Editor's Note: This article was written by the ASA and NCCAOM Advocacy Team.
The American Society of Acupuncturists (ASA) and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) are working on behalf of the acupuncture profession to establish Medicare recognition for qualified acupuncturists.
Medicare recognition is a transformational step for a growing profession. 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.
Legislation: A Crucial Step
To become a law, the House of Representatives and the Senate would need to sponsor and pass legislation. To date, no bill exists in the current 117th Congress (2021-2022) to recognize acupuncturists as Medicare providers. A bill, however, is in draft form through the collaborative work of the ASA and NCCAOM. The two organizations will keep the profession updated on its progress and will look to individual acupuncturists to help with grassroots efforts after the bill's introduction. See the Medicare Roadmap for more information about the process for obtaining Medicare recognition.
The Current State of Medicare Coverage
As of January 2020, CMS began covering acupuncture services for back pain (see ASA and NCCAOM letter); however, the lack of a specific Medicare recognition for licensed and national board-certified acupuncturists creates a serious access problem for Medicare beneficiaries. As U.S. service-delivery models of care continue to embrace integrative and complementary health concepts, policy – or the lack of policy – will exclude acupuncturists from participating in integrative-health opportunities. Medicare's chronic lower back pain (cLBP) coverage decision is an example of this type of exclusion.
Currently, CMS recognizes just one acupuncture diagnosis for Medicare beneficiaries: cLBP. As acupuncturists are not Medicare providers, they cannot directly provide this service to Medicare beneficiaries. They must do so as "auxiliary personnel," which requires practicing under supervision of another practitioner. This requirement does not align with the acupuncture practice model and thus severely limits acupuncturists' abilities to provide a service they are specifically trained to provide.
Medicare policy stipulates that physicians, physician assistants, nurse practitioners, and clinical nurse specialists with appropriate training can provide acupuncture services to Medicare beneficiaries without supervision – and can directly bill CMS.
Acupuncturists, who have specific training for certification and licensure to provide these services, must only do so under another practitioner's supervision. They also cannot directly bill CMS. This is because the above provider groups are recognized Medicare providers; acupuncturists are not.
Breaking Through the Barriers: the Only Option
The only way to break through these barriers is for acupuncturists to become recognized Medicare providers. Without this recognition, acupuncturists will continue to be excluded from future opportunities to provide acupuncture services. The number of Medicare-recognized services will eventually grow. To meet the demand for these services, other Medicare-recognized provider groups will step in and replace acupuncturists.
This problem is not just a Medicare problem. Many federal and national health initiatives (student-debt forgiveness, federal grant and research opportunities, telemedicine programs, integrative health programs) use Medicare provider status as a criterion for eligibility. Third-party payers often follow Medicare's lead as well.
Unless the profession obtains Medicare recognition, the profession will not thrive and may contract due to the access barriers. This could mean practitioners with less training and expertise have more access to patients seeking acupuncture services. Ultimately, the profession will become less appealing because of these access barriers.
Medicare is a federal program that provides health insurance for Americans over the age of 65. The program continues to expand in services, beneficiaries and influence. Today, Medicare covers more than 50 million individuals. In fewer than 10 years from today, the program will cover 80 million Americans.
The ASA and the NCCAOM continue to advocate for Medicare recognition. You can find more information about the Medicare program and its effect on the profession via the ASA and NCCAOM websites.
Both organizations are partnering to continue to provide progress updates, survey the profession for data, communicate talking points and grassroots advocacy guidance, and provide information on how individual acupuncturists 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:
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