Medicare update: HR 4803 Acupuncture for Seniors Act
Megan Gale
HR 4803 Acupuncture for Seniors Act (new this summer 2021)
Rep. Judy Chu (CA) introduced a federal bill to include acupuncturists on the list of recognized providers in the Social Security Act (SSA). This bill, HR 4803 Acupuncture for Seniors Act, is new this summer 2021 and is related to Medicare coverage for services.
Source: July 30th, 2021, press release from Rep. Judy Chu (CA)’s office.
In 2020 Medicare determined to cover acupuncture the procedure as a benefit for Medicare beneficiaries. However, the practical boots-on-the-ground aspect of the average Medicare beneficiary accessing care and getting acupuncture services covered has been challenging because the main profession that is board certified and trained in providing acupuncture isn’t yet recognized as a distinct “provider type” recognized by CMS. As we discussed in the April 2021 Issues in Hospital-based Practice session, the January 2020 coverage determination by Medicare to cover acupuncture services is a big step forward, but because LAcs are not included as a provider type in the SSA, this has created a lot of challenging workarounds or denial of services by Medicare program contractors’ varying interpretations of the coverage determination.
So, to streamline patients accessing acupuncture care by licensed acupuncturists (LAcs) AND streamline the reimbursement process for medical centers, FQHCs, and other healthcare entities that employ LAcs, LAcs need to be included as a “recognized provider type” in the Social Security Act (which governs Medicare coverage). To be included as a recognized provider type takes an Act of Congress. And, this bill that Rep. Judy Chu (CA) introduced is a big first step toward getting this accomplished.
To support CMS clearly covering services of licensed acupuncturists, the next steps (that you can help with) are:
Ask your state representatives to co-sponsor or sign on to bill “HR 4803 Acupuncture for Seniors Act of 2021” with original sponsor Rep. Judy Chu (CA)
Sign up for AcuCongress, the big learning event that our April HHP “Issues in Hospital-based Practice” webinar series guest speaker, Dr. Kallie Byrd Guimond, OM.D., MPH, introduced us to in her HHP-hosted presentation this past April 2021.
What is AcuCongress?
AcuCongress is a
“coalition formed to serve as the federal legislative training ground for the purposes of shepherding and passing legislation that promotes acupuncture services as performed by Licensed Acupuncturists. AcuCongress works with state acupuncture associations and individuals to provide the tools necessary for Congressional outreach and influence for successful, sustainable legislative campaigns. AcuCongress Founder Dr. Kallie Byrd Guimond, OM.D, MPH is a state and federal lobbyist for more than two decades and principal at Sustainable Influence, a government affairs firm with a focus on educating trade associations in grassroots techniques and overseeing Capitol Hill Advocacy events such as Congressional briefings, health fairs, and fly-ins. For more information, contact Dr. Kallie Byrd Guimond at kalliebyrd@sustainableinfluence.org.”
AcuCongress is a virtual event. Source: AcuCongress press release 8.6.2021.
Why Rep. Judy Chu’s bill introduction is important for hospital and healthcare system-based LAcs
HHP resource with more information
Dr. Kallie Byrd Guimond, OM.D, MPH was our guest speaker at our April 2021 Issues in Hospital-based Practice webinar series session. The topic was: Medicare, the Social Security Act, and Acupuncturists—their connections, why it matters, and what are current advocacy efforts?
Right now (August 2021), if you log in to the April 2021 session lectures for Issues in Hospital-based Practice webinar series online resource you can see:
a recording of my introduction to this topic, with info on how and why it is relevant to the hospital and healthcare system-based acupuncturists and program community
pdf of my presentation slides
pdf of Kallie’s presentation slides
pdf of a comprehensive “Notes” document with screenshots and citations of relevant resources
link to the YouTube video from Rep. Judy Chu
recording of the Q&A session with Kallie—available to view now for a limited time
The recording for the entire set of live session presentations needs comprehensive edits. I am working with our video editor this month to get a recording edited and shareable. I’ll announce in a future HHP email newsletter when the refined recording is ready.
You can support this video editing work by subscribing to the Issues in Hospital-based Practice webinar series this month or by supporting via the virtual coffee option on the website.
Why this Act of Congress bill is important to the hospital-based acupuncturist community, program managers, and students of acupuncture and integrative health programs
Quotes from the session
“What I have found is, when you’re working in hospital-based practice or healthcare system practice, you will eventually come to the issue of ‘why can’t we do that?’ And often what that comes down to is that you’re just not included in that language. Or you’re not included in the federal legislation language that allows you to do that.”
“What’s good about HHP community discussion is that it helps the community narrow down [what is known] and come up with [develop] good questions. Because when you have good, clearly defined questions, it is easier to find answers to them.”
Lesser-Known Benefits of inclusion as a provider type in the U.S. Social Security Act (SSA)
One of the things we learned in the April 2021 Issues in HP presentation (paraphrase):
CMS funds residency programs in hospitals. Most of the funding for residency programs in hospital settings comes from CMS.
CMS only funds residency programs for provider types recognized/listed as distinct provider types in the Social Security Act.
Reference to learn more about CMS funding of residency programs:
Committee on the Governance and Financing of Graduate Medical Education; Board on Health Care Services; Institute of Medicine; Eden J, Berwick D, Wilensky G, editors. Graduate Medical Education That Meets the Nation's Health Needs. Washington (DC): National Academies Press (US); 2014 Sep 30. 3, GME Financing. Available from https://www.ncbi.nlm.nih.gov/books/NBK248024/