Acupuncturists: Medicare Recognition

September 23, 2020

Dear Colleagues, Patients, and Supporters of the Acupuncture Profession:

The American Society of Acupuncturists (ASA) and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) are pleased to announce efforts to recognize acupuncturists as Medicare providers. Medicare recognition is a logical next step for our growing profession, especially as the healthcare system looks for non-pharmaceutical options for pain management.

To accommodate the growing interest in—and demand for—acupuncture services, the profession needs to increase access to services and demonstrate acupuncture as a viable profession to continue to grow the workforce. Medicare recognition would help ensure this access and demonstrate the profession’s viability by enabling acupuncturists to practice at the top of their scopes, which means without supervision.

About Medicare Recognition and its Benefits
Medicare is a federal program that predominantly provides health insurance for Americans over the age of 65. This 60-year-old program continues to expand in services, beneficiaries, and influence. Today, Medicare covers over 50 million individuals. By 2030, the program will cover 80 million Americans. Because of Medicare’s size, influence, and scope, Medicare policies influence third-party payer coverage decisions. For that reason, healthcare professions seeking enhanced recognition and reimbursement from third-party payers often start with Medicare.

The Centers for Medicare and Medicaid Services (CMS) currently recognizes just one acupuncture service for Medicare beneficiaries—chronic lower back pain (cLBP), but does not recognize acupuncturists as Medicare providers. While acupuncturists can provide this service to Medicare beneficiaries, they must do so as “auxiliary personnel,” which requires practicing under a recognized CMS provider’s supervision. Auxiliary personnel cannot directly bill Medicare for services rendered and must instead bill incident to the supervising provider.

Acupuncturists are independent providers, but without Medicare recognition, will continue to practice under supervision as auxiliary personnel for any Medicare purposes. CMS’ required supervision clause conflicts with the acupuncture profession’s scope and practice model.

The lack of provider status significantly restricts Medicare beneficiaries’ access to qualified acupuncturists and prohibits many acupuncturists from treating Medicare beneficiaries with cLBP. CMS has the authority to recognize specific services, but must receive that directive from Congress to recognize a provider group.

Steps toward Medicare Recognition
This Congressional directive results from a Congressional amendment to Social Security Act, the law that established the Medicare program in 1965. Congressional protocol informs the steps of this process, but successful efforts incorporate a provider group’s unique needs. The legislative effort to establish acupuncturists as practitioners under Medicare must be strategic and reflect the profession’s interests. The ASA and the NCCAOM understand the nuances of the acupuncture profession and are strategic and steadfast in advocating for these interests.

Congressional Medicare Strategy
In addition to expanding access to acupuncture services and to individuals who would benefit from these services, Medicare recognition would enable qualified acupuncturists to practice independently when treating Medicare beneficiaries, directly bill Medicare, and generate data that demonstrates acupuncture’s cost and quality values.

This process takes time–often years. Congress is a deliberative body and while we recognize our profession’s value, we must make the case to policy makers. Our legislation will require a score from the Congressional Budget Office (CBO). For our bill to succeed, the CBO will need to score it as a cost-saving or a cost-neutral initiative. This will take an organized effort to gather and present the data available that show that acupuncture is a cost-effective service.

Establishing a cost-effectiveness case for acupuncture recognition is critical to a successful Medicare campaign. Collectively, the profession needs to demonstrate that acupuncture treatments cost less than surgery and opioids and, simultaneously, patients show more progress with the acupuncture.

Congress is heading into a busy campaign season that will last through 2020. During this time, the ASA and the NCCAOM will work with Congressional offices to draft legislation that would direct CMS to recognize acupuncturists as Medicare providers. We will also gather data that demonstrates acupuncture’s effectiveness and cost-benefits. We will look to the profession in due time to provide grassroots advocacy and to message our value as healthcare practitioners.

Next Steps and What the Profession Can Expect
Over the summer, the ASA and NCCAOM hosted a series of Town Halls to answer Medicare-related questions and developed resource documents about Medicare recognition for acupuncturists. You can find these resources at the ASA  and the NCCAOM websites.

We will continue to provide progress updates, query the profession for data, communicate talking points and grassroots advocacy instruction, and provide information on how you can help advance this initiative. This effort is strategic and deliberate. It will take time and patience, and ultimately, a united voice from the profession. As always, we welcome your questions and comments—please get in touch:  [email protected] and [email protected].

Sincerely,

The Board of the American Society of Acupuncturists
The National Certification Commission for Acupuncture and Oriental Medicine