Congress must close Medicare gaps in access to non-drug pain management


As our population ages and the opioid crisis continues to ravage our communities, increasing access to high-value non-pharmacological options to manage pain and chronic disease must be a top priority for Congress. Current Medicare coverage does not reflect current guidelines for pain treatment, and a simple first step is to improve coverage for pain. 64 million Americans enrolled to better include chiropractic and acupuncture.

Bipartisan solutions have already been introduced, but as the midterm elections approach, the window for Congress to address the current limitations of the Medicare program through reconciliation is closing.

Chiropractic care and acupuncture are advised in many best practice guidelines as first-line pain treatments. Both are more and more covered in commercial health plans, and patients are looking for non-drug approaches to managing their pain and chronic conditions.

However, arbitrary limits on Medicare coverage mean that the elderly – arguably one of the most important groups to consider when thinking about pain and chronic disease – do not have access to recommended, evidence-based care. on evidence they deserve. Now is the time for Congress to pass bipartisan legislation to create greater choice and better outcomes for patients, as well as projected cost savings to the system.

Current limits

The American College of Physicians (as well as other reputable organizations) recommended both spinal manipulation and exercise (usually provided by chiropractic physicians) and acupuncture for common back pain, before prescription or over-the-counter medications. One would expect Medicare coverage to reflect current guidelines, ensuring our seniors have convenient and affordable access to the safest and most effective care. Unfortunately, it is not the case: arbitrary limits on interventions and visits restrict beneficiary access.

For example, chiropractic coverage in Medicare consists of a single service: spinal manipulation. Examinations, clinically necessary imaging, rehabilitation and exercise are not covered if provided by a chiropractor, although they are covered if provided by another type of provider. This results in the event of interrupted or delayed care, and higher out-of-pocket costs for the beneficiary.

Like chiropractic, early acupuncture treatment for spinal pain was shown to reduce the need for advanced imaging, invasive procedures and opioid medications. However, recipients cannot receive acupuncture from most licensed acupuncturists, arguably the most expert in providing this service. (CMS limits licensed providers to physicians or “auxiliary personnel” who must be supervised by a physician, physician assistant, or nurse practitioner.)

Lack of access to these safe and recommended procedures directs patients with back pain in particular to less valuable services such as advanced imaging and invasive procedures, including surgery, and increase the risk of an acute problem becoming chronic.

Closing these gaps would close a gap between the current Medicare program and the Affordable Care Act, which states that group health plans and health insurance issuers cannot discriminate against a health care provider acting within the scope of their license under state law . Congress has a responsibility to update and reform these programs to align them with the intent of this non-discrimination provision, especially as they seek to extend expiring grants to keep costs low.

Legislative proposals to extend health insurance coverage

Better access to chiropractic and acupuncture services can lead to fewer visits to primary care providers, resulting substantial savings in annual Medicare program costs, lower costs per beneficiary among patients within Medicare, and projected cost savings to the system.

Bipartisan legislative measures at the federal level have already been introduced and are viable options to address existing coverage gaps within Medicare:

  • S. 4042/HR 2654, The Chiropractic Health Insurance Coverage Modernization Act – this bill would expand Medicare coverage to include more chiropractic care options, resulting in improved spine care for seniors, increased access to opioid-free pain management and cost savings overall in the Medicare system. This bill does not expand benefits within Medicare; rather, it allows beneficiaries to seek care from chiropractors for covered services that fall within their scope of practice, thereby expanding patient choice and the health care provider workforce.
  • HR 4803, The Acupuncture for Our Elders Act – this bill will allow the Centers for Medicare & Medicaid Services (CMS) to recognize licensed acupuncturists as Medicare providers, which will result in increased and expanded access to acupuncture services for the treatment of back pain chronicles. This will allow beneficiaries to see a licensed acupuncturist for care, rectifying current coverage that discriminates against a class of licensed providers and severely limits access, essentially constituting a virtual benefit.

Expanding coverage of chiropractic and acupuncture services is a simple but necessary policy solution to increase access to carereduce the use of opioids and make health care more affordable. It would be shortsighted for Congress to debate ways to reform Medicare and expand coverage options without closing these coverage gaps. Our seniors deserve access to the safest and most effective pain and chronic disease care. Chiropractic care and acupuncture are sought and recommended; Congress must make them accessible.

Michele MaiersDC, MPH, PhD, is executive director of research and innovation at Northwestern University of Health Sciences


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