FACILITATING TEAM MEMBER RESPONSIBLE FOR WORK PLAN: Vic Gladstone, Chief Staff Officer for Audiology
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 2004
1. By December 31, 2004 the Health Care Economics and Advocacy Team (HEAT) will have updated, 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 Convention and at up to five state association meetings. A report on the conferences held and the number of attendees will be submitted to the Chief Staff Officer for Audiology.
2. By December 31, 2004 the HEAT will provide support for State Advocates for Reimbursement (STARs) interactions via bimonthly conference calls, and interactive messages on the STARs forum and email listserv. Two to four additional state associations will add representatives to STARs. The Director of Private Payer Advocacy will maintain the list of network participants and a report of network activity.
3. By December 31, 2004, the HEAT will have conducted a telephone seminar for up to 53 participants/lines with a replay option for up to 32 replays and conducted a series of Web-based instructional modules to provide further private payer reimbursement training for STARs. A report on the telephone seminars held and the number of attendees will be submitted to the Chief Staff Officer for Audiology.
4. By October 31, 2004 the HEAT will have developed a new Web page on the ASHA Web site for employers, insurers, and labor unions that will provide links to ASHA documents that can be used to develop new benefits or improve existing benefits in speech-language pathology and audiology. A report on the content included on the Web page will be submitted to the Chief Staff Officer for Audiology. Note: this strategy relates to both Outcomes 1 & 2)
5. By October 31, 2004 the HEAT will have developed a new Web age on the ASHA Web site for consumers that will provide links to documents (ASHA and external agencies) that can be used by consumers to assist them in the appeals process as well as in advocating for more comprehensive coverage of speech-language pathology and audiology services. A report on the content included on the Web page will be submitted to the Chief Staff Officer for Audiology.
6. By October 31, 2004, the HEAT will develop a document on medical necessity for use by members that includes information on how payers determine medical necessity, the information needed in the decision-making process to determine medical necessity, and related legal issues. A copy of the document will be submitted to the Chief Staff Officer for Audiology.
7. By December 31, 2004 the Governmental Relations Public Policy (GRPP) cluster in collaboration with the Communications, Marketing and Information Systems clusters will have developed and regularly published for at least six months, an ASHA “e-zine or newsletter” to specific ASHA-member constituencies that may include audiology, SLP schools, SLP health care, academics, and researchers. that includes payment and reimbursement advocacy information, based on members’ work settings and other resources and information of interest. Copies of the “e-zine or newsletter” and the dates published will be submitted to the Chief Staff Officer for Audiology.
8. By December 31, 2004 the HEAT will continue to collect and track data in the coverage and reimbursement policies of health plans, insurers and employers and produced another graphic representation (i.e., report card) of the findings. A copy of the report card will be submitted to Chief Staff Officer for Audiology.
Strategy Update - October 2004
- Developed an instructional module on how to advocate/negotiate for private health plan coverage for speech-language pathology and audiology services that has been presented at meetings of the Mississippi, Missouri, New Jersey, New Mexico, and Washington state speech-language-hearing associations.
- Continued development of the State Advocates for Reimbursement (STARs) network by developing Web-based instructional modules related to negotiating, legislative advocacy, medical necessity, and actuarial data) and by presenting a teleseminar for STARs on "Dynamic Useful and Serious Tactics for Advocacy." Currently there are 43 representatives from 43 state speech-language-hearing Associations on the STARs network.
- Developed and published four new "e-zines targeting specific ASHA-member constituencies (audiology, SLPs in schools, SLPs in health care, and academics, and researchers)to provide subscribers with current information on payment and reimbursement, advocacy, and other resources and information of interest based on members' work settings.
OUTCOME 2: Increase the number of employers that cover comprehensive speech-language pathology and audiology services in their health benefits package.
STRATEGIES FOR 2004
1. By October 31, 2004, the HEAT will advocate with the following BCBS plans for more comprehensive coverage of audiology and speech-language pathology services:1) Florida; 2) Michigan; and 3) Pennsylvania. A report on the BC/BS plans worked with and the results in increasing more comprehensive coverage will be submitted to the Chief Staff Officer for Audiology.
2. By December 31, 2004, the HEAT will advocate with the Federal Employee Health Benefits Program (OPM) for direct access to audiology services. A report on the advocacy activities and the results in increasing direct access will be submitted to the Chief Staff Officer for Audiology.
3. By December 31, 2004, members of the HEAT will have identified and targeted decision-makers from five major employers, labor unions, or health plan associations for an awareness campaign that will center on the need for improved coverage of speech-language pathology and audiology services in their health plans. Face-to-face meetings will occur with at least two of the decision-makers or their representatives. A report on the decisions-makers worked with and the results in obtaining improved coverage will be submitted to the Chief Staff Officer for Audiology.
4. By December 31, 2004, a team consisting of Audiology, Speech-Language Pathology, GRPP, and Public Relations units will develop a plan to increase awareness and disseminate the consumer flyer and checklist created through the 2003 Focused Initiative on Reimbursement to consumer organizations (e.g., A.G. Bell, SHHH, ATA, Deafness Research Foundation, American Stroke Association, etc.). A list of organizations who have agreed to place this information in their communication vehicles will be submitted to the Chief Staff Officer for Audiology.
