Medicaid, Private Practice, and Independent Contracting in School Services
School Services Frequently Asked Questions
Can public schools bill Medicaid for speech-language pathology services?
To date, most states have implemented or plan to implement Medicaid billing in the schools. There are provisions in federal and state law requiring state and local education agencies to seek sources other than those available under Part B or Part C of IDEA to pay for services for students with disabilities. Schools are increasingly tapping other sources to help finance special education programs. Covered Medicaid benefits include speech-language pathology services identified in the child's individualized education program (IEP) or individualized family service plan (IFSP). There are a number of legal, ethical, and professional issues that SLPs who are providing services and submitting claims to Medicaid for reimbursement should review. See ASHA's resources, Introduction to Medicaid and Medicaid in the Schools.
Can SLPs provide private services to students who are on their school caseload?
According to ASHA's Issues in Ethics statement, Obtaining Clients for Private Practice from Primary Place of Employment, it is possible for practitioners to accept cases for their private practice from the primary place of employment if the following guidelines are observed:
- The persons served professionally must be (a) fully informed of services available from the practitioner's primary employment setting as well as those from the private practice or other practice environment and (b) given freedom to choose whether and from whom they will obtain professional services.
- The costs associated with obtaining services from the practitioner's primary employment setting versus those associated with the private practice must be made clear.
- Practitioners accepting cases in a private setting from their primary place of employment must inform the administrator at their primary employment setting of their intent.
- Practitioners must honor any non-compete contractual agreements stipulated by the employer.
See Everyday Ethics: Avoiding Conflict-of-Interest Situations in Your Practice and Doing the Right Thing After School.
How does an SLP work as an independent contractor in schools?
Contractual employment is a private arrangement between an SLP and a school or school district to provide services to students. In a traditional arrangement, the SLP is hired by the district to work full or part time as a staff member receiving employment benefits from the district. As an independent contractor, the SLP works under an agreement or contract with the school district or agency that contracts with the public school or charter school. In some cases, SLPs may work for companies who have established contracts with schools. The terms and benefits of these arrangements are determined by the company that employs the SLP. The Internal Revenue Service (IRS) defines independent contracting [PDF] for tax purposes.
Becoming an independent contractor requires several steps that will ensure both success and compliance with relevant state regulations. You must be licensed to practice in the state where you will be providing services. Check your state's licensing regulations. Also, apply for an Employer Identification Number (EIN). It is also recommended that you:
- track expenses using software, and open a checking account for your business transactions and expenses;
- consult an accountant to determine which expenses are deductible;
- become familiar with business tax laws, including those published by the IRS; and
- purchase a malpractice or professional liability insurance policy.
ASHA offers coverage for members through AMBA (formerly Mercer) Learn more about business practices, in general, by consulting ASHA's Frequently Asked Questions About Business Practices.
Does ASHA have guidelines on establishing fees for services?
ASHA does not determine fees for services, as they can vary widely across the country and are subject to possible allegations of "price fixing," which is a violation of antitrust laws. Read more about what to consider when determining fees for services.
