Massage therapy is being called for to help combat the Opioid Epidemic. The massage therapy profession is 20 years behind WA State in getting massage therapy covered by health insurance.
The Affordable Care Act of 2010 has set the stage for more acceptance of massage being paid for by health insurance companies.
Section 2706 of the Affordable Care Act
(Section 2706) “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”
It is very similar to the ‘Every Category Law” in WA State that makes it mandatory that insurance companies must pay massage therapists.
(1) Issuers must not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits, as defined in WAC 284-43-878 and RCW 48.43.715, for individual and small group plans; and as covered by the basic health plan, as defined in RCW 48.43.005(4), for plans other than individual and small group.
For individual and small group plans, the issuer must not exclude a category of provider who is licensed to provide services for a covered condition, and is acting within the scope of practice, unless such services would not meet the issuer’s standards pursuant to RCW 48.43.045 (1)(a). For example, if the issuer covers outpatient treatment of lower back pain as part of the essential health benefits, any category of provider that provides cost-effective and clinically efficacious outpatient treatment for lower back pain within its scope of practice and otherwise abides by standards pursuant to RCW 48.43.045 (1)(a) must not be excluded from the network.
The problem now is that the Affordable Care Act is in a precarious position and we are not sure if it will survive the current administration. The massage therapy profession has missed a very big chance to make very big changes to the profession.
In 2010, The Affordable Care Act opened the doors with Section 2706 that said insurance companies “shall not discriminate” against any health provider with a state-recognized license. Section 5101 includes licensed complementary and alternative medicine providers and integrative health practitioners in its definition of health professionals in the“health care workforce.” Yet nothing was done by any of the massage therapy associations.
In 2011, Relieving Pain in America:(PDF) A Blueprint for Transforming Prevention, Care, Education, and Research said reviews of research on acupuncture, massage, and chiropractic spinal manipulation for chronic low back pain suggest these therapies may be beneficial.
In 2016, the CDC even said:
“Although there are perceptions that opioid therapy for chronic pain is less expensive than more time-intensive nonpharmacological management approaches, many pain treatments, including acetaminophen, NSAIDs, tricyclic antidepressants, and massage therapy, are associated with lower mean and median annual costs compared with opioid therapy. CDC Guideline for Prescribing Opioids for Chronic Pain “— United States, 2016
In Feb 2017, the National Association of Attorney Generals, issued this letter (PDF), asking for alternatives to Opioids be considered to help end the epidemic.
“When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.”
In Jan 2018, the Academy of Integrative Pain Management (AIPM) and the US Pain Foundation, wrote a letter to the U.S. Senate Committee on Finance (the Committee with jurisdiction over the Centers for Medicare and Medicaid Services, or CMS), asking them to cover massage therapy.
The Joint Commission has also previously called for coverage of massage therapy in 2015 (PDF). Their report: “Revised Rationale for PC.01.02.07 (New for Ambulatory Care and Office-Based Surgery Practice) says:
“The identification and management of pain is an important component of patient-centered care. Patients can expect that their health care providers will involve them in their assessment and management of pain. Both pharmacologic and nonpharmacological strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following: Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy”. https://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf?fbclid=IwAR0Skq7t_LjeDn4XmlNGoT0JCpL1LHTdM1LdcLCdzr8Fc_BBcweTRpwD4nw
The Joint Commission stated this again in 2017
“When a patient’s preference for a safe nonpharmacologic therapy cannot be provided, hospitals should educate the patient on where the treatment may be accessed post-discharge. Nonpharmacologic strategies include, but are not limited to: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy.”
In April 2017, the American College of Physicians did
a study to systematically review the current evidence on nonpharmacologic
therapies for acute or chronic nonradicular or radicular low back pain and here
is their recommendation:
“Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence).” https://www.ncbi.nlm.nih.gov/pubmed/28192793
In April 2017, the Federation of State Medical Boards April 2017
adopted its policy on Chronic use of Opioids and recommended:
“The treatment plan may contain information supporting the selection of therapies, both pharmacologic (medications other than opioids to include anti-inflammatories, acetaminophen, and selected antidepressants and anticonvulsants) interventional, and non-pharmacologic therapies such as cognitive behavioral therapy, massage, exercise, multimodal pain treatment, and osteopathic manipulative treatment. The plan should document any further diagnostic evaluations, consultations or referrals, or additional therapies that have been considered to the extent they are available.”
In Oct 2017, the first Integrative Pain Policy Conference was held in San Diego. The AMTA was invited and was supposedly there according to the report from the Academy of Integrative Pain Management, but to date, I have not heard any report from the AMTA.
The Congressional Integrative Health and Wellness Caucus (https://www.integrativepractitioner.com/topics/analysis/ihpc-promoted-integrative-health-congressional-caucus-kicks-off-pain-briefing-staffers) held on March 15, 2018 calls for:
“The mission: “Amidst Opioid Crisis: New Caucus Will Focus on Integrative Health Solutions.”
Medicare Managed Care Manual Chapter 4 – Benefits and Beneficiary Protections. Revised for 2019 coverage Year also calls for more massage therapy as an alternative to Opioids. “Medically-Approved Non-Opioid Pain Management (PBP B13d, e, or f ): Medically-approved non-opioid pain treatment alternatives, including therapeutic massage furnished by a state licensed massage therapist. “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health-related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).” https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf
Other states have health insurance plans that are covering massage even though there are no laws in place to make it so and again no one is standing up for us and representing us at the table. The professional associations have said that they do not want to help implement the Affordable Care Act Section 2706 which would help us get our foot in the door. (See: AMTA: Supporting Massage Therapists for the Affordable Care Act (or Not?) by Laura Allen) Their reason for lack of involvement is that they say the majority (51%) of their members do not want this. What about the other 49%? There are many massage therapists who do want it though.
Excerpt from Massage Insurance Billing – Billing, Healthcare Integration and Advocacy.
The massage therapy profession is so far behind. It is time to stand up and make a difference. Learn how to bill so that you know how it works. Start with my Call to Action in the latest edition of Massage Insurance Billing