ASHA Focused Initiatives

Reimbursement in Health and Education

4^th 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 31, 2007, the ASHA Healthcare Economics and Advocacy Team (HEAT) will have revised ASHA HEAT publications related to negotiating with private health plans. [Completed]
2. By June 15, 2007, 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 January 15, 2007, the HEAT will contract with a private health plan advocacy consultant(s) to assist in continuing to develop and implement advocacy approaches. [Completed]
2. By March 15, 2007, the HEAT will have awarded up to 25 grants to state associations in support of private health plan advocacy efforts. [Completed]
3. By March 15, 2007, the HEAT will have purchased 50 USB flash drives to give to organizational representatives as a reminder of good faith in considering including speech, language and hearing benefits in their health plans. [Completed]
4. By May 1, 2007, a HEAT team will have evaluated and summarized the health plan report card data collected in 2005 and 2006 and will determine the best use of this data. Additionally, revision of the database elements will be explored. [Completed]
5. By June 1, 2007, the HEAT will convene a meeting of the STAR members (currently numbering 38) and create new STAR strategies and initiatives for the next three years. [Completed]
6. By August 15, 2007, the HEAT will have met with representatives of two Maryland employer groups and advocated for improved coverage of speech and hearing services. [Completed]
7. By August 1, 2007, the HEAT will determine the need for advertising and revising the ASHA billing and reimbursement Web site. [Completed]
8. By August 1, 2007, the HEAT and the Professional Practices in Speech-Language Pathology cluster will have determined the feasibility of revising the presentation proposal 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]
9. By September 15, 2006, the HEAT will have met with representatives of America's Health Insurance Plans, the National Business Group on Health and the Blue Cross and Blue Shield Association of America to initiate improved coverage of speech and hearing services. The purpose of the meetings with the health plan groups will also be to establish a method to resolve issues brought by ASHA members. [Completed]
10. By October 15, 2007, the HEAT will have determined the feasibility of creating a tracking system for denials and complaints against private health plans. [Completed]
11. By October 1, 2007, the HEAT will have contracted with Milliman to write a white paper regarding the return on investment from health plan coverage for comprehensive speech and hearing services. [Completed]
12. By November 15, 2007, the HEAT will have retained a consultant to assist with the development of documents and strategies that address: 1) initiating state legislative efforts that prevent health plans from adding to contracts a “government agency exclusion” clause that allows plans to exclude services provided by a public agency (such as schools); 2) the elimination or restriction of speech and hearing services by Medicaid and private health plans; 3) countering Medicaid contracted medical review organizations denials of payment for pediatric speech-language services in Medicaid programs and 4) obtain information on speech-language and hearing benefits from select state's Medicaid agencies using the revised template developed in 2006 and post results on the ASHA Web site. [Completed]
13. By December 31, 2007, the HEAT will have contacted and encouraged manufacturers, suppliers, and vendors of products in the area of speech-language pathology and audiology to include coverage of speech-language pathology and audiology programs and services in their health benefits packages. [Completed]
14. By December 31, 2007, the HEAT will have updated, planned and conducted at least six 1/2-day specialized conferences in conjunction with a state association's or related professional organization's annual meeting on negotiating for private health plan coverage for speech-language pathology and audiology coverage. [Completed]
15. By December 31, 2007, the HEAT will have provided continued support for the State Advocates for Reimbursement (STAR) Network via monthly (n = 12) 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]
16. By December 31, 2007, 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]

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.

Strategy

• By August 31, 2007, 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]

Outcome 4: Improved tools to facilitate reimbursement through effective documentation and accurate coding of services.

Strategy

• By November 1, 2007, the HEAT, in collaboration with the State & Consumer Advocacy team, will disseminate via the ASHA Web site and published documents, the Legislative Advocacy packet on mandating coverage of cognitive rehabilitation, autism related speech-language services, and auditory rehabilitation developed in 2006. [Completed]

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

Strategies

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 via conference calls with Audiology, Government Relations and Public Policy (GRPP), and Public Relations (PR) clusters to determine the audiologic rehabilitation (AR) reimbursement related issues and strategies for assisting members. [Completed]
2. By December 31, 2007, the AUD cluster will have disseminated to members and consumers the Checklist for Audiologic Rehabilitation that assists members and consumers in communicating with private health plans and Medicaid when consideration is given to reimbursement for AR services. Dissemination of the check list will be at all audiology exhibits including: AAA, EAA, ARA, EHDI, LHAA, NHCA, and ASHA. [Completed]
3. By December 31, 2007, the AUD cluster will have disseminated to members the power point presentation that informs professionals about AR reimbursement for both Audiologists and Speech-Language Pathologists at all audiology exhibits including: AAA, EAA, ARA, EHDI, LHAA, NHCA, and ASHA and will link to the web version from the audiology web page. [Completed]
4. By December 31, 2007, the AUD cluster and Brand Marketing will have promoted all the materials available to members for use in the provision of Audiologic Rehabilitation via Leader ads, E-mail flyers, and announcement flyers at exhibits and by inclusion of this information in the Have you Heard? Audiology Resources for Adult Audiologic Rehabilitation book. [Completed]
5. By December 31, 2007, the AUD cluster will have updated the Audiology & Audiologists ASHA Web-site to provide links to reimbursement information specific to AR coverage and to products and materials for use in the provision of AR available in the ASHA catalog. [Completed]
6. By December, 2007, the AUD cluster will have updated and disseminated the Have you Heard? Audiology Resources for Adult Audiologic Rehabilitation book. [Completed]
   7. By December 2007, the AUD cluster and Professional Development will have infused AR content in all appropriate professional development products created in this fiscal year. [Completed]

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

Strategy

• By December 31, 2007, the ex-officio and members of the School Finance Committee will have completed and presented a training module on how to access funds for programs and services at four state association meetings. [Completed]

There are 28 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.