5 states have mandatory acupuncture benefits, California being one of them and it is the only state to specify that acupuncture be provided unlimited for pain management. The vast majority of California's 38 million residents will have a basic level of acupuncture coverage starting in 2014. In all likelihood, this base acupuncture coverage will be equivalent to the coverage currently provided under the Kaiser Small Group HMO plan, which provides for up to 20 covered acupuncture visits per year (this is about the average number of visits per year that's been being covered prior to 2014).
Although we don't totally see this as a green light for coverage (they will still put us through rigorous medical authorization reviews more regularly and/or with high deductibles, gaining access to coverage can be more difficult for some to utilize benefits versus others) this hopefully will still be a huge step in the right direction for the acupuncture profession. Additionally, there can be no discrimination that allows acupuncture by an MD only (a previous exception we sometimes experienced) -if acupuncture is a covered benefit, it must be paid to a licensed acupuncturist. (section 2706 and 2707 of the ACA).
What does this mean for you?
ANY and ALL plans in the State of California must now cover acupuncture. The ONLY possible exception are plans that were "grandfathered" in:
- A grandfathered plan is any coverage provided by a group health plan or a health insurance issuer in which an individual was enrolled on or before March 23, 2010.
- This provision doesn't apply to plan years starting prior to 2014.Starting in 2014, it will take a full year for all non-grandfathered plans to be covered by this section of the law. The non-discrimination provision will only apply to plan years starting in 2014. For example, a plan year that starts in November won't be covered by this provision until November 1, 2014.