My home state of Oregon is currently third in the nation when it comes to prescription opioid narcotic abuse, which is particularly prevalent within the Medicaid population suffering from musculoskeletal conditions. That reality, combined with the state's 2011 low back guidelines, has pressured Oregon legislators to look at moving back and spinal pain conditions above the prioritized funded line and allow reimbursement for effective, evidence-based interventions.
I served on the task force that reviewed this issue, and I have great news to report: As of Jan. 1, 2016, for the first time, Oregon Medicaid patients will be able to be treated by a doctor of chiropractic for their spinal (cervical, thoracic, lumbosacral) complaints. Additionally, for the first time chiropractic physicians will be paid with parity for their evaluation and management codes, CMT codes and two physiotherapy codes.
In 2011, I was appointed to a legislative work group by Oregon State Representative Jim Thompson, co-chair of the House Health Committee. We had become good friends over the years dating back to our first meeting in 2001, when he was the legislative assistant to a now-retired state senator. (When he ran for the Oregon House of Representatives, we held a large and quite successful Christmas season fund-raising event in our home.) This work group was formed to pound out the particulars of House Bill 2100, designed to combine two current commissions into one, to be known as the "State of Oregon Health Evidence Review Commission."
This new commission would determine what interventions Oregon's Department of Medical Assistance Programs (DMAP) would reimburse for exclusive to the Medicaid population. This commission, in concert with Oregon Health and Sciences University's Center for Evidence-Based Policy, would produce evidence-based guidelines for medical interventions and coverage guidance for insurers based on evidence of efficacy, level of adverse events and cost.
As a member of the H.B. 2100 work group, I was in a position to push for one seat on the commission to go to a complementary and alternative medical (CAM) provider: a chiropractic physician, naturopathic physician or licensed acupuncturist. Once the bill passed, I filed the necessary governor's office paperwork and called then-Oregon Governor John Kitzhaber, MD, asking for the appointment, which was granted. The commission appointment is for a four-year term and I assure you, no lay lobbyist or lobbying firm would commit to such a position.
The first guidelines our new commission created and adopted were the state's official LBP guidelines, "Evaluation and Management of Low Back Pain," released in 2011, which would ultimately help facilitate our new pro-chiropractic Medicaid provisions. As a member of the commission and appointed by the director to the commission's Subcommittee on Evidence-Based Guidelines Development and Coverage guidance, I was in a position to provide valuable evidence-based input to the proposed guidelines. As a result, Oregon's low back pain guidelines recommend spinal manipulation as the only nonpharmacological treatment for all three phases of low back pain – acute, subacute and chronic.
I have served on many policy-changing groups, most recently an advisory committee formed by our insurance commissioner that met over 10 months and successfully insert Section 2706 of the Patient Protection and Affordable Care Act into Oregon State law (Oregon House Bill 2468). I have served on many administrative rule advisory committees that were critical to proper implementation of bills we pushed through the legislature.
My take-home message to chiropractors and other state associations? These sorts of policy changes can be accomplished in your state, but it will take a true chiropractic advocate. No lay lobbyist will have your colleague's clinical knowledge, expertise, time or passion for this type of policy work.
