2006 Focused Initiatives

Focused Initiative: Reimbursement in Health and Education

Fourth Quarter Progress Report (October - December)

Facilitating Team Member Responsible For Work Plan: Vic Gladstone, Chief Staff Officer for Audiology

Issue: Coverage rules, reimbursement rates, and federal, state, and local funding streams are increasingly affecting access to and scope of services provided by audiologists and speech-language pathologists in health and education settings.

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

1. By March 30, 2006, the ASHA Healthcare Economics and Advocacy Team (HEAT) will have revised ASHA HEAT publications related to negotiating with private health plans will be revised. [Completed]
2. By June 15, 2006, the ASHA Healthcare Economics and Advocacy Team (HEAT) will have revised and updated the HEAT Web-site whenever new materials that can be used to negotiate with private health plans are received. [Completed]

Outcome 2: Increased number of employers that cover comprehensive speech-language pathology and audiology services in their health benefits package.

Strategies

1. By March 1, 2006, the HEAT will have enlisted a private health plan advocacy consultant to assist in developing and implementing advocacy approaches. [Completed]
2. By March 15, 2006, the HEAT will have purchased 10 USB flash drives to give to organizational representatives (e.g., National Business Coalition on Health, American Physical Therapy Association, and American Society of Association Executives) as a reminder of good faith in considering including speech, language and hearing benefits in their health plans. [Completed]
3. By April 1, 2006, the HEAT and the Professional Practices in Speech-Language Pathology cluster will have determined the feasibility of making a presentation on the ASHA NOMS data to the BC/BS Association Best Practices annual meeting. If such a presentation is feasible, it will be made at the annual meeting. [Completed]
4. By July 1, 2006, the Professional Practices Speech-Language Pathology and Audiology, GRPP, and Public Relations clusters will have met with an advisory group of benefits managers/employers to identify issues related to the need for audiology and speech-language pathology benefits that should be highlighted in an awareness campaign directed at employers and elicit guidance from the group with respect to campaign message, targets, strategy, and approaches. [Completed]
5. By November 1, 2006, the HEAT will have developed a strategy checklist for members to assist with communicating with private health plans and Medicaid when consideration is given to eliminate or reduce coverage of speech-language pathology and audiology services. [Carry Over to 2007]
6. By November 1, 2006, the HEAT will have developed a Health Savings Account (HSA) coverage document that explains how HSAs cover speech-language pathology and audiology services and devices. [Completed]
7. By December 31, 2006, the Professional Practices Speech-Language Pathology and Audiology, GRPP, and Public Relations clusters will have developed the outlines of a campaign, complete with message, strategy, targets, goals, and tactics (that will possibly include an ad campaign). The campaign will actually be implemented in 2007. [Completed]
8. By December 31, 2006, the Healthcare Economics and Advocacy Team (HEAT) will have contacted and negotiated for coverage with the health plans that received information from ASHA 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. [Completed]
9. By December 31, 2006, the HEAT will have contacted and negotiated for coverage with 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. [Completed]
10. By December 31, 2006, the HEAT will have updated, planned and conducted up to 6 1/2-day specialized conferences in conjunction with a state association's or related professional organizations' annual meeting on negotiating for private health plan coverage for speech-language pathology and audiology coverage. [Carry Over to 2007]
11. By December 31, 2006, the HEAT will have provided continued support for the State Advocates for Reimbursement (STAR) Network via bi-monthly (n=6) conference calls, interactive message on the STAR listserv and member community forum and will have provided STAR members with a copy of Bargaining for Advantage: Negotiating Strategies for Reasonable People to assist them in preparing for meetings with representatives of employers, unions and health plans. [Completed]
12. By December 31, 2006, the HEAT will have provided continued support for the Medicare Intermediaries and Carriers (MICS) Network via bi-monthly (n=6) conference calls, interactive message on the MICS listserv and member community forum. [Completed]
13. By December 31, 2006, the HEAT will have continued to expand the database created through the 2003 Focused Initiative on Reimbursement to track coverage and reimbursement policies of health plans. [Completed]
14. By December 31, 2006, the HEAT will have communicated information about ASHA products related to coverage of speech-language pathology and audiology programs and services in health benefits packages for dissemination to members of the National Business Coalition on Health. [Completed]
15. By December 31, 2006, the HEAT will have an article and information on the coverage of speech-language pathology and audiology programs and services in health benefits packages for publication in a National Business Group on Health publication. [Completed]
16. By December 31, 2006, the HEAT will have assessed the success of the National Business Coalition on Health pilot and determine if other employer organizations exist. If so, HEAT will determine the feasibility and marketing approach to other employer organizations. [Completed]
17. By December 31, 2006, the HEAT will have met with staff of the National Association of Children's Hospitals and Related Institutions to assist them in communicating the issues associated with their member institutions coverage of speech-language pathology and audiology programs and services in health benefits packages for children. [Completed]
18. By December 31, 2006, the HEAT will have contracted with Milliman USA to update and provide explanatory text for the 2003 report Commercial Managed Care Contracting Analysis. [Completed]

Outcome 3: 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.

