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Speech-language pathologists in Georgia have recently reported a substantial increase in Medicaid denials for pediatric SLP services. The denials coincide with the introduction of a new state-contracted Care Management Organization (CMO) system. ASHA determined that there may be a compliance issue with Georgia Medicaid fulfilling Early & Periodic Screening, Diagnosis and Treatment (EPSDT) requirements. EPSDT is a federal Medicaid requirement for comprehensive services to children. In addition, the proprietary "Therapy Review Criteria Guidelines" used by at least one of the CMOs was strictly followed without the flexibility called for by the guideline authors.
ASHA wrote to the regional office of the Centers for Medicare and Medicaid Services (CMS) and requested a review to determine compliance with federal Medicaid regulations. A copy of the letter was sent to the Georgia Medicaid director. Shortly after the ASHA letter was sent, representatives of the Georgia Speech-Language-Hearing Association (GSHA) met with the Governor's staff on September 6 to discuss Medicaid issues. The Governor's staff appeared to be positively disposed in bringing about change in the system and requested additional information. GSHA continues to pursue the issue at the State and CMS regional levels. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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