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Current Legislative/Regulatory Activity
60-Second Advocacy Update - Feb 2020
GAC At The State Capital
All Practice Areas
OSLHA belongs to the Governmental Affairs Coalition (GAC) along with 3 other state professional associations. The GAC Lobbyist (Kelly O’Reilly) organized a ‘Legislative Day in Columbus’. A GAC business meeting was held in the morning then Representatives Weinstein and Russo, sponsors of HB 243, joined GAC at lunchtime. The afternoon was dedicated to visiting with legislators at the statehouse. Ms. O’Reilly developed a ‘white paper’ that included the scope of practice for SLPs and Audiologists as well as information on the following issues.
House Bill 243: Proposed to Ensure Hearing Aids Coverage in Health Plans to Cover Hearing Aids Up To Age 21
Audiology, Schools, Private Practice/Non-Profit Practice Areas
Requires commercial insurance plans to cover hearing aids for children up to age 21. Provides coverage for hearing aids up to $2500/aid every 48 months. Contact bill sponsors – Representatives Weinstein & Russo at http://www.ohiohouse.gov. Sponsor testimony was given on October 1, 2019. Proponent testimony was scheduled to be held February 4th, 2020.
Senate Bill 238: Art and Music Therapy Licensure
All Practice Areas
Introduced in November, to license art and music therapists. As written, this bill currently contains language that infringes on the SLP & Audiology Scopes of Practice. OSLHA opposes this bill. Contact your legislators to tell them you oppose it. Find your legislator here = http://www.ohiohouse.gov/members/district-map
House Bill 436: Dyslexia Screening for Children
Schools, Private Practice/Non-Profit Practice Areas
The first hearing was held in January 2020. This bill establishes a program for Dyslexia screening and intervention by trained teachers. In schools, speech-language pathologists play a critical role in diagnosing and treating dyslexia. Literacy outcomes for the children of Ohio stand to benefit from multidisciplinary teams charged with screening, diagnosing, and treating dyslexia and other reading disorders. Currently this bill does NOT include SLPs on the Ohio Dyslexia Committee. Contact Representative Baldridge (sponsor of bill) to ask him to amend the bill to include SLPs. Phone (614) 466-2124 Email = http://www.ohiohouse.gov/brian-baldridge/contact
Schools Practice Area
ODE’s Related Services Shortage Task report was released in November 2019. OSLHA has asked that the legislature focus attention on implementing the report’s recommendations surrounding education, recruitment and retention of practitioners in the schools.
Increase Medicaid SLP Reimbursement
Schools, Private Practice/Non-Profit, DD, Healthcare & Univ. & Student Affairs Practice Areas
HCPCS Code 92507 for individual speech therapy is reimbursed at $37.03 by Ohio Medicaid. That rate is woefully inadequate and has not been changed since 2010.
Retroactive Corrections Being Accepted for Unintentional CCI Edit that Prevented Same-Day Billing of Videofluoroscopic Swallowing Study by SLPs and Radiologists
In a recent communication, CMS noted that corrections have been made to an unintentional edit that prevented same-day billing of 92611 and 74230. We are pleased to report that with the reversal of the CCI edit, Speech-Language Pathologists (SLPs) and Radiologists will once again be appropriately reimbursed for each distinctly different portion of their professional collaboration during the videofluoroscopic swallowing study (VFSS). Billing adjustments will be retroactive to January 1, 2020, and the wording will be implemented as soon as technically possible in a future edit update!!
CMS further clarified that claims for same-day billing of 92611 and 74230 must include a modifier to note that the services are separate and distinct. This means that claims for VFSS should include 92611 first on the claim, as the “column 1” code, followed by 74230 with the modifier -59 (or subcategory modifiers) appended.
Additional information on the use of CCI-associated modifiers is available on ASHA’s website.
Effective January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) implemented a new National Correct Coding Initiative (CCI) edit that prevents same-day billing of Current Procedural Terminology (CPT ® American Medical Association) codes 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) and 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording).
Speech-language pathologists (SLPs) typically collaborate with radiologists to perform the videofluorscopic swallowing study (VFSS), also called the modified barium swallowing (MBS) study. CPT codes 74230 and 92611 describe the work required to identify the medical diagnosis by the radiologist (74230) and to evaluate swallowing function by the SLP (92611). With the new CCI edit in place, SLPs and radiologists will not be appropriately reimbursed for each distinctly different portion of their professional collaboration during the VFSS.
ASHA is engaging with CMS and the contractor that manages the NCCI program to resolve this issue. In the meantime, ASHA recommends providers continue to submit same-day claims for 92611 and 74230. Because the new CCI edit lists 92611 as the “column 1” code, it should be placed first on the claim, followed by 74230. This means that 92611 should be processed for payment, but 74230 will be denied. If CMS reverses the CCI edit, all claims submitted since January 1, 2020, can be reprocessed for payment of 74230.
The NCCI (or more commonly, CCI) is an automated edit system to control specific procedure code pairs that can or cannot be reported on the same day. CMS developed the system for use in all Medicare Part B (outpatient) and Medicaid claims. See CCI Edits for Speech-Language Pathology Services for additional information on same-day billing restrictions.
ASHA NOMS Release Date Delayed
ASHA has been working hard to develop a new National Outcomes Measurement System (NOMS), which they anticipated would be ready for launch by the end of this year. However, due to some delays the new NOMS is now scheduled to be released in 2020.
