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Acupuncture regulation – Letter from the CCAA

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.

LETTER FROM THE CCAA

Hamilton, May 26, 2013

Subject:  This document is intended to be freely and widely distributed among any potentially interested party, including Professional Colleges and other regulatory bodies of the professions in Ontario with acupuncture included in their scope of regulations, as well as policy makers of the health care insurance industry, and health care professionals practicing a profession in Ontario with acupuncture included in their scope of practice.

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, (included as an addendum to this document) 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:

1. 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.

2. 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.

3. 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.

To further clarify the topic, following is an extract from BILL 50, TCM Act 2006 that specifically names the seven professions (in addition to Medical Doctors and Naturopathic Doctors and persons administering acupuncture as part of an addiction treatment program) that are excluded from the regulatory powers of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, created by the Bill:

Complementary Amendments to CHAPTER 27

An Act respecting the regulation of the profession of traditional Chinese medicine, and making complementary amendments to certain Acts

Assented to December 20, 2006

Note: This Act amends or repeals more than one Act. For the legislative history of these Acts, see Public Statutes – Detailed Legislative History on www.e-Laws.gov.on.ca.

O. Reg 107/96

19.  (1) Paragraph 1 of section 8 of Ontario Regulation 107/96 (Controlled Acts) under the Regulated Health Professions Act, 1991 is revoked.

(2) Section 8 of the Regulation is amended by adding the following subsections:

(2) Subject to subsection (4), a person who is a member of a College listed in Column 1 of the Table is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, in accordance with the standard of practice and within the scope of practice of the health profession listed in Column 2.

TABLE  

                    Column 1                                              Column 2

1.       College of Chiropodists of Ontario            Chiropody

2.       College of Chiropractors of Ontario           Chiropractic

3.       College of Massage Therapists of Ontario  Massage Therapy

4.       College of Nurses of Ontario                              Nursing

5.       College of Occupational Therapists of Ontario     Occupational Therapy

6.       College of Physiotherapists of Ontario                Physiotherapy

7.       Royal College of Dental Surgeons of Ontario       Dentistry

(3) Subject to subsection (4), a person who is registered to practice under the Drugless Practitioners Act by The Board of Directors of Drugless Therapy is exempt from subsection 27 (1) of the Regulated Health Professions Act, 1991 for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, in accordance with the practice of the profession.

(4) A person mentioned in subsection (2) or (3) is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture only if he or she has met the standards and qualifications set by the College or The Board of Directors of Drugless Therapy, as the case may be.

(5) A person is exempt from subsection 27 (1) of the Act for the purpose of performing acupuncture, a procedure performed on tissue below the dermis, if the acupuncture is performed as part of an addiction treatment program and the person performs the acupuncture within a health facility.

In Conclusion:

With the following 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, specifically these facts:

1. 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.

2. 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.

3. 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.

These are our recommendations to the insurance industry:

1. 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. From a legal standpoint, acupuncture is not a profession in Ontario, it is a "regulated treatment procedure" and service provided by 11 different professions, within their respective scope of practice: Chiropodists, Chiropractors, Dentists, Medical Doctors, Naturopathic Doctors, Nurses, Occupational Therapists, Physiotherapists, Registered Acupuncturists, Registered Massage Therapists, and Traditional Chinese Medicine Practitioners.

2. 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.

3. 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.  

4. 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.

5. 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; once again acupuncture in Ontario is a service that these 11 professions can provide legally, 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.

For the benefit of the public of Ontario, 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