Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.300 - Complementary Health and Alternative Therapies for Chronic Pain Management

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the MO HealthNet
				  payment policy for the complementary health and alternative therapies for
				  chronic pain management for adult Medicaid participants. The goal of this
				  policy is to improve health outcomes and decrease opioid use by adult
				  participants to manage chronic pain.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) Administration.
(A) This rule governs the practice of
				complementary health and alternative therapy for adult participants as a
				covered MO HealthNet benefit. The intent of this regulation is to provide
				complementary health and alternative therapy, coordinated by the prescribing
				physician, in an effort to provide alternatives to opioid use for the treatment
				of chronic pain, reduce opioid misuse, improve MO HealthNet participants'
				chronic pain management skills, reduce avoidable costs, and improve health
				outcomes.
(B) Complementary health
				and alternative therapy for chronic pain management shall be administered by
				the Department of Social Services, MO HealthNet Division. The services covered
				and not covered, the limitations under which services are covered, and the
				maximum allowable fees for all covered services shall be determined by the
				division and shall be included in the MO HealthNet Physician Provider Manual,
				which is incorporated by reference and made a part of this rule as published by
				the Department of Social Services, MO HealthNet Division, 615 Howerton Court,
				Jefferson City, MO 65109, at its website http://www.dss.mo.gov/mhd on August
				15, 2018. This rule does not incorporate any subsequent amendments or
				additions.
(C) The following
				definitions will be used in administering this rule:
1. "Adult participant" means a person who is
				at least twenty-one (21) years of age or older and who is enrolled as a MO
				HealthNet participant;
2.
				"Complementary health and alternative therapy for chronic pain" combines the
				use of physical therapy, cognitive-behavioral therapy, chiropractic therapy,
				and/or acupuncture to promote chronic pain relief for adult participants;
3. "Physical therapy treatment for
				chronic pain" includes, but is not limited to, participant education and
				counseling, manual techniques, therapeutic exercises, electrotherapy, and
				massage;
4. "Cognitive-behavioral
				therapy for chronic pain" or "CBT" combines treatment of emotional thinking and
				behavioral health for participants with chronic pain, trains in behavioral
				techniques, and helps patients modify situational factors and cognitive
				processes that exacerbate pain;
5.
				"Chiropractic therapy for the treatment of chronic pain" may include, but is
				not limited to, spinal manipulation or spinal adjustment, and as further
				defined by section 331.010.1, RSMo;
6. "Acupuncture" involves the use of needles
				inserted into the body by piercing of the skin and other modalities as defined
				by sections 331.030.8 and 324.475(1), RSMo;
7. "Prescribing physician" means a physician
				licensed under Chapter 334, RSMo, who specializes in family medicine or
				internal medicine and is authorized to prescribe medication or other therapy
				within the scope of such person's practice;
8. "Complementary health and alternative
				therapy provider" means a complementary health and alternative therapy care
				provider licensed by the state of Missouri and authorized to provide health
				care services within the scope of such person's practice;
9. "First-line non-opioid medication therapy"
				includes, but is not limited to, analgesics such as non-steroidal
				anti-inflammatory drugs (NSAIDs), acetaminophen, cyclooxygenase 2 (COX-2)
				inhibitors, SAM-E herbal therapy, topical analgesics, selected antide-
				pressants, selected anticonvulsants, and/or muscle relaxer medication;
10. "Opioid medication therapy"
				includes any prescription drug, natural or synthetic, that binds to the brain's
				opioid receptors having an addiction-forming or addiction-sustaining ability,
				or being capable of conversion into a drug having such addiction-forming or
				addiction-sustaining ability;
11.
				"Chronic pain" means a non-cancer, non-end-of-life pain lasting more than three
				(3) months, or longer than the duration of normal tissue healing;
12. "Acute pain" means pain, whether
				resulting from disease, accidental or intentional trauma, or other cause that
				the practitioner reasonably expects to last only a short period of time. Acute
				pain does not include chronic pain, pain being treated as part of cancer care,
				hospice or other end of life care, or pain being treated as part of palliative
				care; and
13. "High dose opioid
				therapy" is to be considered as any therapy greater than ninety (>90) MME
				(morphine milligram equivalents) per day