ST. LOUIS, September 30, 2019 – The State of Missouri, Department of Social Services (DSS), hereby notifies the public of its intent to amend the Gateway to Better Health Demonstration to add a physical function improvement benefit. A copy of the full amendment request under consideration may be found at http://dss.mo.gov/mhd/. We are providing this notice pursuant to Centers for Medicare & Medicaid Services (CMS) requirements in 42 C.F.R. 431.408.
The Gateway to Better Health Demonstration is designed to provide coverage to uninsured adults residing in St. Louis City and St. Louis County, who are between the ages of 19 and 64, with family incomes between 0 and 100 percent of the Federal poverty level (FPL), and who do not qualify for Medicaid. The Demonstration is set to expire on December 31, 2022; however, should the State opt to expand Medicaid during the extension period to cover this population, the Demonstration will terminate immediately.
Affecting at least 116 million individuals, chronic pain affects more people in the United States than heart disease, diabetes, and cancer combined. Despite enormous evidence in favor of multidisciplinary, integrated approaches, primary care providers lack the necessary tools to address patient pain. Many providers report that they initiate opioid treatment for pain relief, despite its high risk and lack of efficacy for chronic pain, because of limited access to other effective modalities. Physical function services, including physical therapy, occupational therapy, chiropractic services, and acupuncture, have been shown to ameliorate pain. On April 1, 2019, MO HealthNet (Missouri Medicaid) implemented a new statewide health benefit for their recipients addressing chronic pain. The benefit is coordinated through the patient’s primary care provider and gives patients access to physical therapy, chiropractic therapy, and acupuncture, alongside cognitive-behavioral therapy (CBT) for chronic pain and non-opioid medication therapy. This initiative responds to the growing pool of research that supports the cost benefits of addressing pain proactively.
The State is requesting authority to extend the current benefits for the population covered by the Gateway to Better Health Demonstration to include preventative physical function improvement services for patients with pain-related diagnoses. Physical function services would include office visits for physical therapy, occupational therapy, chiropractic, and acupuncture services provided at the primary care health home. Through the addition of preventative physical function improvement services, the Demonstration expects to reduce reactive specialty care costs while improving health outcomes for uninsured patients. Currently the Demonstration covers these codes solely after an orthopedic surgery. This new benefit will align with the Medicaid chronic pain benefit offered by MO HealthNet.
The public is invited to review and comment on the State’s proposed amendment request. The full public notice document for the Gateway to Better Health Waiver amendment request, as well as a draft of the amendment itself, can be found at https://dss.mo.gov/mhd/waivers/1115-demonstration-waivers/gateway-to-better-health.htm
Public hearings will be held on the following dates:
Tuesday, October 1, 2019, 7:30-8:30*
Ethical Society of St. Louis
9001 Clayton Road, St. Louis, MO 63117
Thursday, October 3, 2019, 3:30-4:30 pm*
Forest Park Visitor and Education Center
5595 Grand Drive, St. Louis, MO 63112
Monday, October 7, 2019, 2:00-3:00 pm*
St. Louis Regional Health Commission
1113 Mississippi Avenue, Suite 113
St. Louis, MO 63104
*Individuals wanting to participate in the public hearings via conference call may dial 888-808-6929, access code: 9158702