Integrative Healthcare Policy Report Preview

2018

INTEGRATIVE HEALTHCARE POLICY

A YEAR IN REVIEW

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Veteran's Administration Recognizes Licensed Acupuncture PAGE 6

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Oregon Medicaid Proposal to Cut All Opioids for Chronic Pain Patients PAGE 16

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Opioid Crisis Response Act of 2018 PAGE 23

2018 INTEGRATIVE HEALTHCARE POLICY

A YEAR IN REVIEW

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9 22 EDITORIAL Katherine Rushlau Editor krushlau@divcom.com SITE MANAGER Faith Irek Digital Product Manager firek@divcom.com SALES Carmella Perrone Sales Manager cperrone@divcom.com DESIGNER Mariah Blodgett Production Designer

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Medicaid Covers Acupuncture in Ohio

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U.S. Department of Agriculture Opens Dietary Guidelines for Public Comment

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Veteran’s Administration Recognizes Licensed Acupuncturists

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Maine Government Passes Law Requiring Coverage for Naturopathic Services

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National Center for Complementary and Integrative Health Receives Largest Budget Increase in Over A Decade

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Congress Passes Legislation Expanding Veteran Access to Non-drug Chiropractic Services

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Integrative Health & Wellness Caucus on Capitol Hill

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NIH HEAL Initiative (Helping to End Addiction Long-term)

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Food and Drug Administration Committee Supports CBD Epilepsy Drug

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JAMA Opioid Addiction Prevention Strategies

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Open Letter from Homeopathic Practitioners Regarding Antibiotic Resistance

■ American Society of Clinical Oncology Endorses Guidelines Established by Society for Integrative Oncology ■

Oregon Medicaid Proposal to Cut All Opioids for Chronic Pain Patients

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Food and Drug Administration Releases Opioid Analgesic Risk Evaluation and Mitigation Strategy

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Preserving Patient Access to Compounded Medications

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Senate Passes Bill Banning “Gag Clauses” for Pharmacists

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Farm Bill

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New Report Reflects NCCIH Research Interest in Emotional Wellbeing

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Opioid Crisis Response Act of 2018

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World Health Organization Declaration on Primary Care

Integrative Healthcare Policy

Looking Back at 2018 THE HEALTHCARE INDUSTRY—

could not refuse participation in the plan or

towards non-pharmacologic and integrative

and the laws and policies that regulate the

coverage for providers if they act within the

approaches. The time has never been better

system—has been changing rapidly over

scope of their license or certification under

for integrative medicine to take center stage,

the past few years. At the demand of both

applicable state laws. While this does not

and developments in integrative healthcare

consumers and practitioners who advocate

explicitly call out integrative healthcare, it did

policy and regulation are reflective of this.

for a preventative, whole-person approach

open doors for many integrative care providers

to care, the industry has started to shift away

to receive coverage for their services.

from the traditional “sick care” model and bring

The purpose of this annual update is to summarize the past year’s successes,

Additionally, Section 3502 recommended

challenges, and progress in integrative

healthcare teams include “doctors of

healthcare policy on the national level. This

However, a real shift to integrative healthcare

chiropractic, licensed complementary and

includes key laws, actions, and other influential

requires not only awareness and acceptance,

alternative medicine practitioners.”; Section

statements by both federal government and

but solid organizational, institutional, and

4001 included integrative health as a focal

quasi-governmental agencies. The focus is on

policy change. As the process historically

point in its National Prevention Council;

practitioners and their patient practices, as well

goes, standard-setting, self-regulation, and

Section 5101 mandated a complementary

as nutrition and product-related regulations

then governmental action.

and alternative medicine (CAM) workforce

that significantly affect integrative practitioners.

for the National Healthcare Workforce

In addition, we do our best to outline any

In the early ‘90s, when the New England

Commission, though it was never funded;

significant progress made on the state level,

Journal of Medicine published a special report

Section 2301 allowed licensed midwives to

specifically regarding licensing, mandates, and

highlighting revealing more Americans (425

be included as practitioners in birth centers;

inclusion in state-specific legislation.

million visit) sought care from “providers of

and Section 6301 discussed patient-centered

unconventional therapy,” than primary care

outcomes research, and required advisory

physicians (388 million), stakeholders started to

panels to include “experts in integrative

pay more attention to the need for integrative

health,” and a licensed member of the CAM

care in the greater healthcare industry.

professions to sit on its Board of Governors.

