Similar to other chronic conditions like diabetes and high blood pressure, chronic pain isn’t typically cured, but is managed with a combination of therapies and approaches specific to the individual. However, if you’re at all familiar with the current state of pain management in the United States, you already know that this kind of interdisciplinary integrative pain care is uncommon—in part because services other than traditional allopathic medical care are often poorly reimbursed and in part because these services are often in short supply in rural and other underserved areas.
Recently, in an effort to optimally treat the 100 million Americans living with pain while reducing the prescription drug overdose epidemic, policymakers are beginning to truly understand the urgent need to ease access to alternative forms of treatment, including chiropractic care, physical therapy, massage therapy, and more. During the 2017-2018 legislative sessions, we have witnessed an encouraging new trend: bills to advance comprehensive, integrative pain management are finally passing!
United States – In relevant part, the National Defense Authorization Act for Fiscal Year 2018 directs the Secretary of Defense to conduct a study on the effectiveness of the training provided to military health care providers regarding opioid prescribing practices. In doing so, the Secretary of Defense shall, in part, consider the feasibility and advisability of further strengthening opioid prescribing practices by means of developing methods to encourage health care providers of the Department to use physical therapy or alternative methods to treat acute or chronic pain.
Louisiana – Senate Bill 285 (2018) prohibits a health insurance issuer from denying a non-opioid prescription in favor of an opioid prescription when prescribed for chronic pain. Effective August 1, 2018, it shall be unlawful for an insurer to deny a prescribed medication and attempt to substitute an alternative medication that requires any of the following:
- An increased number of pills per prescription.
- A higher Drug Enforcement Administration schedule medication than the one prescribed.
- The substitution of an extended release medication that does not have defined abuse deterrent properties for a prescription of a medication that does have defined abuse deterrent properties.
Maine – In March 2018, overriding the Governor’s veto, the legislature passed LD 1030 (2017), An Act to Require Health Insurance Coverage for Covered Services Provided by Naturopathic Doctors. A carrier offering a health plan in this Maine shall provide coverage for health care services performed by a licensed naturopathic doctor when those services are covered services under the health plan when performed by any other health care provider and when those services are within the lawful scope of practice of the naturopathic doctor. The law also institutes requirements related to deductible and co-pay limits and network participation. See AIPM’s letter of support (note: the bill was unfortunately amended after this letter was written—it had started as a non-discrimination bill that would have applied to all health care services, not just naturopathic doctors).
Missouri – House Bill 1516 (2018) states that MO HealthNet shall, subject to appropriation, cover up to twenty visits per year for services limited to examinations, diagnoses, adjustments, and manipulations and treatments of malpositioned articulations and structures of the body provided by licensed chiropractic physicians practicing within their scope of practice. See AIPM’s letter of support for the companion bill, SB 597.
Tennessee – SB 2155 (2018), which took effect July 1st, specifies that in developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance provided by the bureau of TennCare or the health care finance and administration (HCFA), the bureau and the HCFA shall exclude charges related to pain relief that decreases the use of opioids from the calculation of costs for any episode of care.
Washington – Senate Bill 5779 (2017) states that “Health transformation in Washington state requires a multifaceted approach to implement sustainable solutions for the integration of behavioral and physical health.” The legislation concerns behavioral health integration in primary care, requiring a complete review of payment codes available to health plans and providers related to primary care and behavioral health, including adjustments to payment rules if needed to facilitate bidirectional integration.
Finally, there are two important bills just shy of passage:
Delaware – The legislature sent Senate Bill 225 (2018) to the Governor on June 30, 2018. The bill awaits action from the Governor. This bill would prohibit numerical limits on physical therapy and chiropractic care and would ensure that practitioners understand when these treatments are indicated for particular patients by adding continuing education requirements for prescribers relating to risks of opioids and alternatives to opioids. The bill also creates a pilot program within the state employee health care plan that allows the use of massage therapy, acupuncture, and yoga for the treatment of back pain. See the letter of support from AIPM and US Pain Foundation.
Vermont – Senate Bill 224 (2018), as introduced and passed by the Senate, allows health insurers to subject health care services provided by a chiropractic physician to co-payments, but only so long as those co-payments are not greater than the amount of the co-payment applicable to care and services provided by a primary care provider under the plan. However, the House dramatically amended the bill prior to passage, so the bill must go to Conference Committee before reaching the Governor. See the letter of support from AIPM for the as-introduced version of the bill.