Oregon Health Authority (OHA), which administers the state's Medicaid program, has delayed coverage of alternative treatments for back pain, saying it needs more time to assess the implementation plan and fiscal implications. The state had planned to begin covering certain treatments on January 1, 2016.

Officials want to ensure that providers are ready to implement the changes, that guidelines are complete, and that the fiscal impact has been estimated accurately, according to an OHA statement. An implementation date has not been set, said Stephanie Tripp, an OHA communications specialist.

Treatments to Be Covered

The coverage expansion is designed to help people manage pain with fewer surgeries and less medication. The following alternative treatments will be covered and will be prioritized over surgery and narcotics for most back conditions:

* Acupuncture;

* Chiropractic manipulation;

* Cognitive behavioral therapy;

* Osteopathic manipulation; and

* Physical and occupational therapy.

OHA also recommends that yoga, intensive rehabilitation, massage, and supervised exercise therapy be included in patients' comprehensive treatment plans where available. The Medicaid plan will continue to cover short-term opiate drugs and surgery for conditions where evidence demonstrates that surgery is more effective than other treatment options.

Previously, Oregon Medicaid had limited coverage of alternative treatments to patients with muscle weakness or other signs of nerve damage. Once the new plan is implemented, the treatments will be covered for all back conditions.

The state added coverage for alternative treatments after a task force reviewed the evidence on the effectiveness and potential harms of the various treatments, according to OHA. The task force was composed of a neurosurgeon, chiropractor, acupuncturist, orthopedic surgeon, primary care physician, physiatrist, physical therapists, specialists in mental health and addiction, a health plan medical director, pain specialists, and a national expert in the evidence on treatments for back pain.

Back pain is common among Oregon Medicaid recipients. In 2013, about 8% of recipients saw a health provider for a back condition, and about half of them were treated with narcotics. Officials said the changes are based on new evidence, including "a bio-psycho-social model design."

"Alternative treatments have been shown to work," Denise Taray, coordinator of the Oregon Pain Management Commission, told NPR News.1

"Research is out there that suggests that with back conditions we're spending a lot of money on health care treatments and services that aren't improving outcomes," she said. "The only thing that might have been covered in the past was narcotics. But treatments such as acupuncture, chiropractic, massage therapy, physical therapy, and rehab would never have been covered."

Oregon officials hope that covering alternative treatments will save money and also mean that fewer people will become addicted to opioids. The state is No. 1 in the United States for nonmedical use of opioids, NPR reported.

Florida Covers Alternative Treatments

In Florida, Medicaid also covers alternative treatments for pain.

"The more traditional pain management options such as epidurals, intrathecal, IV therapy, anesthesia, neurostimulators, and chemodenervation have been covered services in Florida Medicaid for many years, as well as chiropractic and physical therapy services," according to a spokeswoman for the Agency for Health Care Administration, which administers the Medicaid program. "Florida Medicaid also covers holistic options such as physical therapy, chiropractic manipulative treatment, and osteopathic manipulative treatment."

A pilot study conducted about a decade ago in Florida found that an integrative approach to treating chronic pain was effective for Medicaid recipients. Those who received complementary and alternative medicine services that were managed by a traditional medical provider saw significant improvement in physical and mental health over a 3-year period at a lower cost to the state, according to a report on the study.2

The Centers for Medicaid and Medicare Services does not seem to track which state plans cover alternative treatments for pain, but certain state-level information on alternative benefits is available online.3,4

Support for Alternative Therapies

The American Academy of Pain Management is advocating for a minimum set of health insurance benefits for people whose pain is severe enough to require ongoing therapy. The group supports "an interdisciplinary clinical approach" that would be covered by all insurance payers and would include such treatments as cognitive behavioral therapy, according to a 2014 position statement.5

The Institute of Medicine, in a 2011 report commissioned by the US Department of Health and Human Services, reported that an interdisciplinary approach to treating pain may produce the best results for people with chronic pain and noted the effect that insurance incentives can play in encouraging the use of alternative treatments.6

References