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 Medicaid Ohio

Ruling 5160-8-51
Theresa Mhanna

Health Care System

PCOM

11/2017 

In my State of Ohio, Medicaid has just pasted a new ruling to allow acupuncture as an alternative treatment. Ohio is the first Midwest state to offer acupuncture to Medicaid. (Weeks, 2017) The ruling is 5160-8-51.  It became effect October 1, 2017.  It is restricted to low back pain, migraines and must be considered medically necessary. The qualified acupuncturist will receive payment for up to 30 visits per year, this is generous, compared to chiropractors and massage therapist only get 12 visits per year.. A referral or written script is required by a physician that takes Medicaid.  The acupuncturist has to be a registered Medicaid provider. (Rule, 2017) Treatment for Acupuncture with electrical stimulation has been covered since Jan 1, 2017. (UHC, 2017)

 30 visits per year are generous for treatments. There is a provision that allows a request to be granted by Medicaid for more treatments if medically necessary. This is fantastic when compared to allowed Chiropractic treatments of 12 a year.

All of this is fantastic news for the acupuncture world. Ohio is usually the middle of the road type of state. It is now taking the lead to open avenues for Ohio acupuncturist and for other states to follow.  I don’t like the restrictions of only low back pain and migraines, but the board is open to discussion of widening the scope of what we do in the future. For the time being it is a starting point as recognition and will help us in being leaders as primary care providers in the future. We have just begun to break the ice in educating the medical society of the scope of conditions we address.

The new ruling states there will be no payment if there is no improvement after” initial treatment period” (initial treatment period is not defined.) or if symptoms worsen over the course of treatment.  I will be writing the president of our organization, so maybe in the future, there will be a better definition. Services are to be covered in non-institutional settings. No Hospitals.  

Reimbursement rates are $25.00 for 97810 code and $17.50 for 97811 code. You can bill 97811 up to 3 times. Code 97813 rate of pay is $31.15, and code 97814 rate of pay is $23.65.(UHC, 2017) These prices are fantastic if you compare them to California reimbursement rates of $5.79 for each code 97810, 97811, 97813, and 97814 (CA.gov, 2007) I think that what Ohio wants to pay us is not a fair market value. It is a way too low for the services and results we offer. Ohio should be paying acupuncturist a minimum of $70.00 for initial 15 unit, then $60.00 for each additional unit. Historical Example of acupuncture from the ‘Chambers’s Twentieth Century Dictionary (part 1 of 4: A-D) state that acupuncture is an operation for pain relief. (Various, 2017) We do penetrate (brake) the skin. Surgery is defined by Segen’s Medical Dictionary that which is an incision in the skin and mucous membrane surface, to skillfully cut and to manage or revise a failing body part to make better. (Segen’s, 2012) Considering this, we should be paid higher for our services.

 There will be no payment for evaluation and management of services (E&M).  No extra payments for Gua Sha, Tui’ n,' cupping, Qigong breathing exercises, etc. (rule, 2017 ) We should be reimbursed for E&M and all other modalities such as cupping, Tui’na, etc. We do the work it, and it can make a difference in our outcomes. No other doctor can evaluate for us because we have a different standard of diagnosis. Other doctors who use acupuncture in their office don’t understand how our diagnosis affects the outcome of our work. It is an in-depth study we have learned. This can end up being detrimental to us because we can’t treat if we don’t’ make a Chinese diagnosis. This would cause us not to be able to practice if the importance of our diagnosis is not recognized.  It could also benefit us in that other health care providers will come to respect us and learn that our techniques are valuable. This will come about through talk from clients. So, we might not be getting reimbursed at the moment but in the long run, we will because what we do works.

This new ruling is expected to increase Ohio State expenditures to $186,000. This is only an estimate. There is a speculation that will make the increase in expenditures neutral because people won’t be using other health care services (RSFA, 2017) I can see the state saving a lot of money. Research has shown that Acupuncture for low back pain, breech birth can save money. (CU, n.d.)

All acupuncture providers are acceptable under this new ruling as long as they have the proper credentials accepted by the State of Ohio.  This would include registered nurses, Physician Assistants, Physicians (must hold an active specialization through the NCCAOM), there is no mention of any Physical Therapist. I’m not thrilled about sharing what I do with under qualified medical professionals. For the time being this is how the law is. We can only be happy that we have gained grown by being part of this new ruling of Medicaid.

