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Posted on Feb 28, 2019

Congress Includes Chiropractic Care in Two New Bills

Jun 4, 2018 ICA News

June 4, 2018, (Falls Church, VA) Legislators in the US House of Representatives have introduced two pieces of legislation in which chiropractic is mentioned. They are:

HR 5722 – Dr. Todd Graham Pain Management Improvement Act of 2018
HR 5776, – MOST Act
HR 5722 was introduced by Representative Jackie Walorski (R-IN) and Representative Judy Chu (D-CA).  The legislation calls upon the Secretary of Health and Human Services to conduct a study and report back to Congress on how to improve the use of non-opioid treatments for acute and chronic pain management in both Part A and B of the Medicare program.

The requested study is to evaluate the effect reimbursement, coverage and coding policies related to non-opioid treatments for both acute and chronic pain management should be revised. The legislation specifically mentioned integrative health approaches as well as chiropractic and calls for an evaluation and recommendation of both administrative and legislative changes needed to improve patient access to non-opioid therapies.

The legislation is named in honor of South Bend, Indiana physician Todd Graham who was murdered by the husband of a patient in 2017.  Dr. Graham had refused to write a pain prescription when he determined the patient’s pain was chronic not acute.

HR 5776 was introduced by Representative Richard E Neal, (D-MA) with Representatives Matt Cartwright (D-PA), George Holding (R-NC), and Scott Taylor (R-VA). The acronym “MOST” stands for Medicare and Opioid Safe Treatment.

HR 5776 seeks to expands Medicare coverage to include reimbursement for opioid use disorder treatment services.  The main objective of this bill is to extend Medicare reimbursement to Opioid treatment programs, provide clarity on the standards needed to be reimbursed as a program, and to provide 100% reimbursement for bundled services in these programs.  A second objective is to expands access under Medicare to addiction treatment in federally qualified health centers and rural health clinics.  As a result, these facilities will be reimbursed for dispensing methadone and other maintenance drugs related to addiction.

Among the additional provisions in the bill, are calls for a review and adjustment of payments under Medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments;
the exploration of ways to avoid unnecessary hospitalizations,
a GAO study on mental and behavioral health services under Medicare;
a study on whether and how to revise payment to providers and suppliers of services and coverage related to “the multi-disciplinary, evidence-based, non-opioid treatments for acute and chronic pain management for individuals under Part A and B of Medicare”;
consultation by HHS with outside professionals and organizations with expertise in the field diagnosing and treating pain; and
evaluating barriers to accessing treatments; potential legislative and administrative changes needed to improve an individuals’ access to currently covered services and a cost and benefits associated with potential expansion of coverage to pain treatment to include acupuncture, therapeutic massage, and items and services furnished by integrated pain management programs.
Both HR 5722 and 5776 are bi-partisan and have assignment to both the Committee on Ways and Means and Committee on Energy and Commerce.  There are similarities in the two bills in the requests to review administrative and legislative changes needed in Medicare related to pain management care.  If these bills should they progress into law offer significant opportunity for chiropractic providers.

Beth Clay, ICA’s Director of Government Relations stated, “A major concern arises in reviewing the MOST Act in that there will be significant costs associated with the expansion of services sought in the bill. Less than two years ago, the Department of Health and Human Services again reported that Medicare with its shrinking taxpayer base, swelling beneficiary numbers and the continued increase in health care costs is not sustainable.[1],[2]Given that 300,000[3]Medicare recipients have been diagnosed with opioid addiction, and some are paying out of pocket for Methadone and other addiction drugs that are currently not reimbursed by Medicare, Congress will is challenged with balancing the desire to be compassionate and the requirement managing costs.”

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