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Medicaid Will Cover Low-and Moderate Level Evaluation and Management Services Performed by Ohio Chiropractors
The Department of Medicaid released a statement that Medicaid will cover low-and moderate level E&M services represented by CPT codes 99202, 99203, 99212, and 99213 when performed by a chiropractor. The Department of Medicaid will cover up to three E&M services per benefit year and plans to make these changes effective by October 1, 2022.[1]  

Ohio H.B. 136 expanded Medicaid coverage of chiropractic services to include evaluation and management (E&M) services provided by a licensed chiropractor.[2] Further, there is no requirement for the chiropractor to obtain prior authorization or receiving a referral from another prescriber. Moreover, Medicaid must pay the chiropractor the same rate it pays any other licensed health professional for the same service.

It should be noted that federal law limits coverage for chiropractic services to treatment by means of spinal manipulation.^[3] The Ohio law exempts chiropractic services from the limitations set out in the statute and requires that Medicaid cover the services without federal financial participation. 

The primary sponsor of H.B. 136 was State Rep. Scott Lipps.[4] Rep. Lipps spoke about H.B. 136 stating that it “will improve access to chiropractic treatment options for Medicaid patients.”[5] Rep. Lipps included that “This expansion is vital as chiropractic treatment is a non-addictive and cost-effective option for many patients who might otherwise turn to opioids. This bill simply offers an alternative solution to pain management thereby moving Ohio closer to alleviating the opioid crisis.”[6] The Ohio State Chiropractic Association and the Northeast Ohio Academy of Chiropractic both supported H.B. 136.[7] Remarkably, there was no testimony submitted opposing H.B. 136.[8]

Prior to H.B. 136, Ohio’s Medicaid Program only covered certain chiropractic services.[9] In alignment with the Federal Medicaid limitations on chiropractic coverage, the Department of Medicaid adopted rules that limited “chiropractic services to manual manipulation of the spine for correction of a subluxation after a determination has been made via physical examination or diagnostic imaging that the subluxation exists.”[10] Payments are allowed for the diagnostic imaging required to determine the existence of a subluxation.[11] However, “Unless prior authorization is received, coverage is limited to the following: one treatment per day, two images of the entire spine per year, two sessions of any other images per six-month period, 30 visits in an outpatient setting per year for individuals younger than 21, and 15 visits in an outpatient setting for individuals older than 21.”[12]

Now, H.B. 136 has substantially expanded the services a chiropractor can provide under Medicaid to E&M services.[13] Importantly, H.B. 136 allows the Director of Medicaid to adopt additional rules; thus, there is a potential for expansion in the future. [14] The Ohio Department of Medicaid estimated that there would be 1.33 E&M visits per chiropractic patients, which would result in around $11.1 million worth of E&M services from chiropractors.[15] Additionally, now that chiropractors can see patients for E&M services, additional cost shifting may occur if patients choose to visit a chiropractor instead of a different healthcare practitioner.[16] Overall, H.B. 136 allows chiropractors to bill for E&M services under the Medicaid Program, in efforts to fight the opioid epidemic and provide different avenues of pain management. 

For more information, please contact Amanda Waesch at alwaesch@bmdllc.com or 330-253-9185.

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[1] These changes will be made in the O.A.C. 5160-8-11.

[2] H.B. 136, 134 Gen. Assembly., Reg. Sess. (Oh. 2022).  H.B. 136 amended O.R.C. § 5162.06 and enacted O.R.C. §§ 5164.061, 5167.15.

[3] Jason Hoskins, Final Analysis, H.B. 136 134th General Assembly (June 28, 2022, 9:25 AM), https://www.legislature.ohio.gov/download?key=18641&format=pdf.

[4] Bill Expanding Access to Chiropractic Care Passes General Assembly, Heads to Governor, The Ohio House of Representatives (June 28, 2022, 8:39 AM), https://ohiohouse.gov/members/p-scott-lipps/news/bill-expanding-access-to-chiropractic-care-passes-general-assembly-heads-to-governor-109065#:~:text=State%20Rep.,chiropractic%20care%20for%20Medicaid%20patients.

[5] Id.

[6] Id.

[7] Id.; see also Jordan Laird, Could Expanded Access to Chiropractor Services Curb Opioid Prescriptions?, Springfield News-Sun (June, 28 2022, 8:52 AM), https://www.springfieldnewssun.com/local/could-expanded-access-to-chiropractor-services-curb-opioid-prescriptions/MUBCFQPYTFEKBJFRWHGN7W2GTU/ (“‘Conservative treatment like chiropractic offers two major benefits: It saves lives by reducing opioid use and abuse and it saves money by offsetting more expensive and invasive treatments,’ Spaulding said.”).

[8] Laird, supra; see also House Bill 136 -134^th General Assembly, The Ohio House of Representatives (June 28, 2022, 8:59 AM), https://ohiohouse.gov/legislation/134/hb136/votes (passing with only three votes against it passage in the house and zero in the senate).

[9] Hoskins, supra; see also O.A.C. 5160-8-11(listing what is currently covered).

[10] Nelson V. Lindgren, Final Fiscal Note & Local Impact Statement, H.B. 136 134th General Assembly

[11] Id.

[12] Hoskins, supra.

[13] Id. (“The bill requires the Medicaid Program to cover [E&M] services provided by a licensed chiropractor.”).

[14] Id.

[15] Id.

[16] Id.