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DATE: January 2, 2002
FACILITATING TEAM MEMBER RESPONSIBLE FOR WORK PLAN:
Arlene Pietranton, Chief Staff Officer for Speech-Language Pathology
ISSUE: Coverage rules and reimbursement rates are increasingly affecting access to, and scope of services provided by audiologists and speech-language pathologists.
OUTCOME 1: ASHA members will have access to information and tools to effectively negotiate with private health plans to ensure appropriate coverage criteria and equitable reimbursement rates.
STRATEGIES FOR 2003:
- By December 31, 2003 the Health Care Economics and Advocacy unit will have developed an instructional module and planned and conducted up to 7 half-day specialized conferences to provide information on how to advocate/negotiate for private health plan coverage for speech-language pathology and audiology services to be held at: the ASHA/CSAP Conference; the ASHA Convention; and at the annual meetings of up to five state associations. A copy of the instructional module, the workshop agenda, and a report on the conferences held and the number of attendees will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Health Care Economics and Advocacy unit will have contracted with Milliman USA to update to the 1994 Report, Managed Care Contracting: An Actuarial Analysis for use by ASHA members. A copy of the updated analysis will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Governmental Relations and Public Policy unit will have developed and promoted a section on the ASHA Web site related specifically to reimbursement to make information about existing ASHA/non-ASHA tools and resources related to private health plan coverage for speech-language pathology and audiology services easily accessible to ASHA members by having all the resources in one section on the Web site. To alert members to this Web site and to promote the existing resources and tools, a multimedia approach using written communications, telecommunication activities, and tangible products will be used. A copy of the Web site information and a list of promotional activities implemented will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Consumer Advocacy unit in collaboration with the Information Systems unit will have developed a database to track coverage and reimbursement policies of health plans, insurers and employers. A template of the database information will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Health Care Economics and Advocacy unit with the ASHA special interest divisions will update the 10 current treatment efficacy summaries for dissemination to state associations, special interest division affiliates and ASHA members. A copy of the updated summaries will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Speech-Language Pathology Health Care Services and the Audiology Practices units will develop talking points on future trends that will impact speech-language pathology and audiology services for use by ASHA members in maximizing health plan coverage. A copy of the talking points will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Health Care Economics and Advocacy unit will have established a state-based reimbursement network to include: a train the trainers full-day reimbursement boot camp workshop in conjunction with 2003 ASHA-CSAP conference; bimonthly conference calls for network participants; and establishment of an email list and a Web-based forum for network participants for exchange of information and to serve as a repository of resource items, documents, and forms. The Chief Staff Office for Speech-Language Pathology will maintain a list of network participants and a report of network activity.
OUTCOME 2 : Increase the number of employers that cover comprehensive speech-language pathology and audiology services in their health benefits package.
STRATEGIES FOR 2003:
- By December 31, 2003 the Governmental Relations and Public Policy unit will have developed, implemented, disseminated, and publicized the results of a Health Plan Report Card to identify and profile employers and health plans who have appropriate coverage for speech-language pathology and audiology benefits. The Report Card will include: standards for each of the SLP/A benefit categories that can be used to evaluate and grade employers’ and health plans’ coverage and reimbursement levels for speech-language pathology and audiology benefits and a guide to assist members in grading employers and health plans in their state. A copy of the Health Plan Report Card and a report on the results of using the Report Card will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Health Care Economics and Advocacy unit will have developed, publicized, and disseminated a “how to” check list to encourage and help members approach their employers about including speech-language pathology /audiology services in their insurance coverage. A copy of the checklist and a report on the use of and results of the checklist will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the Health Care Economics and Advocacy unit will have identified and met with decision-makers in organizations such as the Society for Human Resource Management, National Association of Insurance Carriers, and the Health Insurance Association of America to promote the value of speech-language pathology and audiology benefits and encourage these organizations to include/expand insurance coverage of speech-language pathology and audiology services. A list of organizations and decision makers identified and a report of the results of ASHA’s liaison with these organizations will be submitted to the Chief Staff Office for Speech-Language Pathology.
OUTCOME 3: Increase the number of states introducing legislation that mandates appropriate coverage of audiology and speech-language pathology services.
STRATEGIES FOR 2003:
- By December 31, 2003 the State Advocacy unit will have developed model bills for insurance coverage of speech-language and audiology services with supporting information for dissemination to state association leaders and for discussion at the ASHA State Policy Workshop. A copy of the model bills will be submitted to the Chief Staff Office for Speech-Language Pathology.
- By December 31, 2003 the State Advocacy unit will promote awareness of model state legislation designed to increase insurance coverage of speech-language pathology and audiology services through program and/or exhibit participation in national meetings of organizations for state government officials such as the National Conference of State Legislatures (NCSL), the National Governors Association (NGA), and the Council of State Governments (CSG). A list of organizational meetings at which ASHA participated/exhibited and a report on the evaluation of the impact of the activity will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the State Advocacy unit will provide grants to states that want to pursue passing legislation to mandate insurance coverage for speech-language pathology and audiology services. A list of states receiving grants and the activities initiated will be submitted to the Chief Staff Officer for Speech-Language Pathology.
OUTCOME 4: ASHA members will have access to information and tools to help them effectively navigate state funded insurance programs (e.g., Medicaid, CHIPs) at the state and local level to ensure appropriate coverage criteria and equitable reimbursement rates.
STRATEGIES FOR 2003
- By December 31, 2002 the Health Care Economics and Advocacy unit will have developed and implemented a campaign to promote existing ASHA tools and resources related to Medicaid to ASHA members that includes Web access (when available) to the Medicaid Technical Assistance Manual, and Web links (where available) to state Medicaid agency Web sites. A copy of the campaign elements and information will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2002 the Health Care Economics and Advocacy unit will have developed informational tools based on information contained in The Center for Medicare and Medicaid Services (CMS) Medicaid Technical Assistance Manual for use by ASHA members to use in understanding how the state Medicaid program is used to provide funding for speech-language pathology and audiology services within the schools. A copy of the tools developed will be submitted to the Chief Staff Officer for Speech-Language Pathology.
- By December 31, 2003 the School Services in Speech-Language Pathology unit will have investigated the need to develop guidelines for school-based members in addressing the issue of what constitutes “under the direction of” when school-based certified speech-language pathologists work with a Bachelor’s level provider/teacher. A report that includes recommendations related to the need for guidelines will be submitted to the Chief Staff Officer for Speech-Language Pathology.
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