The Patient Protection and Affordable Care Act (ACA)
Provider Non-Discrimination Provision
Patient Protection and Affordable Care Act
What This Is
The ACA includes non-discrimination language that will restrict health insurance companies from discriminating against any health care provider, with respect to participation under the plan, who is acting within the scope of the applicable state license or state law.
What This Means for SLPs and Audiologists
The provision will apply across all categories of providers. It will prevent insurers from routinely discriminating against entire classes of health care providers if they are willing to abide by the terms and conditions for participation and are acting within their scope of practice and in compliance with their state licensure requirements. This provision will apply to group health plans and health insurers offering group or individual health insurance coverage, which could include
- self-insured employee health benefit (Employment Retirement Income Security Act, ERISA) plans
- group health insurance
- individual health insurance
- plans participating in health insurance exchanges
However, the provision does not require coverage of a previously uncovered service, regardless of who provides the service, nor does it require a plan to contract with any willing provider. Insurers will also have the option of restricting the number of providers of a given specialty in their medical panel. Speech-language pathologists and audiologists may have the option of appealing decisions based on proximity to clients or on specialty areas (e.g., pediatric swallowing) that are inadequately addressed by the insurer. Additionally, the provision cannot prevent the establishment of varying reimbursement rates based on quality or performance measures.
Implementation Time Line
The non-discrimination provision will go into effect at the beginning of the applicable plan year on or after January 1, 2014.
ASHA will monitor the potential impact of this provision, including how it will be interpreted and enforced.