1. By August 31, 2006, the Healthcare Economics and Advocacy Team (HEAT) will have revised and updated the HEAT Web-site whenever new materials related to state funded insurance programs are received. [Completed]
2. By November 1, 2006, the HEAT and the State & Consumer Advocacy team will have developed a template of information to be gathered on speech, language, and hearing benefits under Medicaid; hired a consultant to obtain this information from all state Medicaid agencies; and post results on the ASHA Web site. [Carry Over to 2007]

Outcome 4: Increased advocacy for and use of public and private reimbursement systems/insurance programs that enhance the ability of consumers to receive quality programs and services by audiologists and speech-language pathologists.

1. By November 1, 2006, the HEAT will have developed and published in a packet format legislative advocacy materials including sample bills that explain mandated coverage of cognitive rehabilitation, autism speech and language services, and auditory rehabilitation. [Completed]
2. By December 31, 2006, the HEAT will have disseminated information and contacted the American Federation of State, County and Municipal Employees (AFSCME) union and the president of the Directors of Speech and Hearing Programs in State Health and Welfare Agencies to advocate for health benefits including coverage of speech-language pathology and audiology programs and services in state employee health benefits packages. [Carry Over to 2007]
3. By December 31, 2006, the Director, State Legislative and Regulatory Advocacy, will have monitored an expanded database of state documents to identify legislative and regulatory opportunities for expanded coverage of speech, language, and hearing services and to notify both state speech-language-hearing associations and the coordinator of the State Advocates for Reimbursement (STAR) Network of these opportunities. [Completed]

Outcome 5: Increased reimbursement for audiologic rehabilitation services in federal and private insurance programs.

1. By July 1, the Professional Practices Audiology (AUD) cluster will have established an advisory group from the Academy of Rehabilitative Audiology that will have met with Audiology, Governmental Relations and Public Policy (GRPP), and Public Relations (PR) clusters to determine the audiologic rehabilitation (AR) reimbursement related issues for an advocacy campaign. [Carry Over to 2007]
2. By December 31, the Professional Practices Audiology, GRPP, and PR clusters will have developed the outlines of a campaign to increase reimbursement for audiologic rehabilitation, complete with strategy, message, legislative and policy targets, goals, and tactics (that will possibly include an ad campaign) that will be waged by professional orgs/audiologists and may also feature the enlistment of consumer support. The campaign will actually be implemented in 2007. [Carry Over to 2007]
3. By December 31, 2006, the AUD cluster will have developed a power point presentation that will inform professionals about AR reimbursement for both Audiologists and Speech-Language Pathologists and to present to STAR members in facilitate advocacy for coverage. [Completed]
4. By December 31, 2006, the AUD cluster will have developed a strategy checklist specific to the benefits and "What's in it for the insurer?" of the provision of AR services to assist members and consumers in communicating with private health plans and Medicaid when consideration is given to reimbursement for AR services. [Completed]
5. By December 31, 2006, the AUD cluster will have updated the Audiology & Audiologists ASHA Web-site to provide more direct links to reimbursement information specific to AR coverage. [Completed]
6. By December 31, 2006, the AUD cluster and Product Sales will have increased the number of materials available to members for use in the provision of Audiologic Rehabilitation. [Completed]
7. By December 31, 2006, the AUD cluster will have infused AR content in all appropriate Professional Development products created in this fiscal year. [Completed]
8. By December 31, 2006, the AUD cluster and Academic Affairs unit will have provided information from ACCESS Audiology on the topic of AR on the academic affairs Web page. [Completed]
9. By December 31, 2006, the AUD cluster in collaboration with the National Center for Evidence Based Practice will have conducted a systematic review of the literature to investigate the benefits of AR services. [Carry Over to 2007]
10. By December 31, 2006, the AUD Cluster and the Preferred Practice Patterns Working Group will have developed a tool to be used by CMS to measure the quality and efficiency of AR services provided. [Carry Over to 2007]

Outcome 6: Increased availability of information related to access for Federal, state, and local funding streams for programs and services in the schools.

1. By April 15, 2006, the ASHA School Finance Committee and HEAT will have updated the information on Medicaid web site to reflect current issues on funding for programs and services in the schools. [Completed]
2. By September 30, 2006, the ex-officio of the School Finance Committee (SFC) and the Surveys and Information Unit will have collaborated with the SFC on the development and implementation of a plan to promote the SFC Web resource, evaluate its usefulness with school-based members through an online survey and modify, as needed, the content of the page based on survey results. [Completed]

There are 37 strategies in the Reimbursement in Health and Education work plan. Following is the status for the 1^st, 2^nd, 3^rd, and 4^th quarters.

*Following further review, strategies eliminated in the 3^rd quarter due to the shortage of three personnel in the Audiology Practices Unit were carried over to 2007.