FAQ could be used to restrict provider participation in group health insurance plans and limit beneficiary access to services. If insurance plans exclude certain types of providers patients could face an inadequate number of diversely-skilled health care professionals from whom they can obtain treatment.

Section 2706(a) states that group health plans and health insurances issuers shall not discriminate against any health care provider acting within the scope of his or her licensure, from participating under the plan or insurance coverage. The FAQ indicates that the section does not require plans or issuers to accept all types of providers into a network and also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations. 

A July 11, 2013 report from the Senate Committee on Appropriations found that the FAQ as written indicates that section 2706(a) allows the very discrimination that the Public Health Service Act was intended to prohibit. APAPO supports the Senate Committee’s position that the only exceptions to the prohibition against discrimination in reimbursement rates should be performance and quality measures. 

As long as the FAQ guidance is in circulation, there is a risk that plans and insurers could use discriminatory methods to determine reimbursement and coverage for health care services, and limit beneficiary access to qualified health care professionals.