Here is a document that will help you become more informed about how services become Essential Health Benefits.
Note the second to the last section of this document states that "...The first line of defense is to educate decision-makers about the nondiscrimination provisions and make your state association's voice heard."
To make the state association's (AOMSM) voice heard it is imperative that we have both a strong membership and representation. If you are not an ASM member, please become one today! If you feel passionate about this issue or would like to support other relevant issues, then please volunteer to join an ASM committee; email us today.
New MassHealth regulations went into place allowing for 20 acupuncture treatments. Under the new regulations acupuncture can be provided in three locations acute care settings, community center and physician offices but there needs to be a physician referral, supervision and billing...AOMSM is working to change this so that no physician over site is needed. here is a link to the sections of MassHealth related to acupuncture.
http://www.mass.gov/eohhs/docs/masshealth/regs-provider/regs-physician.pdf (pg. 2, 3, 36, 37, 49)
On December 2, 2013 MassHealth had a public hearing to take testimony on four proposed regulations. We provided a united front, providing similar and supportive testimonies by the AOMSM, NESA and Pathways to Wellness (has 13 licensed acupuncturists who provide 15,000 acupuncture services a year). Although our testimony was well received, it was noted that decisions are going to be made within the month so that programs can be implemented for January 1, 2014.
That this means it that the recommendations although appreciated and offered within the timeline set forth by MassHealth may be too ambitious to be implemented this round. It was reassuring to hear that what we offered in testimony had already been discussed by MassHealth and that if MassHealth is not able to include it in this round of promulgations it will most definitely be added at a later date.
The aspect of the hearing that we were interested in as acupuncturists was"...The proposed changes to MassHealth and Health Safety Net regulations are intended to conform with the changes to eligibility, benefits, and operational processes that will be implemented in accordance with the Affordable Care Act (ACA) and consistent with the Commonwealth’s plans for implementation of the federal Affordable Care Act and related regulations at 42 CFR 433, 435, 440,447, 457..."
The regulations are in reference to services offered in acute care facilities, community health centers and physicians offices. The regulations included the addition of acupuncture as a service in MassHealth plans with the provision that there be a referral by a physician and supervised by a physician, and billing restrictions for acupuncturists.
The AOMSM (supported by NESA and Pathways to Wellness) requested language changes to remove physician referral, supervision and add billing abilities for acupuncturists. We also offered wording and requested a regulation be written specifically for acupuncturist and their services in their own offices.
Below is the testimony that the AOMSM offered on Dec. 2nd 2013 to MassHealth, with the help of our political agent, Dan Delaney &nbssp;
December 2, 2013
Executive Office of Health and Human Services
Office of Medicaid
One Ashburton Place, Room 1109
Boston, MA 02108
The Acupuncture and Oriental Medicine Society of Massachusetts is pleased to see that Office of Medicaid has proposed regulatory changes that recognize the important role that acupuncture can play in improving health care quality and reducing health care costs for MassHealth participants. We believe that these changes are in the interest of patients and health care providers and offer this testimony in support of the proposed regulations.
While strongly supporting the intent of the proposed regulations, we do believe that licensed acupuncturists in the Commonwealth could more effectively meet the intent of the regulations by being permitted to provide care within their scope of practice, and for the services proposed in the regulations, without a mandated supervisory relationship with a physician.
Acupuncturists in Massachusetts are licensed by the same board that licenses physicians. The conditions of their licensure mandate a minimum of 2500 hours of classroom and clinical training. We are highly professionalized and regulated health care practitioners. Our efficacy is well documented in the scientific literature. The widespread incorporation of acupuncture techniques in military and civilian health care in the U.S. and in Europe lend practical evidence to the literature.
We feel strongly that acupuncturists should be eligible to treat MassHealth participants in clinical settings such as community health centers and hospitals without being placed under the direct supervision of a physician and that they should be able to receive direct reimbursement from MassHealth for covered services. We also feel that acupuncturists should be able to provide care to MassHealth participants in their own offices and to be able to receive reimbursements in that clinical setting as well.
The Acupuncture and Oriental Medicine Society of Massachusetts respectfully requests that the Division of Medicaid make the following changes in the proposed regulations:
· Strike 130 CMR 405.474(E)(3)
· Strike the language “under the supervision of a physician” in 130 CMR 405.474(F)(1)
· Strike 130 CMR 410.438(E)(3)
· Strike the language “under the supervision of a physician” in 130 CMR 410.438(F)(1)
· Insert after the words “services performed”, the following : “licensed practitioner” in 130 CMR 410.438(F)(2)
· Strike 130 CMR 433.440(E)(3)
· Strike the language “under the supervision of a physician” in 130 CMR 433.440(F)(1)
· Insert after the words “independent nurse practitioner licensed
· in acupuncture”, the following : “licensed acupuncturists” in 130 CMR 433.440(F)(2)
In addition, we suggest the insertion of the following new section creating a category for acupuncture services, including a definition of acupuncture consistent with the currently proposed regulations, provisions for reimbursement:, and other language as needed. Please see sample language below to indicate AOMSM intent:
130 CMR 485 – Acupuncture Services
Acupuncture – the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of an electric current, and with or without the application of heat to the needles, skin, or both.
(A) Introduction. MassHealth members are eligible to receive acupuncture for the treatment ofpain as described in 130 CMR 433.440(C), for use as an anesthetic as described in 130 CMR 433.454(C), and for use for detoxification as described in 130 CMR 418.406(C)(3).
(B) General. 130 CMR 485.440 applies specifically to licensed practitioners of acupuncture.
(C) Acupuncture for the Treatment of Pain. MassHealth provides a total of 20 sessions of acupuncture for the treatment of pain per member per year without prior authorization. If the member’s condition, treatment, or diagnosis changes, the member may receive more sessions if medically-necessary acupuncture treatment with prior authorization.
(D) Provider Qualifications for Acupuncture
(1) Qualified Providers.
(b) Other practitioners who are licensed in acupuncture by the Massachusetts Board of Registration in Medicine under 243 CMR 5.00 et seq.
(2) Supervising physicians must ensure that acupuncture practitioners for whom the physician will submit claims, possess the appropriate training, credentials, and licensure.
(E) Conditions of Payment. The MassHealth agency pays licensed acupuncturists for acupuncture services when the:
(1) services are limited to the scope of practice authorized by state law or regulation (including but not limited to 243 CMR 5.00 et seq); and;
(2) the acupuncturist has a current license or certificate of registration from the Massachusetts Board of Registration in Medicine.
(F) Acupuncture Claims Submissions.
(1) Licensed acupuncturists may submit claims for acupuncture services when they provide those services directly to MassHealth members or as an exception to 130 CMR 450.301(A) when a licensed practitioner provides those services directly to MassHealth members.
Acupuncture & Oriental Medicine Society of Massachusetts, Board President