Medicare to Pay for Acupuncture to Lower Opioid Use

medicare to pay for acupunctureCMS announced a coverage determination that will allow Medicare to pay for acupuncture that treats chronic low back pain. This new coverage is highly consequential in the legal industry as the stated purpose is to expand options that reduce opioid use. Opioids just so happen to be a major expense in Medicare Set-Asides (MSAs).

Health and Human Services Secretary Alex Azar said offering alternative treatments for pain management “is a key piece of the Trump administration’s strategy for defeating our country’s opioid crisis.” According to CMS, up to 66% of patients with chronic lower back pain are prescribed opioids.  “Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries,” CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt said in a news release.

Does acupuncture mean MSAs shouldn’t include opioids?  No. Of course not. Medicare paying for acupuncture creates a new option of care. We are also skeptical that CMS’s MSA reviewers will allow an MSA that does not include pain medication.

That skepticism combines with the trend for Non-Submit MSAs (NSMSAs) to create a new point of contention between plaintiff or workers’ compensation attorneys and defense or workers’ compensation carriers. After all, the trend of NSMSAs is partially a response to the high cost of prescription drugs included in many MSAs. Does it give one side more new arguments over the other? Does it mean CMS will eventually approve MSAs with fewer prescription drug payments included?

Ultimately, the key to this shake up will be the injured claimants. If medicare is to pay for acupuncture to lower opioid use, then the MSA should not include the opioid as Medicare will pay for acupuncture.  However, if the plaintiff is not using acupuncture prior to the MSA being created, then CMS will likely require the MSA include prescription painkillers.

If you need help with a Medicare Set-Aside or any Future Medical Cost Projection please let us know. MASSIVE: Medical and Subrogation Specialists is on top of MSA guidance rule changes – so you don’t have to be.