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Medicaid in NM Update for DOMs
To follow is the flyer content that has been circulated to NM Senators and more during this fast-paced 2024 NM Legislative Session. It was researched and produced by Drs. Allison Donnell, DOM, NP and Brandon Taylor, DOM. The material is important for all DOMs, as the facts are relevant even if one never plans to become a Medicaid provider. As of this posting, it is still necessary to amend the NM budget to include DOMs as Medicaid providers in NM. There was an oversight where DOMs are not in the budget when the left hand was not talking to the right hand. It is up to the Senate Finance Committee now to do the right thing and include the DOM part of the budget with an amendment. The hearing has already been delayed each day for four days.
Integration of Acupuncture / Doctor of Oriental Medicine (DOM) Services in NM Medicaid Program is Essential
Why is this important? New Mexicans need healthcare help!
– NM is ranked 40th in the country for overall health, 1 and is short 264 primary care providers as of June 2023.2
– DOMs are Primary Care Providers and Physicians according to New Mexico state law (61-14A-3.C.F. NMSA 1978, & 13 NMAC 10.13.9.1.1).
– There are 675 currently licensed DOMs in NM according to RLD’s NM Board of Acupuncture and Oriental Medicine (BAOM) website.
– Medicaid Patients typically wait months for non-urgent MD/NP/PA visit, and about 3+ months to begin outpatient Physical Therapy. 3
Quick Facts
– Acupuncture is defined as an Essential Health Benefit under the Affordable Care Act (ACA) in our state.
– Our ACA Benchmark Plan requires a minimum 20 Visits of Acupuncture coverage per year.
– By New Mexico law (27-2-12 NMSA 1978), DOM services are reimbursable by Medicaid.
– Acupuncture is recommended as a first line, non-pharmacologic, and cost-effective treatment for low back pain*
– *Joint Commission, *FDA, *American College of Physicians, and *World Health Organization. 4,5,6
Did you know???
– The “fair price” listed for lumbar spinal fusion is $64,240, and $41,824 for cervical spinal fusion per individual in Santa Fe, NM.7
– DOM’s provide many services (including manual therapy, preventive health, nutrition/movement support) for pain relief—not just Acupuncture!
– The national average out-of-pocket cost for Acupuncture is reasonable at $80.00 per visit.14
Comprehensive Pain Care and More…
– Evidence demonstrates that Acupuncture is a safe, effective intervention for the following problems: many types of pain, cancer treatment side
effects, headaches and migraines, insomnia, anxiety, digestive issues; even alcohol and drug detoxification and recovery.9,10,11,12
– Acupuncture is not just an “add-on” expense. There is evidence of cost-effectiveness and savings through:
– Avoiding high-cost conventional care, avoiding invasive procedures, lowering future health care utilization, and lowering lost productivity costs.10,11
What’s happening around the country?
– Forty-seven states (and the District of Columbia) have practice acts in place to define and regulate the practice of Acupuncture.
– Currently 4 states include Acupuncture as a benefit in their state Medicaid plans: Oregon, Minnesota, Ohio, and Washington
– Medicare currently covers Acupuncture for low back pain, and the Veteran’s medical benefit package includes Acupuncture since 2017.
– WA State found state-insured users of non-pharmacologic therapy including Acupuncture had lower insurance expenditures than controls.11
What would inclusion of DOM services in NM Medicaid / Centennial Care accomplish? Who is in favor?
– Provide access to comprehensive, evidence based, and cost-effective care to all New Mexicans.
– Limit wait times for evaluation and treatment of acute and chronic conditions, especially pain!
– Reduce the need for costly opioids and often expensive non-opioid pain relieving medications.
– Offer Medicaid enrollees a holistic approach to establishing solid foundations of health and improving their own quality of life.
– NM Governor’s Overdose Prevention and Pain Management Advisory Council unanimously supports including Acupuncture within Medicaid.
– NM HSD’s and NM Governor’s own proposed Budgets include 20 Acupuncture Visits per year for all Medicaid enrollees.
