November 1, 2013 Departments

News in Brief: November 2013

UnitedHealthcare Must Cover Speech-Language Treatment in California

UnitedHealthcare must provide coverage in California for medically necessary speech-language services and reimburse members who paid out-of-pocket for these services after they were inappropriately denied, according to an agreement between UHC and the California Department of Managed Health Care.

According to information from CDMHC [PDF], the insurer also must revise all current health plan documents to ensure they comply with California law, which requires health plans to arrange for and cover medically necessary speech-language treatment.

A CDMHC review of consumer complaints identified a pattern of UHC denials for speech-language services because the beneficiaries' communication difficulties were not due to a medical condition.

The settlement took effect Aug. 23 and requires UHC to notify all affected members of the change within 60 days and to notify all of its members of the agreement in its November newsletter. The notice will include information on how to request reimbursement for past out-of-pocket speech-language treatment expenses. UHC members have until July 30, 2014, to file for reimbursements.

In February 2012, CDMHC reached a similar settlement with Kaiser Permanente Foundation Health Plan. The department had received complaints from more than 100 Kaiser policyholders, dating back to 2009, who were denied coverage for occupational therapy, physical therapy and speech-language services because the policyholders lacked a physical or mental health condition.

In the Kaiser case, the department cited people who stutter or have a lisp—and were denied speech-language pathology services under the insurer's policy—as an example of the difficulties stemming from Kaiser's coverage policies. Kaiser claimed that its policies were mischaracterized as limited only to patients with physical conditions. It is significant to note that some observers view the Kaiser settlement as an order to cover treatment for "developmental conditions," which often are excluded from coverage by many health plans.

In a statement, UHC said that its original policy was "appropriate," but that the agreement was reached "to resolve this old issue."

Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor.

  • jmccarty@asha.org

Tip Sheet for Medicare Providers on Avoiding Penalties

A new document can help Medicare Part B providers who are confused about how to avoid future penalties for failure to participate in the 2013 Physician Quality Report System. The Centers for Medicare and Medicaid Services has an online tip sheet [PDF] that includes guidelines on eligibility and step-by-step how-tos.

PQRS applies to all private- and group-practice audiologists and speech-language pathologists who submit claims for Medicare Part B beneficiaries. To avoid the 1.5% payment penalty on all 2015 claims, providers must report at least one valid measure through claims or a registry in calendar year 2013. Providers can meet this requirement by submitting codes on Medicare Part B claims specifically for PQRS. The functional outcomes reporting requirements for all Medicare Part B therapy services do not satisfy the PQRS reporting requirements. All 2013 PQRS submissions must apply to service dates in 2013 on payable claims processed by Feb. 28, 2014.

Feds Grant $1.9 Million for Assistive Technology

The U.S. Department of Education has awarded $1.9 million to organizations in California, Missouri and Washington to help people with disabilities purchase assistive technology, including hearing aids.

The grants, given through the Assistive Technology Alternative Financing Program, will help people with disabilities get private financing to buy services and devices, including hearing aids, computers, vehicle modifications, vision aids and other devices. The organizations will use the funds for their own programs:

  • The California Foundation for Independent Living Center will establish the FreedomTech Low-Interest Loan Program, offering low-interest loans and a loan guarantee option for some applicants.
  • The Missouri Assistive Technology Council will offer Show-Me Loans, which have distributed more than $1.2 million in support to individuals with disabilities since 1998.
  • The Washington Access Fund will provide low-interest loans and matched savings accounts for assistive technology, as well as business equipment needed for employment or self-employment grants.

The Assistive Technology Alternative Financing Program is administered by the Education Department's Rehabilitation Services Administration of the Office of Special Education and Rehabilitative Services.

Model Privacy Practice Notices Available

Providers who want help developing privacy practice notices required under the Health Insurance Portability and Accountability Act can download customizable templates in a variety of formats from a federal government website.

HIPAA regulations that took effect in September require providers to explain how they will handle patients' protected health information.

The Office of the National Coordinator for Health Information Technology and the Health and Human Services Office for Civil Rights developed the forms with input from consumers and key stakeholders. Providers may enter their own information (name and contact information, for example) into a format and print the notice for distribution and/or post the electronic version on their websites.

AHRQ Report Compares Tinnitus Treatments

The U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality recently released "Evaluation and Treatment of Tinnitus: Comparative Effectiveness" [PDF]. The authors evaluated the peer-reviewed literature on three areas of tinnitus management: measures used to assess patients for management needs, the effectiveness of various treatments, and identification of prognostic factors.

The report, which is based on research conducted by the McMaster University Evidence-based Practice Center in Ontario, Canada, is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and, therefore, improve the quality of health care services.


  

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