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  • CMS Promotes More Access to Nondrug Pain Management in Medicaid

    Could states be doing more to increase access to nonopioid and nonpharmacological approaches to management of chronic pain under Medicaid? The US Centers for Medicare and Medicaid Services (CMS) thinks so, and has issued guidance that outlines options and shares examples of some states' promising initiatives. The approaches are largely consistent with APTA's #ChoosePT opioid awareness campaign, which emphasizes the importance of patient access and choice in the treatment of pain.

    The CMS information bulletin released in late February is anchored in the US Centers for Disease Control and Prevention's (CDC) guidelines for prescribing opioids for chronic pain, published in 2016. Those guidelines, which recommend nonopioid approaches including physical therapy as the preferred first-line treatment for noncancer chronic pain, have been increasingly acknowledged and adopted by state health care entities, and early reports are positive, according to CMS. The new CMS document is designed to help states understand possible avenues for incorporating programs that help support the CDC guidelines.

    In outlining possibilities that could allow for the use of nonpharmacological approaches to chronic pain, CMS offers states a wide palette of mandatory and optional benefits, from more effective use of inpatient, outpatient, and health center services to expanded coverage for rehabilitative, physical therapy, and preventive services. The bulletin also offers home health benefits, special "demonstration" projects, and potential waivers as ways states could take creative steps to strengthen their nondrug offerings.

    CMS also offers examples of states that have changed or extended their Medicaid coverage options, including Oregon, which expanded its list of Medicaid-covered services for uncomplicated back and neck pain to include physical therapy, cognitive behavioral therapy, and other services; and California, where a 14-county Medicaid program implemented an intensive prescriber education program on nonopioid options for pain management.

    APTA has been engaged in the fight against opioid misuse in multiple ways. In addition to its flagship #ChoosePT opioid awareness campaign, the association has produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship. On the advocacy front, APTA continues to meet with legislators and agency representatives to address the opioid crisis, and comments on a range of topics, including a federal Pain Management Best Practices Inter-Agency Task Force draft report. Additionally, a recent formal partnership between APTA and the Department of Veterans Affairs includes collaboration to promote veterans' access to nopharmacologic approaches to pain management.

    "Providers and beneficiaries need access to effective therapy for chronic pain," CMS writes. "A multidisciplinary approach…that incorporates nonopioid pharmacologic and nonpharmacologic therapies, well-communicated treatment goals and expectations, and a careful consideration of the benefits and risks of available treatment options is the most appropriate approach for most patients and has the potential to lead to more appropriate prescribing of opioids."

    Comments

    • Thank you for this coverage of changes in service for Medicaid. I wou;ld like to clarify the new benefits for back pain in Oregon. We actually have coverage for any spinal pain, regardless of complexity, with the STarT tool triggering a greater number of visits for PT, chiropractic, acupuncture and/or CBT. The decision to expand coverage for chronic/persistent pain was based on research indicating that a lack of services leads to inappropriate utilization of the ED, opioids, radiological testing and surgery. Services chosen were based on evidence and reviewed by a multidisciplinary team of clinicians and payers. It is refreshing to be able to offer PT services to those historically underserved by our profession, and the services are sorely needed. Sincerely, Nora Stern, MS PT Clinical Porgram Manager Providence Comprehensive Pain Service Portland Oregon Chair, Oregon State Pain Management Commission

      Posted by Nora Stern on 3/7/2019 2:32 PM

    • I had PT in 2016 then 13 ESIs then surgery in 2018 on my c spine .I am crippled because they waited for 2 years before doing surgery .Stop hurting patients for greed

      Posted by Lisa D on 5/13/2019 11:35 AM

    • I am glad that CMS is promoting more access to nondrug pain management. I personally believe that more times than not, drugs are nonessential more times than they are. The usage of drugs in pain management can lead to addictions which end up putting the user in even more danger than before. Drug misuse is a large problem in this country and I am glad that efforts are being made to combat it.

      Posted by Lloyd Bronson on 8/6/2019 1:31 PM

    • The UNITED STATES has failed at every thing We are # 36th in the world when it comes to providing health care to its citizens. Its 2019 and our leaders still cant even figure out how to effectively deliver decent health care to our citizens. The US government along with the dept of labor managed to create a hugh class of welfare dependent people.that is growing everyday. Its 2019 and they still cant produce enough decent paying jobs for people to even live on. Our country has lost 90% of all our manufacturing jobs to 3rd world countries and is outsourcing the rest of all the higher paying jobs and government still hasn't done one thing to stop it . The US dept of the treasury along with there failed policies has gotten us so far in debt that we'll never get out. The US dept of social services has been largely instrumental in causing the demise of the traditional family. Instead of promoting nuclear families they do the opposite which is they promote single motherhood along with billions of dollars in legal services for the mothers only with the sole purpose which is to punish the fathers.They have been on the forefront in urging women to label there boyfriends husbands abusers urging them the best advice is to just leave them and take the kids with you rather than urging them to change there own behavior and the list goes on. In the past 50 years US policy has failed at providing any type of affordable housing to the middle and lower class at all.Its so bad THEY DON'T EVEN TALK ABOUT IT ANYMORE. The criminal justice system locks up more people in the world sometimes for the smallest of things creating another class of welfare dependent people who will need to be cared for by the state for the rest of there life. And now finally the most vulnerable of our entire population are now starting to feel the sting of yet another failed US policy that's bound to be a high failure just like all the rest. The good ole boys that brought you all these other failures is now putting there nose in between the doctor and patient relationship. Effective medical treatment policies that were used since the beginning of time a now being replaced by so called better options like yoga, tai-chi, and behavioral therapy.Instead of time tested proven medical treatments the US government has now mandated that patients do things there way. Patients are being forced to do things take things like antidepressants, which caused alzheimers and early dementia, take more Physical therapy, take lots of NSAIDS. which cause a whole host of other problems, get massages, go to chiropractors, meditate and the latest thing is called virtual reality movie watching with special 3-d glasses do anything but stop taking the drugs that once brought relief. Worse the US pain patient is being brainwashed into believing they have an addiction problem to the once helpful drugs that were taken away from them. Everyone of these new policies are being mandated because of special interest groups namely the substance abuse industry exercising there interests and the patient be dammed. Lastly I've got one last thing to say although I HAVE ALWAYS HATED REPUBLICANS I've got to admit that when they tell you larger government is a problem you need to believe them LARGE GOVERNMENT IS THE PROBLEM.

      Posted by John haislip on 8/15/2019 5:09 AM

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