Topic:
MEDICAID; MEDICAL CARE; MEDICARE; LEGISLATION; SOCIAL SERVICES; HEALTH INSURANCE;
Location:
INSURANCE - HEALTH;

OLR Research Report


December 21, 2005

 

2005-R-0918

MEDICAID AND MEDICARE COVERAGE FOR NATUROPATHS

By: Robin K. Cohen, Principal Analyst

You asked a number of questions regarding publicly-funded coverage for naturopathy services. You wanted to know (1) whether Medicaid pays for services provided by a naturopath, including blood work these practitioners order and (2) if not, whether the legislature has tried to mandate this coverage. You also asked if Medicare covers naturopathy services.

SUMMARY

Until 2002, Medicaid paid for naturopathy services. But PA 02-7, May 9 SS, eliminated coverage for a number of Medicaid “optional” services, although it did not explicitly eliminate any particular services. Rather, it required the Department of Social Services (DSS) to submit a Medicaid state plan amendment to conform to the 2002 budget act, which reduced funding for Medicaid “other practitioners.” DSS subsequently issued policy transmittals outlining its intention to stop paying independent practitioners (including naturopaths), effective January 1, 2003.

Although it will not pay for services a naturopath provides directly to a patient, Medicaid will pay for blood tests that a naturopath orders provided (1) the ordered test falls within the naturopath's scope of

practice, (2) the lab performing the blood work in enrolled in Medicaid, and (3) the test is a covered Medicaid procedure, reports DSS' David Parrella.

In the 2003, 2004, and 2005 sessions, the legislature considered bills to restore Medicaid coverage for optional services, but none passed. The bills received overwhelming support from the medical community and other advocates, but DSS consistently opposed them for budgetary reasons. None of these bills made it past the Appropriations Committee.

Medicare does not pay for naturopath services, nor does it pay for blood tests these practitioners order. Medicare pays only for services performed or ordered by Medicare-certified providers, and naturopaths are not certified because (1) federal Medicare law does not include them and (2) federal policymakers have concluded that their services are not adequate to diagnose and treat illness.

LEGISLATION TO RESTORE MEDICAID COVERAGE

Although the legislature eliminated optional Medicaid services in 2002, it considered bills in the next three sessions to restore them. HB 6680, raised by the Public Health Committee, received support from numerous advocacy groups, including the National Association of Social Workers. But DSS opposed the bill, citing the lack of funds in the proposed FY 04 budget. The committee passed it unanimously and referred it to Appropriations. Appropriations did not act on it.

The Human Services Committee passed its own version of this legislation. Its bill (SB 685) also died in Appropriations.

Public Health and Human Services raised identical bills in 2004 and 2005, respectively. These bills also died in Appropriations, but the votes were not unanimously in favor of passage.

MEDICARE

The Center for Medicare Advocacy's Lara Stauning points to relatively old federal caselaw as cementing Medicare's unwillingness to cover naturopath services, including blood tests that a lab would perform. In the case, (Rastetter v. HEW, 379 FSupp. 170), plaintiffs challenged a portion of the Social Security Act that did not include chiropractors and naturopaths in the definition of “physician services.”

In the case, the judge wrote that Congress had requested a study just after Medicare was first enacted to determine what should be included in Medicare Part B. The study, conducted by the U.S. Department of Health, Education, and Welfare (now Health and Human Services) concluded that naturopathic services should not be included because (1) naturopathic theory and practice were not based on the body of basic knowledge related to health, disease, and health care that the medical community had widely accepted and (2) the “scope and quality” of naturopathic education did not prepare the practitioner to make an “adequate diagnosis” or provide “appropriate treatment.”

Interestingly, in 2003, the Centers for Medicare and Medicaid Services, the federal Medicare agency, appointed two naturopaths to the U. S. Medicare Coverage Advisory Committee, possibly signaling the Bush administration's willingness to re-think the policy.

RC:dw