SENATE MEMORIAL 94

52nd legislature - STATE OF NEW MEXICO - second session, 2016

INTRODUCED BY

Mary Kay Papen

A MEMORIAL

REQUESTING THE OFFICE OF SUPERINTENDENT OF INSURANCE TO CONVENE A MEETING OF STAKEHOLDERS ON REIMBURSEMENT AND COST-SHARING PRACTICES OF STATE GROUP HEALTH PLANS AND HEALTH INSURERS WITH RESPECT TO COMPLEMENTARY AND ALTERNATIVE MEDICINE SERVICES.

     WHEREAS, New Mexico has been among those states that, early on, recognized the value of oriental medicine, chiropractic, massage therapy and naprapathic services, which are referred to as "complementary and alternative" to conventional medicine; and

     WHEREAS, New Mexico has licensed or otherwise authorized the practice of these complementary and alternative services by educated and trained health professionals; and

     WHEREAS, New Mexico is a rural state with many areas designated as medically underserved and as health professional shortage areas; and

     WHEREAS, it is in the best interests of New Mexicans to expand, rather than limit, access to the full range of practitioners licensed or otherwise authorized by the state to provide health care services; and

     WHEREAS, the national center for complementary and integrative health of the national institutes of health defines "integrative medicine" as a combination of "mainstream medical therapies and complementary and alternative medicine therapies for which there is some high-quality scientific evidence of safety and effectiveness"; and

     WHEREAS, over the last twenty-five years, the demand for integrative medicine has increased dramatically and created a national community of more than three hundred fifty thousand complementary and alternative service providers; and

     WHEREAS, integrative medicine is becoming part of conventional medical programs in the nation's most respected and innovative health care systems, such as the Cleveland clinic, the Mayo clinic and the M.D. Anderson cancer center, in military and veterans health systems and as part of the curriculum at the nation's top medical schools; and

     WHEREAS, according to the Cleveland clinic children's center for pediatric integrative medicine, integrative medicine "may help to reduce the severity or frequency of disease episodes, decrease stress related to chronic disease" and improve quality of life; and

     WHEREAS, conditions that this children's center commonly treats with integrative medicine include anxiety, arthritis, asthma, brain injury, chronic pain, concussion, headache, mobility impairment, pulmonary issues, slow healing and vocal chord dysfunction; and

     WHEREAS, according to the Cleveland clinic, integrative medicine "can reverse" the consequences of unhealthy lifestyles, prevent illness and reduce symptoms resulting in decreased pain; improved sleep; enhanced immune function and fewer infections; lowered blood pressure, cholesterol and glucose levels; fewer complications following surgery; improvements in posttraumatic stress disorder; and improved post-operative outcomes; and

     WHEREAS, the university of New Mexico center for life was established in 2007 as part of an expansion of clinical services of the section of integrative medicine at the university of New Mexico health sciences center; and

     WHEREAS, the center for life is "a healing oriented practice" that "makes use of all appropriate therapies, both conventional and complementary"; and

     WHEREAS, the university of New Mexico cancer center, a designated national cancer institute, offers complementary and alternative medicine and integrative medicine among a wide range of programs to support its patients' total well-being; and

     WHEREAS, despite the wider recognition and adoption of integrative medicine, group health plans and health insurers have discriminated against complementary and alternative service providers when it comes to reimbursement, compared to reimbursement of conventional medical providers; and

     WHEREAS, insured patients who prefer nonsurgical and nonpharmaceutical approaches to address pain or illness, or to supplement conventional modes of treatment, are required to pay more out of pocket to access complementary and alternative services, either through higher co-payments or limits on the number of treatments in a policy year; and

     WHEREAS, Section 2706 of the federal Patient Protection and Affordable Care Act provides that group health plans as well as insurers offering group or individual health insurance coverage shall not discriminate against licensed health care providers "with respect to participation in the [health] plan or coverage"; and

     WHEREAS, according to the United States senate committee on appropriations, the goal of this provision is "to ensure that patients have the right to access covered services from the full range of providers licensed and certified in their [s]tate"; and

     WHEREAS, while Section 2706 does not prevent a health insurer from "varying reimbursement rates based on quality or performance measures", the same senate committee noted that Section 2706 was intended to prevent discrimination against certain types of providers in reimbursement rates based on factors other than quality or performance, such as "market considerations"; and

     WHEREAS, it does not appear that Section 2706 is working as intended for New Mexicans, including state employees and retirees; and

     WHEREAS, it appears that health insurers and group health plans, including those administered by the risk management division of the general services department, are discriminating against complementary and alternative medicine providers in favor of conventional medicine and the use of pharmaceuticals; and

     WHEREAS, New Mexico's prescription opioid epidemic should be reason alone for the state to ensure that group health plans and health insurers encourage and pay for nonpharmaceutical alternatives to treat chronic pain through equitable access to complementary and alternative medicine;

     NOW, THEREFORE, BE IT RESOLVED BY THE SENATE OF THE STATE OF NEW MEXICO that the office of superintendent of insurance convene a meeting of stakeholders to discuss the following business policies or practices in effect at any time on or after January 1, 2014 for group health plans for state employees, local public bodies, public schools and institutions of higher education and for the state's ten-largest health insurers, based on the number of covered lives that are regulated by the office of superintendent of insurance:

          A. reimbursement of complementary and alternative medicine services;

          B. patient cost-sharing for complementary and alternative medicine services;

          C. reimbursement of conventional medical providers who see patients for chronic pain; and

          D. patient cost-sharing for visits to conventional medical providers for chronic pain; and

     BE IT FURTHER RESOLVED that stakeholders be requested to provide input for these same group health plans and health insurers with respect to business policies or practices in effect at any time on or after January 1, 2014 on:

          A. whether reimbursement and patient cost-sharing have contributed to or correlate with patterns of increased prescribing of opioids for diagnoses of chronic pain or have resulted in or correlate with a decreased use of complementary and alternative medicine for chronic pain;

          B. the financial impact of reimbursement and patient cost-sharing on New Mexico's providers of complementary and alternative medicine;

          C. the financial impact on patients who have sought access to complementary and alternative medicine services; and

          D. whether reimbursement and patient cost-sharing pose barriers to making integrative medicine more widely available to insured New Mexicans; and

     BE IT FURTHER RESOLVED that stakeholders include, at a minimum, representatives of:

          A. complementary and alternative medicine professions that are licensed or otherwise authorized to practice in New Mexico;

          B. health care systems, providers or facilities that offer integrative medicine in New Mexico;

          C. tribal health care providers;

          D. the university of New Mexico center for life;

          E. the university of New Mexico cancer center;

          F. the ten-largest health insurers in the state;

          G. the office of superintendent of insurance;

          H. the New Mexico health insurance exchange;

          I. the department of health;

          J. the medical assistance division of the human services department;

          K. the risk management division of the general services department;

          L. the board of pharmacy;

          M. patient and consumer advocates; and

          N. such other parties as determined by the office of superintendent of insurance; and

     BE IT FURTHER RESOLVED that the office of superintendent of insurance report its findings and recommendations resulting from the stakeholder meeting to the interim legislative health and human services committee no later than October 1, 2016; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the office of superintendent of insurance, the risk management division of the general services department, the boards and commissions division of the regulation and licensing department, the naprapathic task force of the New Mexico medical board, the university of New Mexico center for life, the university of New Mexico cancer center, the department of health, the human services department and the Indian affairs department.

- 8 -