Essential Health Benefits Recommendations to Expand Coverage of Nonpharmacological Therapies.
1. Inclusion of criteria and evidence standards for coverage of nonpharmacological approaches 2. Inclusion of chronic pain as an identifier in policy statements with discussion of how treatments differ from other types of pain, including as follows: a. Acknowledgment and support for multidisciplinary care b. Reduced burden of cotreatment visit limitations 3. Transparent and consistent wording regarding coverage of nonpharmacological therapies in terms of practitioner/therapist, and number of allotted treatments 4. Avoidance of behavioral treatment for pain exclusions and focus on coverage based on evidence of treatments for pain (eg, MBSR, CBT, and biofeedback) 5. Avoidance of arbitrary or outdated language or labeling of therapies with focus of coverage based on currently available evidence (eg, CAM exclusions) 6. Avoidance of licensed practitioner-based exclusions with focus on identification of available certified practitioners 7. Avoidance of exercise, self-care, and stress management exclusions and focus on coverage of identified facilities and practitioners available to provide treatments (eg, yoga, tai chi, MBSR) 8. Development of criteria for coverage eligibility based on nonresponse and/or nontolerability of covered treatments similar to tiered coverage recommendations commonly used for medication and comprehensive recommendation that incorporate nonpharmacological care40
Abbreviations: CAM, complementary and alternative medicine; CBT, cognitive behavioral therapy; DSM, Diagnostic and Statistical Manual of Mental Disorders; MBSR, mindfulness-based stress reduction.