Current MassHealth Regulations for Acupuncturists and Patients
MassHealth started to cover acupuncture beginning Jan 22, 2022. Acupuncturists sign-up to be Fee-For-Service providers and see members who are enrolled in the MassHealth administered plan (the blue card). The MassHealth administered plans pay for medically necessary acupuncture for the treatment of pain and for acupuncturists to be able to bill for services.
HIghlights of Work The ASM Has Done
- The MassHealth statute was 1st re-written in 2014 and included acupuncture as a covered service when provided by acupuncturists and physicians. Unfortunately there were several issues.
- The language used to define the provider types mirrored those used by Medicare and left out any mention of acupuncturists. Because of this, MassHealth did not permit acupuncturists to enroll as providers, but instead only reimbursed them through a supervising MD.
- Under the regulations acupuncture can be provided in three locations: acute care settings, community centers and physician offices. Yet as an organization we understand that the overwhelming majority of acupuncturists are independent practitioners and are not employed by MD’s, clinics or acute care outpatient hospitals. Thus most patients cannot make use of these services due to the regulation stating that acupuncturists need physician referral, supervision and billing
- ASM reviewed the statute with an attorney and went to work making phone calls, sending letters, and providing testimony to legislative committees.
- When this statute was reopened the department reached out to the ASM and we have participated in meetings over the last few years voicing important issues and needed changes. The goal is to change some of these regulations so that they are better suited to acupuncturists, their practices, and ultimately their patients, including working with MassHealth to ensure that payments to acupuncturists are uniformly fair and appropriate to our work.
- A few of our recommendations included the need to cover evaluation and management (E&M) and to make that payable on the same date as acupuncture services.
- We felt triumphant in November 2021 when we learned that MassHealth would soon allow “acupuncturist” as a new provider type starting on Jan 22, 2022.
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Below are the three pieces of regulations in both the full version as well as just the sections that are pertinent to acupuncturists.