A recent notification from the Great-West Life Assurance Company to advisors and plan sponsors described new developments regarding the submission of claims for acupuncture treatments in the provinces of Ontario, Newfoundland and Labrador.
June 25, 2013 By Massage Therapy Canada
A recent notification from the Great-West Life Assurance Company to advisors and plan sponsors described new developments regarding the submission of claims for acupuncture treatments in the provinces of Ontario, Newfoundland and Labrador. The Canadian Contemporary Acupuncture Association (CCAA) found a number of discrepancies in the document and penned a letter targeted to the insurance industry. The CCAA also wishes to disseminate the letter amongst health professionals who perform acupuncture treatments. The letter contains a clarification of the inconsistencies between the Great West Life document and acupuncture regulations as well as CCAA recommendations to rectify the misperceptions that will, inevitably, result for practitioners and patients as a result of the document. Although the focus of both communiques is Ontario, these developments may come to have relevance for practitioners who perform acupuncture treatments in other provinces. Following, are both documents – from Great-West Life and the CCAA letter – for practitioners to review.
ABRIDGED LETTER FROM THE CCAA
Hamilton, May 26, 2013
To whom it may concern:
This document has been produced by a multidisciplinary group of professionals representing Ontario health care professions with acupuncture included in their scope of practice. The goal of this document is to clarify the legal environment surrounding the provision and reimbursement of acupuncture services in Ontario.
For years, there has been considerable confusion regarding the reimbursement of acupuncture services by third party payers. This confusion seems to have reached a peak due to the recent full proclamation of the 2006 Traditional Chinese Medicine Act on April 1, 2013.
A recent communication from Great-West Life exemplifies the widespread misunderstanding of the meaning of the proclamation of the 2006 TCM Act in regards to the practice of acupuncture in Ontario.
This document contains three inaccurate statements that reflect the confusion among some of the companies responsible for the reimbursement of health care claims for acupuncture services. The document reads (the underlining is ours):
“As of April 1, 2013, acupuncture is a regulated profession in Ontario. This means that in order to practice, acupuncture practitioners must be registered with The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. The college now oversees and regulates the profession to ensure patients receive safe, high-quality health care services.”
In the same order as the inaccurate statements were made, these are the facts:
- Acupuncture is not a regulated profession in Ontario. Acupuncture is a “regulated treatment procedure” and service that 11 professions can provide legally in Ontario, each within their scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners.
- In order to practice acupuncture in Ontario, practitioners do not have to register with The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO). Practitioners with acupuncture in their scope of practice are only required to meet the requirements of their own professional regulatory college to practice acupuncture.
- The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO), does not regulate the practice of Acupuncture in Ontario. It only regulates the practice of two new health care professions: Traditional Chinese Medicine Practitioner and Registered Acupuncturist, both of which include acupuncture within their scope of practice.
With [the above] clarifications, interested parties could quickly correct the misrepresentation of the meaning of the full proclamation of the 2006 TCM Act, in all forms of communications and policies.
These are our recommendations to the insurance industry:
- The provision of acupuncture services (or the generic name “Acupuncture”) should not be confused with the practice of any specific health care profession in Ontario, including the new professions of Traditional Chinese Medicine Practitioner and Registered Acupuncturist.
- The erroneous information provided to practitioners and insured people in Ontario, by several insurance companies, in various communications since April 1, 2013, should be corrected according to the information contained in this letter.
- Since 11 professions are legally authorized to provide acupuncture services in Ontario, patients receiving the services from any one of these 11 professions, should all be equally eligible to have these health care expenses reimbursed. Otherwise, a case for discrimination could be made by any of the excluded parties.
- Should the insurance industry decide to introduce a new category of benefits to cover the professional services provided by the two new professions (in Ontario) of Traditional Chinese Medicine Practitioner and Registered Acupuncturist, the appropriate legal description of these professions should be used to refer to these new benefits.
- Avoid the use of “acupuncture benefits” as a synonym for the professional services provided by TCM Practitioners and Registered Acupuncturists, as “acupuncture” is not the profession of these professionals.
We expect that the unnecessary confusion regarding acupuncture services reimbursement by third party payers in Ontario will be quickly corrected by the combined action of interested parties, most notably by the members of the newly created professions of Traditional Chinese Medicine Practitioner and Registered Acupuncturist, and by the members of the health insurance industry.
Signed in Ontario this 26th day of May 2013: Daniel Agostinelli PT; Heather MacKay PT; Ravinderpal Ohson MD; Chris O’Connor RMT; Michael Prebeg DC; David Salanki DC; Christine Voldner DC.
NOTIFICATION FROM GREAT-WEST LIFE
As of April 1, 2013, acupuncture is a regulated profession in Ontario. This means that in order to practise, acupuncture practitioners must be registered with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. The college now oversees and regulates the profession to ensure patients receive safe, high-quality healthcare services.
The college has begun compiling a list of regulated practitioners, which is expected to be published on its website, www.ctcmpao.on.ca . Practising acupuncturists who want to become regulated need to successfully complete a course and write an exam in jurisprudence principles to have their names added to the list.
Acupuncture also became a regulated profession in the province of Newfoundland and Labrador, in October 2012. Only acupuncturists who are registered members of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Newfoundland and Labrador are considered eligible providers of acupuncture services in that province.
Practitioners in both provinces have a grace period ending July 1, 2013, to complete the registration process with their respective colleges.
After this date, regardless of the date of service, any claims for treatment from non-registered acupuncture practitioners will be declined.
Great-West Life will send notification letters to all plan members who have submitted a claim in the past six months for acupuncture in Ontario or Newfoundland and Labrador.
For more information: Please contact your Great-West group representative.
To view the entire letter go to: https://www.massagetherapycanada.com/content/view/2198/96/
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