5. By October 31, 2004, the HEAT in collaboration with a human resource consultant will develop a long-term strategy and plan for advocating for improved coverage and reimbursement of speech-language pathology and audiology services by group health plans by holding a meeting with National Office staff members and selected members of the Health Care Economics Committee and the STARs to develop the strategy and plan. A copy of the meeting agenda, list of participants, and a copy of the plan will be submitted to the Chief Staff Officer for Audiology
Strategy Update - October 2004
- Contacted and/or met with representatives of Blue Cross-Blue Shield (BCBS) plans in Florida, Michigan, and Pennsylvania to advocate for more comprehensive coverage of audiology and speech-language pathology services. BCBC-MI has revamp their model speech/language benefits using ASHA's model as a framework. BCBC-FL agreed to look into adding AUDS/SLPs as direct access providers, collaborate with FLASHA on documentation requirements, and create optional SLP/AUD benefits through an alternative Blues program. BCBS-PA has requested that ASHA provide them with our "wish list" for speech/language/hearing coverage. The medical director at BCBS-PA will then bring the "wish list" to the BCBS Association for possible inclusion into the Blues' national coverage policy.
- Developed and implemented a plan to increase awareness and disseminate the consumer flyer and benefits plan checklist related to enhancing coverage of speech-language pathology and audiology programs and services in health insurance plans. Information related to the consumer flyer and the checklist has been posted on the following consumer web sites including Aphasia Hope, National Coalition on Auditory Processing Disorders (NCAPD) which also included a link to our article on Auditory Processing, The American Stroke Association, Deafness Research Foundation, HealthCareCoach.com, VOICES (Victory Over Impairments of Communication) Association Online Newsletter, Gallaudet University, Cleftadvocate, and FACES: The National Craniofacial Association, Stuttering Center of Western PA, Stuttering Foundation of America, Self Help for Hard of Hearing (SHHH) , National Stuttering Association (NSA), Prevention Magazine's on-line consumer survey. The consumer flyer and checklist were also disseminated at ASHA exhibits at meetings of the Self Help for the Hard of Hearing (SHHH) and A.G. Bell.
- Developed a strategic plan for advocating for improved coverage and reimbursement of speech-language pathology and audiology services by group health plans. Elements of this plan have been included in the work plan for the 2005 Focused Initiative on Health Care Reimbursement.
OUTCOME 3: Increase the number of states introducing legislation that mandates appropriate coverage of audiology and speech-language pathology services.
STRATEGIES FOR 2004
1. By May 31, 2004, the State Advocacy unit will facilitate a meeting of state association leaders and lobbyists attending ASHA’s State Policy Workshop in May to discuss their efforts and needs in obtaining insurance coverage of speech-language and audiology services through state legislation. A summary of the meeting will be provided to the Chief Staff Officer for Audiology.
2. By December 31, 2004, the State Advocacy unit will promote awareness of model state legislation to increase insurance coverage of speech-language pathology and audiology services through participation in national meetings of the National Conference of State Legislatures and the Council of State Governments. A report on the impact of the activity will be submitted to the Chief Staff Officer for Audiology Pathology.
3. By October 31, 2004, the State Advocacy unit will provide enhanced monitoring and early notification to state speech-language-hearing associations of proposed changes in the coverage of optional speech, language, and hearing services under Medicaid in their states. A list of state associations notified will be submitted to the Chief Staff Officer for Audiology.
Strategy Update - October 2004
- Conducted a meeting of state association leaders and lobbyists to discuss their efforts and needs in obtaining insurance coverage of speech-language and audiology services through state legislation. Twenty- Six (26) attendees representing 19 states participated in the meeting.
- Promoted awareness of model state legislation to increase insurance coverage of speech-language pathology and audiology services through participation in national meetings of the National Conference of State Legislatures and the Council of State Governments
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 2004
1. By December 31, 2004 the School Services in Speech-Language Pathology unit and an ASHA-member working group will have developed a technical report and position statement for school-based members in addressing the issue of what constitutes “under the direction of” when school-based certified speech-language pathologists supervise a Bachelor’s level clinician. A copy of the document and a list of individuals and organizations receiving the document will be submitted to the Chief Staff Officer for Audiology.
2. By October 31, 2004, the HEAT will have created a new document for use by state associations in negotiating better outpatient rates and preserving or adding speech, language and hearing benefits in Medicaid programs that includes Medicare reimbursement rates, actuarial data, and selected state Medicaid rates. A copy of the document will be submitted to the Chief Staff Officer for Audiology.
Strategy Update - October 2004
- Developed a technical report and position statement for school-based members in addressing the issue of what constitutes "under the direction of" when school-based certified speech-language pathologists supervise individuals who do not meet the personnel requirements under the Medicaid program.
- Developed a document for use by state associations for use in negotiating better outpatient rates and preserving or adding speech, language and hearing benefits in Medicaid programs.
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