Administration.
(C) The following
definitions will be used in administering this rule:
1. "Adult participant" means a person who is
at least twenty-one (21) years of age or older and who is enrolled as a MO
HealthNet participant;
2.
"Complementary health and alternative therapy for chronic pain" combines the
use of physical therapy, cognitive-behavioral therapy, chiropractic therapy,
and/or acupuncture to promote chronic pain relief for adult participants;
3. "Physical therapy treatment for
chronic pain" includes, but is not limited to, participant education and
counseling, manual techniques, therapeutic exercises, electrotherapy, and
massage;
4. "Cognitive-behavioral
therapy for chronic pain" or "CBT" combines treatment of emotional thinking and
behavioral health for participants with chronic pain, trains in behavioral
techniques, and helps patients modify situational factors and cognitive
processes that exacerbate pain;
5.
"Chiropractic therapy for the treatment of chronic pain" may include, but is
not limited to, spinal manipulation or spinal adjustment, and as further
defined by section 331.010.1, RSMo;
6. "Acupuncture" involves the use of needles
inserted into the body by piercing of the skin and other modalities as defined
by sections 331.030.8 and 324.475(1), RSMo;
7. "Prescribing physician" means a physician
licensed under Chapter 334, RSMo, who specializes in family medicine or
internal medicine and is authorized to prescribe medication or other therapy
within the scope of such person's practice;
8. "Complementary health and alternative
therapy provider" means a complementary health and alternative therapy care
provider licensed by the state of Missouri and authorized to provide health
care services within the scope of such person's practice;
9. "First-line non-opioid medication therapy"
includes, but is not limited to, analgesics such as non-steroidal
anti-inflammatory drugs (NSAIDs), acetaminophen, cyclooxygenase 2 (COX-2)
inhibitors, SAM-E herbal therapy, topical analgesics, selected antide-
pressants, selected anticonvulsants, and/or muscle relaxer medication;
10. "Opioid medication therapy"
includes any prescription drug, natural or synthetic, that binds to the brain's
opioid receptors having an addiction-forming or addiction-sustaining ability,
or being capable of conversion into a drug having such addiction-forming or
addiction-sustaining ability;
11.
"Chronic pain" means a non-cancer, non-end-of-life pain lasting more than three
(3) months, or longer than the duration of normal tissue healing;
12. "Acute pain" means pain, whether
resulting from disease, accidental or intentional trauma, or other cause that
the practitioner reasonably expects to last only a short period of time. Acute
pain does not include chronic pain, pain being treated as part of cancer care,
hospice or other end of life care, or pain being treated as part of palliative
care; and
13. "High dose opioid
therapy" is to be considered as any therapy greater than ninety (>90) MME
(morphine milligram equivalents) per day