Given the magnitude of these statistics and our highly challenged state of healthcare: NM should immediately ensure DOM medical care is a viable mainstream treatment for Medicaid enrollees. NM healthcare advocates, professionals, health provider associations (including the NM Society for Acupuncture and Asian Medicine), plus the practicing body of NM DOMs look forward to engaging members of the legislature in this effort. Thanks for supporting NM health!
References:
1. Ahr. America’s Health Rankings. (n.d.). https://www.americashealthrankings.org/learn/reports/2022-annual-report
2. Health Resources and Services Administration, Designated Health Professional Shortage Areas Statistics (2023).
3. Hollowell, A. (n.d.). Access to healthcare in New Mexico is “drying up.” Becker’s Hospital Review. https://www.beckershospitalreview.com/hospital-physician-relationships/accessto-
healthcare-in-new-mexico-is-drying-up.html
4. R3 Report: A Complimentary Publication of the Joint Commission . (2017, August 29).
5. FDA Education Blueprint for Healthcare Providers Involved in the Management or Support of Patients with Pain (2017).
6. Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the
American College of Physicians. Annals of Internal Medicine, 166(7), 514. https://doi.org/10.7326/m16-2367
7. www.healthcarebluebook.com
8. Spears, C. A., Hodges, S. E., Kiyani, M., Yang, Z., Edwards, R. M., Musick, A., Park, C., Parente, B., Lee, H.-J., & Lad, S. P. (2020). Health Care Resource Utilization and
management of chronic, refractory low back pain in the United States. Spine, 45(20). https://doi.org/10.1097/brs.0000000000003572
9. Acupuncture: An overview of scientific evidence. Evidence Based Acupuncture. (2022, November 15). https://www.evidencebasedAcupuncture.org/Acupuncture-scientificevidence/
10. Fan, A. Y., Miller, D. W., Bolash, B., Bauer, M., McDonald, J., Faggert, S., He, H., Li, Y. M., Matecki, A., Camardella, L., Koppelman, M. H., Stone, J. A. M., Meade, L., & Pang, J.
(2017). Acupuncture’s role in solving the opioid epidemic: Evidence, cost-effectiveness, and care availability for Acupuncture as a primary, non-pharmacologic method for pain
relief and management–White Paper 2017. Journal of Integrative Medicine, 15(6), 411–425. https://doi.org/10.1016/s2095-4964(17)60378-9
11. Nielsen, A., Tick, H., Mao, J. J., & Hecht, F. (2019). Academic Consortium for Integrative Medicine & Health Commentary to CMS; re: National Coverage Analysis (NCA) tracking
sheet for Acupuncture for chronic low back pain (cag-00452n). Global Advances in Health and Medicine, 8, 216495611985764. https://doi.org/10.1177/2164956119857648
12. U.S. Department of Health and Human Services. (n.d.). Acupuncture: What you need to know. National Center for Complementary and Integrative Health.
https://www.nccih.nih.gov/health/Acupuncture-what-you-need-to-know
13. Candon, M., Nielsen, A., & Dusek, J. A. (2022). Trends in insurance coverage for Acupuncture, 2010-2019. JAMA Network Open, 5(1).
https://doi.org/10.1001/jamanetworkopen.2021.42509
14. Fan, A. Y., Wang, D. D., Ouyang, H., Tian, H., Wei, H., He, D., Gong, C., Wen, J., Jin, M., He, C., Alemi, S. F., & Rahimi, S. (2019). Acupuncture price in forty-one metropolitan
regions in the United States: An out-of-pocket cost analysis based on OkCopay.com. Journal of Integrative Medicine, 17(5), 315–320. https://doi.org/10.1016/j.joim.2019.06.003
Please note: This article expresses the opinions and research of the authors, and does not necessarily reflect all views or policies of NMSAAM members, the NMSAAM BOD, or the ASA.
Green wooden dragon image is courtesy of Etsy.