More recently, the Affordable Care Act put

While much of the current healthcare system

integrative health in federal policy for the first

in the U.S. remains uncertain, national health

time. In Section 2706, which covered non-

crises with both opioid use and chronic pain

discrimination in healthcare, insurance plans

management have prompted yet another shift

integrative medicine to the general public eye.

As agents for this change, it has never been more important to remain at the forefront of this bridging between conventional and integrative care. We hope you find this resource useful in your endeavors. l Editor’s Note: For questions or comments, please e-mail Integrative Practitioner Editor Katherine Rushlau at krushlau@divcom.com

January 2018

Medicaid

Covers Acupuncture in Ohio

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Integrative Practitioner Takeaway

IN JANUARY, OHIO OFFICIALS

announced Medicaid would expand coverage to include acupuncture for treatments of certain types of pain, as noted in Section 5160-8-51 of the Ohio Administrative Code.

The Governor’s Cabinet Opiate Action Team released new guidelines in January 2016 recommending treating pain without

require referral from a Medicaid physician.

Ohio is one of the first states in the country, and the first state in the Midwest, to have Medicaid cover acupuncture. The Ohio Association of Acupuncture and Oriental Medicine (OAAOM) said it is a milestone for acupuncture professionals and practitioners. “[The OAAOM] is proud that we persuaded the Ohio Medicaid to adopt these rules,” said

opioids when possible, which prompted the

Jared West, president of association, in an

Ohio Department of Medicaid to look at

official statement.

alternatives. In 2017, Ohio Medicaid started covering acupuncture when performed by a physician for lower back pain and migraines.

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visits per year, according to the rule, and

West also said the association plans to build on its success with Medicaid and promote more acceptance by private insurance, as well

Now in 2018, Ohio Medicaid broadened

as calling for Medicaid to broaden coverage

its rules to cover acupuncture when

so other types of diagnoses are covered.

performed by acupuncturists, chiropractors,

The OAAOM has been pushing Medicaid to

and

acupuncture

include other evidence-based diagnoses that

providers, including nurses. It also covers

often lead to narcotic prescriptions, such as

acupuncture with electrical stimulation.

osteoarthritis of the knee, chronic pain, and

Coverage will include up to 30 acupuncture

postoperative pain. l

other

recognized

2018 Integrative Healthcare Policy | A Year in Review

Oregon and Vermont notably implemented Medicaid chronic pain treatment pilot programs in 2016, and other states are beginning to follow suit.

Oregon has been a fantastic example of using science and research in healthcare policy, as well as how collaboration between medical professionals and academics in compiling and presenting emerging evidence can be used to leverage coverage of services such as acupuncture in Medicaid and private insurance programs.

Another layer in the acupuncture coverage dilemma is evaluation and management.

Ohio’s Medicaid program, for example, focuses on the acupuncture service itself, but does not cover assessing the needs of patients and impacts of treatment.

Acupuncturists are trained in evaluation and management but would not be reimbursed for this type of work. This is an area of concern that will require persistent feedback through Medicaid comment periods, and other feedback channels in private insurance programs. Integrative practitioners specializing in acupuncture may also look to their state organization under the American Society of Acupuncturists for advocacy opportunities and other involvement. Click here to view a complete list of state organizations.

GOING FORWARD

Our work as the leading online community for integrative practitioners is made possible through your comments, tips, and ideas. We invite our audience to submit to our next volume.

Please e-mail editor Katherine Rushlau at krushlau@divcom.com for more information.

2018 INTEGRATIVE HEALTHCARE POLICY

A YEAR IN REVIEW

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