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OANP Advocacy Moves Beyond Legislature

Monday, August 19, 2013   (0 Comments)
Posted by: Brook Schales
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OANP Advocacy Moves Beyond Legislature

Phil Donovan and Ryan Fisher | NW Public Affairs lobbyists

The OANP’s strategy to expanding insurance coverage of NDs has been guided by a plan to ensure naturopathic physicians can treat:

1) Oregon’s Medicaid population,

2) Oregon’s public employee population, and ultimately

3) All Oregonians covered by private medical insurance.

With implementation of the Coordinated Care Organizations last year, and the Affordable Care Act going into effect January 1, 2014, most of OANP’s advocacy work is no longer in the legislative arena working to pass laws. OANP, AANP and our coalition partners already successfully secured provider non-discrimination language in relevant legislation.

Now our work turns to implementation and enforcement – making sure that the details are done right, that agencies and insurers are educated about the laws, and that appropriate action is taken if and when the laws are broken.

So where are we on these fronts?

1) Oregon’s Medicaid providers: Coordinated Care Organizations (CCOs)

Dr. Bruce Goldberg, director of the Oregon Health Authority (OHA), has convened an Integrative Medicine committee to look at how different types of providers can work with the Medicaid population. Doctors Sara Love, Stephanie Kaplan and Carrie Baldwin-Sayre will be representing the OANP at this roundtable to bring together providers with CCO leadership.

The OANP also continues our outreach efforts to local CCOs. We are working with legislative champions such as Speaker Tina Kotek (D-North Portland), Senator Chip Shields (D-North Portland) and Representative John Lively (D-Springfield) to engage CCOs and encourage their credentialing of naturopathic physicians to address the shortage of primary care physicians.

Outcome: CareOregon – representing 4 CCOs in Portland, Yamhill and Jackson counties, and the North Coast, has started credentialing NDs as PCPs. Trillium CCO in Lane county has started accepting applications from NDs as specialists.

2) Public Employees and the Public Employees Benefit Board (PEBB)

PEBB is putting out a request for proposals (RFP) to contract with a new health insurance company for all public employees beginning in 2015. The contract is currently held by Providence. To gain insight for the RFP, the PEBB board surveyed its members to understand what improvements they would like to see to the plan. OANP helped mobilize public employee patients of NDs, who submitted comments across Oregon to the PEBB survey.

Outcome: PEBB’s summary report of the survey holds several references that members across Oregon "expressed a strong need for more alternative care coverage” including access to doctors like NDs as primary care providers, and removal of the current annual cap on all types of providers.

The OANP has met with members of the PEBB Board to highlight that access to providers is an important component of the next PEBB contract and that the Affordable Care Act (ACA) contains a non-discrimination clause that the existing Providence contract would violate. A first draft of the RFP contains a "network” provision and discussion about inclusion of "alternative care providers.”

The OANP has also participated in Allies for Healthy Oregon (AHO). This has put naturopathic physicians and public employee unions at a common table. We are using this opportunity to grow our relationship with the unions that want their members to receive care from the provider of their choice.

3) Private Insurance Plans

OANP has met several times with Oregon’s Insurance Division to educate them about the provider non-discrimination provision in the Affordable Care Act - referred to as "Section 2706.” Beginning January 1, 2014, the ACA prohibits discrimination against a provider based on the type of provider when the provider delivers covered services within the scope of their license.

Outcome: The Oregon Insurance Commissioner disseminated strong clarifying language to all insurers that they may not cover something when it’s done by one provider if they won’t cover it for another provider. The Division also issued a "data call” to understand how insurance companies will implement Section 2706 in order to develop a useful implementation/enforcement plan.

Under Oregon law, insurance companies are required to respond to the data call. We anticipate hard data from the Insurance Division in the coming weeks.

Defending the ground we’ve gained:

While we try to maintain our focus on our priorities, other issues invariably crop up each session, including:

Dry Needling

The association representing acupuncturists introduced a very broad "dry needling” bill that would have rescinded some treatment modalities that have been available to naturopathic physicians for decades. The bill attracted the opposition of a variety of health professions, and as a result of our comments and theirs, the bill died in committee.

Student Loan Repayment

In 2011, the OANP changed the Oregon primary care loan repayment program to include naturopathic physicians. This year, $4 million of federal government dollars were allocated for loan repayment, but limitations were placed on those funds by the federal agency that oversees those dollars. The Center for Medicare and Medicaid Services (CMS) excluded naturopathic physicians (and others) from a "prioritized list” of providers that the funds can go to. While not technically being "ineligible,” NDs are so far down on the prioritized list of eligible providers that effectively no ND would ever qualify. We will be working to address this inequity in the upcoming year.

Your membership supports this kind of round the clock advocacy work – and there is always more we can do! If you know of a friend who isn’t an OANP member, help us continue this work by recruiting them to join today!

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