We discussed a few months ago on our blog that Medicare was analysing the possibility of including acupuncture in its health insurance coverage. The analysis was be limited to acupuncture treatment for lower back pain only, which does affects millions of people. Finally in January of this year, a memo was published about a final decision.
What’s the Status Now in the States?
Already, many private insurance companies include acupuncture treatments like United Healthcare, most of Blue Cross, Cigna, Aetna, Kaiser Permanente, Medicare Sr. Advantage plans (like Humana)…
The traditional pain treatment for lower back pain is currently opioids – but in 2018 the president of the US, Donald Trump, declared that is was a the root of a public health emergency. Indeed, we know that every day 130 people die because of opioids and 2 million Americans have become addicted to these drugs.
In comes Acupuncture, with its proven efficiency and 0 side effects.
Here is a video that describes how acupuncture is studied as an alternative to narcotics. It describes how, thanks to acupuncture, you can reduce or eliminate the pain in a few minutes, see in just a few seconds!
Switzerland is one of the countries that currently recognises acupuncture as a method of care reimbursed by insurance. Not only that but it is also in Switzerland that homeopathy is covered by health insurance.
In Korea, 96% of people use acupuncture! It is the first country at this level, followed by Japan, Taiwan and China, in no particular order.
The New Medicare Approach
As we mentioned, Medicare specialists studied a lot of previous studies about the effects and benefits of acupuncture – but only in the lower back pain area. This is what concerns the US government the most for now, because they need an alternative to opioids. Obviously.
Out of 10 studies (the study studied other studies), 9 demonstrated that acupuncture was clinically superior to the test group for post-treatment of low back pain (cLBP) both immediate and 3 months later.
In addition, 4 studies have shown an immediate reduction in pain following acupuncture treatment after an operation.
In short, compared to the pain treatment usually given to the patient, acupuncture has proven to be a winner. As the director of the AMCC says, we don’t wait for this kind of news to know that it works, we already know!
But it’s always nice to hear you were right all along.
Qualifications Necessary to Practice with Medicare.
For what is practice as such as an acupuncturist in the United States, here is what we find in the memo:
“Currently, acupuncturists are not recognised by CMS as Medicare providers, and are not eligible to bill for acupuncture services. It is possible, however, for acupuncturists to provide acupuncture as auxiliary personnel “incident to” a physician’s service in certain settings. The incident to regulations requires supervision by a physician or other practitioner. For further details regarding “incident to” services, we recommend that interested parties consult 42 CFR §§ 410.26 and 410.27. We are not able to amend these regulations through the national coverage determination process, however, we will change the specific reference to “direct supervision” and will substitute “the appropriate level of supervision required by our regulations at 42 CFR §§ 410.26 and 410.27. ”
So there’s some level of improvement. You can’t be billed as an acupuncturist but as an aid to a physician, you can find a way to get paid, somehow.
“To ensure the quality of services received by Medicare beneficiaries conforms to at least the requirements of private payers, licensed acupuncturists who provide acupuncture services for Medicare beneficiaries must have a masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM), and maintain licensure in a US state or territory (Olson, 2018). Physicians who wish to furnish acupuncture to Medicare beneficiaries may do so in accordance with applicable state requirements.”
So what’s the deal? Are we or aren’t we allowed to receive refund when we practice acupuncture for lower back pain?
Here’s the bottomline:
“Therefore, we believe that in light of the relative safety of the procedure and the grave consequences of the opioid crisis in the United States, there is sufficient rationale to provide this nonpharmacologic treatment to appropriate beneficiaries with chronic low back pain.”
And here’s the official amendment to the Medicare act:
The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances:
- For the purpose of this decision, chronic low back pain (cLBP) is defined as:
- Lasting 12 weeks or longer;
- nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
- not associated with surgery; and
- not associated with pregnancy.
- An additional eight sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually.
- Treatment must be discontinued if the patient is not improving or is regressing.
Physicians (as defined in 1861(r)(1)) may furnish acupuncture in accordance with applicable state requirements.
Physician assistants, nurse practitioners/clinical nurse specialists (as identified in 1861(aa)(5)), and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have:
- A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM); and
- current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth (i.e. Puerto Rico) of the United States, or District of Columbia.
Auxiliary personnel furnishing acupuncture must be under the appropriate level of supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist required by our regulations at 42 CFR §§ 410.26 and 410.27.
So the ACAOM seems to be the way to go if you want to be recognised as a acupuncturist, to some level, by the government.
The AMCC offers online theoretical chinese medicine courses: Bioenergetics program. Only after completing the Natural Health Practitioner can one register to this speciality, it’s a really fascinating world! I don’t think our graduates can become members of the ACAOM automatically but it’s definitely something to look into.
If you enjoyed this article, you might also want to read: