Medicare Ruling Levels Playing Field Between Nutrition Professionals

Among the private health insurance reforms introduced by Section 1201 of the Affordable Care Act is a new Section 2706 of the Public Health Service Act, “Non-discrimination in health care.” This provision, which went into effect in 2014, states that health plans (including group and individual plans) “shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.” This provision can play a significant role in promoting greater access by consumers to health care and supports your freedom to choose how you maintain your health and wellness.

Many consumers have already felt the benefits of this provision. Here in Washington State, United Healthcare had insurance policies last year which limited acupuncture to a medical doctor. In the State of Washington, Acupuncture is in the scope of practice for an MD. A medical doctor could actually practice acupuncture without any acupuncture training. In addition, the American Board of Medical Acupuncture (ABMA) manages training for Western medical doctors and has a directory of physicians who have completed the program on their web-site. Their requirement is 200 hours of training along with 100 hours of clinic. This is 1/10th of the training required of licensed Acupuncturists and is not a requirement for an MD to practice acupuncture. Today, United Healthcare has to open all their insurance policies to practitioners licensed by the state to practice acupuncture. This is a huge win and a huge benefit for consumers who want the best and most qualified care for their healthcare dollars.

Another strong statement happened this month, June of 2014, the US Department of Health and Human Services Centers for Medicare and Medicaid ruled in favor of expanding § 482.28 to include all qualified nutritional professionals. § 482.28 addresses hospital food and hospital dietary services.

Originally, this section limited food and dietary professionals to Registered Dieticians. Yet, with the adoption of the Affordable Care Act and Section 2706, all nutritional professionals working within the scope of their license would qualify as a nutritional professional in hospitals. The US Department of Health and Human Service ruling to expand § 482.28 supports the intent of Affordable Care Act to advocate for your freedom to choose nutritional guidance from a variety of professionals.

In the State of Washington the current law for nutrition is a “Licensure Without Exclusive Scope of Practice”. This law certifies dietitians and nutritionists and there is a non-RD pathway to certification. Certification gives you the right to use the titles “certified dietitian” and “certified nutritionist”. However, there is no certification requirement for providing nutrition care so non-certified practitioners have the right to practice.

In other words, “licensure without exclusive scope of practice” specifies the criteria that must be met in order to be able to use the title “Certified Dietitian” or “Certified Nutritionist”. Yet, it does not limit nutritional advice to these titles, and does not criminalize th practice of nutrition by other types of professionals not holding a Certified Dietitian or Nutritionist title.

In Washington, scope of practice for Acupuncturists, Chiropractors, Naturopaths, and MD’s include nutritional and dietary advice and recommendation of supplements enabling consumers to choose a variety of different professionals to address the dietary needs. Each profession addresses nutrition from a slightly different background based on the education and training.