Chiropractors are not satisfied with the bill because they are not being covered with 100% reimbursement. Not being reimbursed for E&M is something that needs to be addressed in the future. The chiropractic Association is fighting for this. We could team up with them and have a stronger voice to influence the medical board. Doctors and other qualified acupuncturist are not allowed to be reimbursed for E&M if they are performed by the same practitioner to the same individual on the same day as acupuncture assessment is done. (CSI, 2017)

As a recommendation to the memorandum from Common Sense Initiative (CSI), the suggestion of having a meeting in the next four months with all acupuncture certified practitioners that are concerned to present Scientific Evidence to support expanding acupuncture service and rules regarding chiropractors. (CSI, 2017) HMO Care Source has already changed its benefits package to reflect acceptance of acupuncture (Care Source, 2017, pg. V) this all sounds good. We need more Evidence-Based research to present to the medical board, or they will never take us seriously. Our state organization is asking for peer reviews and clients to submit to our organization and Ohio Medicaid Ohio to expand our services and reimburse us for E&M. (Weeks, 2017)

There are many issues to address here.  How they affect me as a practitioner could be great if I decide to become a Medicaid provider.  My clientele could pick up, and this would be a boom for my small business. I could potentially hire someone to do the billing for me. It also could be a hindrance to me by creating a lot of business with very little pay. So, do I want to be busy with little pay or not participate in this program. It also sets the standard for what our value is in regards to how little reimbursement that we are getting for our services.  I believe that this trickle’s down to how practitioners regard their patients. If I’m getting paid next to nothing for my services how am I supposed to keep a high morale in treating my patients! Yes, I believe in the “it is what I give that is most important, ” but I have to eat and pay bills. I didn’t invest myself in this field just for the feel goods.

It is a precedent for the whole nation. A few states have accepted acupuncture in their Medicaid protocol. This is the recognition we have been seeking. This is the door we have worked so hard to open. It gives the opportunity to the underclass of America to experience the benefits of holistic medicine. The low prices for reimbursement is not a good example for the nation and being restricted to only low back pain and migraines is very limiting and does not show the other areas of medical conditions that we excel in.

An outlined plan to educate other healthcare administrators and legislators will start with our local organization, Ohio Association of Acupuncture and Oriental Medicine (OAAOM). OAAOM has meetings to set goals and brings members together to keep us involved with our federal, state, and local levels. It is a constant process of advertisement and education. My state organization has requested that all members write our legislator and present them with evidence-based research to make them more aware of all the conditions that we treat. We are also making our clients and family informed of how effective acupuncture is and encouraging them to write legislators also.

 Resources

CA.gov, (2007), Part 2- Acupuncture (ACU), Department of Health Care Services, Medi-Cal, Retrieved from http://files.medi-cal.ca.gov/pubsdoco/manual/man_query.asp?wSearch=%28%23filename+%2A%5F%2Aa00%2A%2Edoc+OR+%23filename+%2A%5F%2Aa00%2A%2Ezip+OR+%23filename+%2A%5F%2Aa01%2A%2Edoc+OR+%23filename+%2A%5F%2Aa01%2A%2Ezip+OR+%23filename+%2A%5F%2Az00%2A%2Edoc+OR+%23filename+%2A%5F%2Az00%2A%2Ezip+OR+%23filename+%2A%5F%2Az02%2A%2Edoc+OR+%23filename+%2A%5F%2Az02%2A%2Ezip%29&wFLogo=Part+2+%26%23150%3B+Acupuncture+%28ACU%29&wFLogoH=52&wFLogoW=516&wAlt=Part+2+%26%23150%3B+Acupuncture+%28ACU%29&wPath=N

Care Source, (2017), Member Handbook with Annual Notice of Change for 2018, Care Source/MyCare Ohio, retrieved from https://www.caresource.com/documents/2018-medicare-medicaid-member-handbook-with-anoc-508/

CSI, (10/17/2017), Memorandum, Register of Ohio, Retrieved from http://www.registerofohio.state.oh.us//servlet/RooBusinessPDF?&ruleActionId=530980&docTypeId=15

CU, (n.d.), Do alternative medicine treatments help us save money? Evidence-based Living, Cornell University,                Retrieved from evidencebasedliving.human.cornell.edu/2012/10/24/do-alternative-medicine-treatments-              help-us-save-money/

Rule, (10/17/2017), Acupuncture Services, Register of Ohio, Retrieved from http://www.registerofohio.state.oh.us/pdfs/5160/0/8/5160-8-51_PH_OF_N_RU_20171017_1635.pdf

RSFA, (10/17/2017), Rule Summary and Fiscal Analysis (Part A), Register of Ohio, Retrieved from www.registerofohio.state.oh.us/pdfs/5160/0/8/5160-8-51_PH_OF_N_RS_20171017_1635.pdf

Segen’s, (2012), Surgery Medspeak, The Free Dictionary by Farlex, https://medical-dictionary.thefreedictionary.com/Surgery+operation

UHC, (July 1, 2017), Reimbursement for Acupuncture services for United Healthcare Community Plan Medicaid Members in Ohio, United Health Care Community Plan, Retrieved from https://www.uhccommunityplan.com/content/dam/communityplan/healthcareprofessionals/Bulletins/OH-Bulletins/OH-Bulletin-The Reimbursement-for-Acupuncture-Services-FAQ-10272017.pdf

Various, (2017), acupuncture, Dictionary.com Retrieved from www.dictionary.com/browse/acupuncture

Weeks J, (June 21, 2017), Ohio to open Medicaid to acupuncture; Comment period open through June 23, Integrative Practitioner, Retrieved from https://www.integrativepractitioner.com/whats-new/all-news/ohio-open-medicaid-acupuncture-comment-period-open-june-23/


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