News Alert: CMS Proposing to Cover Acupuncture

Coverage would include those suffering from chronic lower back pain who are also enrolled in approved studies.

The Centers for Medicare & Medicaid Services (CMS) is proposing to cover acupuncture for Medicare patients who suffer from chronic lower back pain and are also enrolled participants in certain clinical trials – a plan that in part represents a federal strategy to help combat a national opioid abuse epidemic contributing to upwards of 70,000 overdose deaths annually.

Such trials are sponsored by CMS itself and the National Institutes of Health (NIH), according to a press release the agency published online this week. Officials said that while evidence reviews have been conducted to inform the proposal, CMS still “recognizes that the evidence base for acupuncture has grown in recent years, but questions remain.”

“Today’s proposal represents the Trump Administration’s commitment to providing Americans with access to a wide array of options to support their health,” U.S. Department of Health and Human Services (HHS) Secretary Alex Azar said in a statement. “Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain.”

Acupuncture, a treatment in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin, is one of the oldest known components of traditional Chinese medicine, its roots having been traced back more than 2,000 years. However, studies on its effectiveness have produced varying results, leading some to label it a form of alternative medicine, or even pseudoscience.

CMS said in its announcement that it has been actively collaborating with the NIH as part of the federal Opioids Workgroup and Evidence Generation Workgroup to launch studies on acupuncture for the treatment of chronic lower back pain in adults 65 and older. Under the new proposal, CMS indicated that it would continue the collaboration with NIH to “further develop evidence to inform future Medicare coverage determinations for acupuncture treatment.”

“Chronic low back pain impacts many Medicare patients, and is a leading reason for opioid prescribing,” CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt said in a statement. “Today’s proposed decision would provide Medicare patients who suffer from chronic low back pain with access to a non-pharmacologic treatment option and could help reduce reliance on prescription opioids. CMS will work closely with our sister agencies to monitor outcomes for Medicare beneficiaries receiving acupuncture to inform our understanding of the efficacy of this therapeutic approach.”

Dr. Ronald Hirsch (MD, FACP, CHCQM), vice president of the Regulations and Education Group at R1 Physician Advisory Services and a member of the Advisory Board of the American College of Physician Advisors and the American Case Management Association, expressed cautious optimism about the plan.

“Chronic back pain is a condition that affects many people of all ages. Any treatment that is proven to be effective in properly performed studies should be covered by Medicare,” Hirsch said. “This proposed coverage decision, which covers only chiropractic care provided as part of a clinical trial, should provide actionable data. But the studies will need to be scrutinized carefully before allowing routine coverage since CMS is allowing not only randomized controlled trials, which are the gold standard but also observational trials and registries.”

To read the proposal in its entirety, go online to https://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=295.