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by Reed Franklin and Neil Snyder
Health care and education issues remain at the top of ASHA's ambitious public policy agenda in 2004-a year that presents both obstacles and opportunities on Capitol Hill. The federal budget deficit, along with the intense focus on defense and homeland security, creates a challenging climate for making advances in domestic policy. ASHA will continue to work hard in this environment to advance the interests of members and the patients and students you serve.
For school-based members, the fight continues for full funding of the Individuals with Disabilities Education Act (IDEA). President Bush's budget begins the debate with the proposal to increase IDEA Part B funds by $1 billion. ASHA will continue to take a leadership role in the fight to make sure that schools have the resources needed to address issues such as caseload and workload. This year also will see the continuation of the effort to re-authorize IDEA. ASHA will be working with policy-makers in this process to address issues such as highest qualified provider and paperwork reduction.
ASHA also will be pressing forward on two important bills for audiologists. One would provide for direct access to audiologists in the Medicare program, giving beneficiaries the option of going directly to audiologists without needing a physician referral. The second bill would provide Medicare coverage for audiologic rehabilitation.
Speech-language pathologists in health care settings won a dramatic victory last year with the two-year extension of the moratorium on the $1,500 Medicare caps on outpatient services. This year efforts will focus on legislation to correct the statutory problem that fails to separate speech-language pathology services from physical therapy. This correction would give SLPs the ability to receive their own Medicare provider number and directly bill Medicare outpatient services.
To achieve success, ASHA members can play a key role by advocating with their federally elected officials. Members may do so by going to the ASHA grassroots Web site (http://takeaction.asha.org). Another success factor is member support for ASHA's political action committee, ASHA-PAC. This important resource supports our champions on Capitol Hill and is an essential element in any legislative success.
Direct Billing for Speech-Language Pathologists
Medicare law has a technical error that has penalized SLPs for far too long. For convenience, legislators in 1972 added SLP services to the existing provision for a physical therapy outpatient benefit. This same provision in the law led to SLPs sharing a $1,500 Medicare cap with physical therapists rather than having their own cap.
Although it's not easy to change Medicare law, ASHA is working hard to correct this statutory problem and fully separate speech-language pathology services from physical therapy. To remedy this problem ASHA supports H.R. 1995 as introduced by Rep. Fred Upton (R-MI) and S. 568 as introduced by Sen. John Ensign (R-NV) that would create separate paragraphs for speech-language pathology and physical therapy services under the Medicare outpatient statute. This legislation would align the outpatient statute with other parts of the Medicare program that recognize two separate services and remove regulatory financial and paperwork burdens that restrict the ability of SLPs to bill Medicare in outpatient private practice settings.
Members of Congress must hear from ASHA members on this important issue. Visit http://takeaction.asha.org to learn how to contact your representatives on Capitol Hill.
IDEA Reauthorization
The bill titled "Improving Education Results for Children With Disabilities Act of 2003" (H.R. 1350), which passed the House, eliminates qualification standards for related service personnel in current law. This could result in unqualified or under-qualified persons delivering services in the schools. The Senate's qualified provider language in S. 1248 is an improvement, but still falls short of standards in current law.
Unqualified or under-qualified providers have little or no clinical practice experience and limited education-which often translates to children remaining longer on special education rolls. This costs local school districts more money and misleads children with disabilities and their parents.
Empirical evidence shows a strong correlation between the qualifications of general and special education teachers, school-based clinicians, and the level of success for students receiving services.
The final appropriations for fiscal year 2004 for IDEA contained a $1 billion increase for Part B state grants, with modest increases for the Part C early intervention and preschool grant programs. ASHA members should be disappointed that Part D Personnel Preparation Grants received their second annual cut with reduction of more than half a million dollars.
While the $1 billion-increase for Part B grants continued the pattern set by the Bush administration of billion-dollar annual increases, the increase falls short of Congress' own budget that set aside $2.2 billion for 2004. This failure demonstrates the need for a mandatory full funding amendment that would lock in specific annual increases to reach the authorized 40%.
The cut to personnel preparation funding continues a pattern of level funding combined with across-the-board cuts followed by level funding and more cuts. These cuts combined with Congress' failure to maintain even inflationary increases will result in either fewer new or extended grants and/or smaller grants.
Audiology: Direct Access and Audiologic Rehabilitation
In 2004 ASHA is supporting two pieces of legislation critical to audiologists. The Hearing Health Accessibility Act would allow Medicare beneficiaries to receive services directly from a qualified audiologist without a referral from a physician. Please urge your representatives in the House to co-sponsor H.R. 2821, introduced by Reps. Jim Ryun (R-KS) and Lois Capps (D-CA), and urge your senators to co-sponsor S. 1647, introduced by Sen. Ben Nighthorse Campbell (R-CO).
The second bill important to audiologists is H.R. 3464, the Medicare Audiologic Rehabilitation Act, introduced by Rep. Jay Inslee (D-WA). This bill would provide Medicare coverage for audiologic rehabilitation and treatment services provided by qualified audiologists.
These bills are important not just to Medicare patients but to everyone. Because other insurance providers often follow Medicare's lead, these bills can be an important precedent for the whole health care system.
Go to http://takeaction.asha.org for more information about how to advocate for these bills.
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