April 1, 2013 Departments

News in Brief: April 2013

New Information for States Choosing Alternative Education Reform

With 34 states and the District of Columbia approved to pursue education reform outside of the requirements of the 2001 No Child Left Behind Act, the U.S. Department of Education has released a series of new informational publications.

The Department of Education offers flexibility to states regarding specific NCLB requirements in exchange for rigorous and comprehensive state-developed plans that improve educational outcomes for all students, close achievement gaps, increase equity and improve the quality of instruction.

The new materials describe the flexibility program and offer examples of programs in some participating states. The publication series includes a brochure and fact sheets on topics that relate to five priority areas under NCLB flexibility.

Medicare Clarifies 2013 Payment Changes

Speech-language pathologists should be aware of new guidance in three areas of Medicare Part B reimbursement. The Centers for Medicare and Medicaid Services recently clarified regulations related to therapy caps, manual medical review and multiple procedure payment reductions.

  • Therapy caps. Therapy services (occupational therapy, physical therapy, speech-language treatment) provided at critical access hospitals are included in a Medicare beneficiary's total therapy dollar amount, even though the critical access hospitals are not required to adhere to the therapy cap provisions. SLPs should use the Medicare Administrative Contractors' resources to track beneficiaries' therapy amounts, and understand that services provided in the critical access hospitals do apply and may affect how quickly a patient reaches the $1,900 cap.
  • Manual medical review. In 2012, the manual medical review process for therapy services beyond a $3,700 per beneficiary threshold required pre-approval. That process is not in effect in 2013. Until CMS determines a long-term process, it will stop all claims beyond the $3,700 threshold and request a review prior to payment.
  • Multiple procedure payment reduction. Payment for multiple therapy services provided to a single patient on a single day in a single facility are subject to the MPPR. This reduction on second and subsequent procedures increased to 50% (from 25 percent for facilities and 20 percent for private practices) of the procedures' practice expense beginning April 1. SLPs may see a decrease of 7 to 12 percent in payment for services in this category. The MPPR applies to speech-language, occupational therapy and physical therapy services performed under the same provider number—it does not apply, however, to services provided in different facilities or practices.

Joint Committee on Infant Hearing Develops Early Intervention Guidelines

Members of the Joint Committee on Infant Hearing recently completed a new document focusing on early intervention practices. The new document, "Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention Following Confirmation That a Child Is Deaf or Hard of Hearing," will be published by the Journal of Pediatrics and on the ASHA website. 

The supplement to the JCIH 2007 Position Statement recognizes the need to provide comprehensive guidelines for establishing strong early intervention systems with the appropriate expertise to meet the needs of children who are deaf or hard of hearing.

Effective newborn hearing screening programs must be linked to timely and effective early interventions. The supplement seeks to enhance the effectiveness of early intervention by providing best practice guidelines.

The document includes several unique features:

  • It provides 12 best practice principles, each supported by background and rationale based on current literature and followed by a set of specific recommendations.
  • It provides a set of benchmarks for systems to monitor their progress as they work toward establishing best practices.
  • Three appendices provide direction on the core knowledge and skills of providers, along with checklists for monitoring quality components and fidelity of interventions. 

JCIH was established in 1969 to advance practices in the early identification of hearing loss in children. Over the past 40 years, the JCIH has published seven position statements that summarize current scientific evidence and recommend preferred practices related to early identification and follow-up stages for newborns and infants at risk for or with hearing loss.

Federal Efforts to Combat Health Care Fraud Yield $4.2 Billion

A team from the U.S. Department of Justice and U.S. Department of Health and Human Services recovered $7.90 for every dollar spent investigating health care-related fraud and abuse over the past three years.

This return is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Program. Since 1997, the program has returned more than $23 billion to the Medicare Trust Funds.

The prevention and enforcement efforts recovered a record $4.2 billion in fiscal year 2012—up from nearly $4.1 billion in FY 2011—from individuals and companies who attempted to defraud federal health programs or sought payments to which they were not entitled.  

The higher return on investment comes in the wake of the 2009 creation of the Health Care Fraud Prevention and Enforcement Action Team. This collaborative effort between Justice and HHS aims to prevent fraud, waste and abuse in Medicare and Medicaid and to crack down on individuals and entities that abuse the systems. These efforts received a boost from new tools and resources—enhanced screenings and enrollment requirements, increased data sharing across the government, expanded recovery efforts for overpayments and greater oversight of private insurance abuses—provided by the Affordable Care Act.

In FY 2012, the team recovered about $4.2 billion stolen or otherwise improperly obtained from federal health care programs and returned the money to the Medicare Trust Funds, the Treasury and others.

More information is available from the Health Care Fraud and Abuse Program; the DOJ-HHS joint effort website; and the federal health care website.

IEP Changes Can't Be Based on Limited Assessment

An independent hearing examiner has upheld a parent's request for an independent educational speech-language evaluation, saying that the Avon Grove (Pennsylvania) school district substantially changed a student's individualized education program based solely on the results of two subtests of a single instrument [Avon Grove Sch. Dist., 113 LRP 3140 (SEA PA 01/04/13)].

The district characterized the discontinuation of a student's individual written language instruction as a change in instructional approach, but the hearing examiner found that the district's flawed assessment of the student, which formed the basis for the IEP modification, entitled the parents to an independent evaluation at public expense.

Court Requires Schools to Use Appropriate Autism Evaluations for Students With Hearing Impairment

Under a District Court ruling, a school district that administered an autism evaluation to an elementary school student who is deaf must reimburse the student's parents for the cost of an outside evaluation because the school's instrument is inappropriate for students who are deaf.

In S.F. v. McKinney Independent School District, 59 IDELR 261 (E.D. Tex. 2012), a school administered the autism test as part of a re-evaluation, but the test's guidelines state it is not suitable for use with children who are deaf or blind or have any other serious motor or sensory disorders. The parents obtained an independent educational evaluation and filed for due process, seeking reimbursement. The district contended that the student had already been classified as having autism and that the re-evaluation results were being used to gain information about the student's social and communicative skills.

The District Court, however, held that the Individuals With Disabilities Education Act does not make such a distinction in its strict requirement that evaluations comply with producers' guidelines, and ordered the district to reimburse the parents $6,780.

Professionals administering assessments should review best practices for evaluating students with hearing impairments for autism to avoid a similar outcome. Tests should be appropriate for such students and administered in their primary mode of communication. Evaluators should conduct observations and interviews to supplement standardized testing and recognize when use of an interpreter is appropriate.


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