The California Acupuncture Board recently covered a broad variety of topics in both public and private meetings. An interesting set of bills, ABX1 (SBX1), was reviewed. The bills prevent health insurance carriers from denying coverage to individuals with pre-existing medical conditions. They also provide guarantees for the small health insurance group market. The bills also establish regions for the establishment of health insurance rates.
Other Recent Legislation
This new California bill coincides with a recently enacted law that adopts a Kaiser Permanente health insurance plan (1637, 30-N) as a template for basic minimum insurance benefits allowed in health insurance plans for small groups and individuals. The Patient Protection and Affordable Care Act, Obamacare, requires all states to set basic minimum standards on essential healthcare benefits such as preventative medicine, ambulatory patient services, hospitalization, maternity care, newborn care, vision screening and tobacco cessation. The California law assures compliance with the new federal law.
The California law, authored by State Senator Bill Monning (D-Carmel) and signed into law by Governor Jerry Brown, establishes details for California’s essential health benefits and takes effect in 2014. Acupuncture for the treatment of pain and nausea will now be a required benefit on all small group and individual healthcare plans in California because it is one of the benefits in the Kaiser plan, which now serves as the minimum template for small group and individual plans. Notably, Maryland has a similar provision assuring that acupuncture treatments are included in all small group and individual plans.
The Kaiser plan adopted as the statewide standard makes no stipulation for the maximum number of visits per a particular time-period. As a result, it will be illegal for insurance companies to arbitrarily limit the number of acupuncture treatments in small group and individual healthcare plans. Limitations will instead be set by medical necessity standards, a common practice in many healthcare plans nationwide. To remain consistent with the current law, ABX1 (SBX1) would need to adopt the same office visit limitation guidelines.
