HHS reverses course on Harkin Law guidance
A federal agency's correction of its erroneous sub-regulatory guidance on the national provider nondiscrimination law represents a hard-fought AOA advocacy victory years in the making.
The U.S. Department of Health and Human Services (HHS) posted online a revised FAQ on May 26, superseding its previous guidance that led some states and health plans to implement the provider nondiscrimination law—more commonly known to AOA members as the Harkin Law—in a way not intended by Congress.
That previous guidance, issued by HHS on April 29, 2013, strayed from the intent of Section 2706(a) of the Public Health Service (PHS) Act that barred discrimination against providers in participation and coverage based on licensure, and suggested insurers could avoid compliance by relying on so-called medical management techniques or market reimbursement standards.
Now, according to the revised FAQ, HHS has stopped embracing those loopholes and will take enforcement action against any group health plan or health insurance issuer that has failed to use "a good faith, reasonable interpretation of the statutory provision."
Removal of the previous guidance language may make it easier for states and third party advocates to grow the impact of the national provider nondiscrimination law, which AOA members fought so hard to enact.
This revised guidance is the result of tireless efforts by AOA, state affiliates and countless members over the past two years to see HHS clarify the misleading language, and to protect the provision against threats from other groups, says AOA President David A. Cockrell, O.D.
"Organized medicine and some in the health insurance industry have never relented in their campaign targeting patient choice and access to local doctors of optometry," Dr. Cockrell says.
"For more than a half-decade, medicine and health insurers have joined forces to fight against AOA and the pro-access policies we champion. Together, they fought us as Congress drafted and later enacted the national provider nondiscrimination law, and they kept on fighting us—on the federal, state and third-party payer levels—to undermine the pro-patient law even before it was fully implemented."
Click here to read more about how AOA, state affiliates and members urged Congressional leaders to increase pressure on HHS to revise the guidance.