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Date: January 1, 2005
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 and Medicare carriers and intermediaries to ensure appropriate coverage criteria and equitable reimbursement rates.
Strategies
- By December 31, 2005, the Health Care Economics and Advocacy Team (HEAT) will have updated, planned and conducted half-day specialized conferences to provide information on how to advocate/negotiate for private health plan coverage for speech-language pathology and audiology services. The conferences will be held at the ASHA Convention and at up to six state association meetings.
- By December 31, 2005, the HEAT will provide support for the State Advocates for Reimbursement (STARs) Network interactions via bimonthly conference calls (n=6/year) and interactive messages on the STAR forum and email listserv. Two additional state associations will add representatives to the STAR Network and replacements will be found for retiring STARs.
- By December 31, 2005, HEAT will provide grants to 4 states represented on the STAR Network who want to advocate for comprehensive coverage of speech-language pathology and audiology services.
- By December 31, 2005, HEAT will continue to expand the database created through the 2003 Focused Initiative on Reimbursement to track coverage and reimbursement policies of health plans.
Outcome 2: Increase the number of employers that cover comprehensive speech-language pathology and audiology services in their health benefits package.
Strategies
- By June 30, 2005, the HEAT and the PRT will have researched the awareness level of consumers and employers about speech-language pathology and audiology programs and services in a health benefits package.
- By July 1, 2005, the PRT will have evaluated the 2004 media pitches of the ASHA Health Plan Report Card and make a recommendation as to whether the media pitches should continue and if so to which publications.
- By July 1, 2005, the HEAT will have updated the list of primary union targets for promoting coverage of speech-language pathology and audiology programs and services in their health benefits package.
- By July 1, 2005, the HEAT will have contacted the National Business Group on Health (NBGH) to determine the membership and mission of the NBGH and what ASHA could do to work with them to promote coverage of speech-language pathology and audiology programs and services in health benefits packages.
- By July 31, 2005, HEAT will have reviewed and updated the current ASHA model benefits and advocacy materials (e.g. NOMS, Employer Insurance Packet, Employer and Consumer Checklists) for use by ASHA members to promote inclusion of comprehensive coverage of speech-language pathology and audiology programs and services in their health benefits package.
- By November 1, 2005, the HEAT and the Public Relations Team (PRT) will have set up advisory groups to determine the audiology and speech-language pathology benefits needed and to identify ways to increase coverage of speech-language pathology and audiology programs and services.
- By December 31, 2005, HEAT will have provided information to and/or contacted professional associations asking them to enhance their own coverage and to promote coverage of speech-language pathology and audiology programs and services in health benefits packages related to their profession.
- By December 31, 2005, HEAT will have disseminated information to health plans on what medical, societal, and quality of life issues exist with a communication disorder and to indicate why it is important to cover speech-language pathology and audiology programs and services in health plans.
- By December 31, 2005, GRPP will have provided information to ASAE/GWSAE to ask them to promote within associations the coverage of speech-language pathology and audiology programs and services in health benefits packages.
- By December 31, 2005, HEAT will have prepared and disseminated information and/or contacted manufacturers, suppliers, and vendors of products in the area of speech-language pathology and audiology asking them to include coverage of speech-language pathology and audiology programs and services in their health benefits packages.
- By December 31, 2005, HEAT will have prepared and disseminated information on coverage of speech-language pathology and audiology programs and services in health benefits packages to consumer organizations to promote coverage in their health benefits package.
- By December 31, 2005, HEAT will have developed and disseminated information and/or contacted state and local public health agencies to indicate the health benefits of including coverage of speech-language pathology and audiology programs and services in health benefits packages.
- By December 31, 2005, the HEAT and NOMS staff will have determined the feasibility of making a presentation on the ASHA NOMS data to the BC/BS Association Best Practices annual meeting.
- By December 31, 2005 the HEAT will have packaged ASHA products related to coverage of speech-language pathology and audiology programs and services in health benefits packages for dissemination to the NBGH.
- By December 31, 2005, the HEAT in collaboration with Marketing and Sales staff will have contacted all companies that advertise in The ASHA Leader, asking them to include coverage of speech-language pathology and audiology programs and services in their health benefits packages.
- By December 31, 2005, the HEAT in collaboration with Convention and Meetings and ASH Foundation staff will have contacted all companies that exhibit at the ASHA convention or who are ASHF donors, asking them to include coverage of speech-language pathology and audiology programs and services in their health benefits packages.
- By December 31, 2005, PRT will continue the work from 2004 with a team consisting of audiology, SLP, GRPP, and public relations to increase awareness and disseminate the consumer flyer and checklist created through the 2003 Focused Initiative on Health Care Reimbursement to consumer organizations. The Chief Staff Officer for Audiology will receive a list of organizations that have agreed to place this information in their communication vehicles.
- By December 31, 2005, HEAT will have provided information and/or contacted the Children’s’ Hospital Association to encourage them to enhance coverage of speech-language pathology and audiology programs and services in health benefits packages for children.
Outcome 3: Increase the number of states introducing legislation that mandates appropriate coverage of audiology and speech-language pathology services.
Strategies
- By January 2, 2005, and throughout the year, 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
- By December 31, 2005, the State Advocacy unit will promote awareness of the benefits of speech-language pathology and audiology services through participation in the national meeting of the National Conference of State Legislatures.
Outcome 4: ASHA members will have access to information 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
- By December 31, 2005, the HEAT will have reinvigorated the Medicare Intermediary and Carrier State (MICS) network by instituting bimonthly conference calls (n=6/year), presenting to the State Association Presidents at the ASHA State Policy Workshop and convening a meeting of the MICS network at the 2005 ASHA convention.
- By December 31, 2005, the School Services Team and an ASHA-member working group will have developed guidelines and knowledge/skills document for school-based members addressing the issue of what constitutes “under the direction of” when supervising non-qualified clinicians for Medicaid reimbursement of speech-language services. The documents will serve as accompanying documents for the technical report and position paper developed as part of the 2004 Focused Initiative on Health Care Reimbursement.
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