As part of the new launch, all clinicians will receive a user guide that will walk them through the updated data collection process and scoring guidelines for the new FCMs. However, clinicians will no longer need to pass a user registration test. Therefore, the new training will not be offered for ASHA CEUs. Because we anticipated the launch of NOMS at the end of the year, we did not renew the current NOMS trainings for ASHA CEUs and their approval will expire on December 31, 2019. However, clinicians who complete the NOMS training will still earn professional development hours (2.5 for adults and 1.5 for pre-kindergarten), which can be used for ongoing certification maintenance and state licensure. For more information, please visit the ASHA Certification Maintenance page.
What does this mean for you and your clinicians?
You should continue to participate in the current version of NOMS as usual. All new NOMS users will still need to be registered for the adult and/or pre-kindergarten NOMS user training(s) in order to submit data. However, users who complete the training after December 31st will not receive ASHA CEUs but will still earn professional development hours. Please let any clinicians who have not completed the training know about this deadline.
House Bill 243 - Voice Your Support for Adequate Hearing Aid Coverage for Children
OSLHA and GAC are teaming up to collect testimony to submit in support of HB243, “Madeline’s Law”. This bill will require health plan issuers to cover hearing aids and related services for persons twenty-one years of age and younger. The revised bill currently covers $2,500 per ear every 48 months. The proposal is similar to laws in Kentucky and Georgia, and 23 other states that require hearing aid coverage for children. Gongwer News Service-Ohio reported recently on concerns about how this legislation might impact Insurance premiums and their publication may rencourage you to share your testimony in response to some of these concerns. We would like to thank Representatives Weinstein and Russo for providing sponsor testimony on behalf of our patients, as well!
Proponent testimony has been submitted and we are awaiting the results of discussion by our House of Representatives:
- Become Familiar With the Current Bill as Proposed
- Review the Fiscal Note & Impact Statement of This Bill
Interstate Compact Update
All Practice Areas
ASHA participated in a meeting with staff from the U.S. Department of Defense-State Liaison Office (DSLO) to discuss how interstate compacts will address the needs of service members and military families. DSLO staff discussed their historical involvement in promoting expedited licensure for military spouses and shared their interest in interstate compacts. Representatives from current health interstate compacts and those in development, including representatives from ASHA, discussed ways to work with the state liaison office to promote compacts. Learn more about the speech-language-hearing interstate compact.
Joint Habilitation/Rehabilitation Benefit Coverage Statement & Guide Made Available by ASHA
The American Speech-Language-Hearing Association (ASHA), American Occupational Therapy Association and American Physical Therapy Association has a new resource for public and private insurers, employers, consumers, state regulators and other stakeholders to evaluate the appropriateness of rehabilitation and habilitation benefit design. The document Joint Habilitation/Rehabilitation Benefit Coverage Statement: Guide to Assessing Adequacy of Benefits outlines the principles that should be evaluated when determining whether an insurance product provides adequate coverage of habilitation and rehabilitation services and devices. Rehabilitation and habilitation address function, communication, participation, mobility, and engagement limitations that result from illness, injury, disability, or other conditions. Habilitation and rehabilitation benefits are cost effective, representing only 2% of the premium for a silver marketplace plan.
ASHA also has a guide entitled Speech, Language, and Hearing Services: Essential Coverage of Habilitation and Rehabilitation. The guide discusses steps that Ohio can take to protect individuals needing medically necessary habilitative and rehabilitative services and devices.
If you have any questions or would like to further discuss the importance of habilitation and rehabilitation coverage, please do not hesitate to contact Susan Adams (ASHA’s Director of State Legislative & Regulatory Affairs) at 301-296-5665, [email protected] or Daneen Sekoni, ASHA’s Director of Health Care Policy, Health Care Reform at 301-296-5651, [email protected]
The Dept. of Medicaid Puts Out a Request for Information to Gather Public Input
The Ohio Department of Medicaid (ODM) has released a request for information (RFI) to gather public input as it begins the process to select managed care partners. ODM’s first step in the process is collecting feedback on current Medicaid services, what is working and ideas for improvement. The mission in this process is to focus on the individual rather than on the business of managed care, and this request seeks information specifically from individuals receiving Medicaid services, providers and advocates.
Feedback is being sought in multiple areas, including:
- How managed care organizations communicate and support individuals and providers
- What benefits and services are most helpful
- How to best coordinate individual care
- How to file complaints and appeal managed care organization decisions
Submit feedback through the RFI webpage.
Error Identified in the Recently Published NCCI (National Correct Coding Initiative) Manual
Changes to Medicare Physician Fee Schedule
All Practice Areas
The Centers for Medicare & Medicaid Services (CMS) reversed course in their 2019 Medicare Physician Fee Schedule Final Rule [PDF] and included audiologists and speech-language pathologists as eligible professionals for the Merit-Based Incentive Payment System (MIPS). The program, which is effective January 1, 2019, requires eligible clinicians to report quality and improvement activity data to CMS that will be used to positively and negatively adjust Medicare payments. ASHA expects MIPS reporting to apply to less than 1% of ASHA members because of low volume thresholds and site of service exclusions. However, inclusion in the program has significant implications for those that must report and for the professions moving forward. To learn more, visit ASHA’s website.
ASHA Develops a New Advocacy Tool for Protecting Therapy Coverage Under the ACA
Healthcare, Schools, Audiology, Telehealth, DD, Private Practice, CLD Practice Areas
Recent changes by the federal government give states more leeway to determine what services are covered or excluded in ACA health plans. Speech, Language, and Hearing Services: Essential Coverage of Habilitation and Rehabilitation is a tool developed by ASHA for ASHA-recognized state associations and Habilitation Advocates to use when speaking with exchange officials, insurance commissioners, and state legislators about the value of audiology and speech-language pathology services as an essential health benefit. We encourage you to use this tool as an educational resource!
CMS Issues Guidance Regarding Medicare Therapy Service (Post Therapy Cap)
Healthcare Practice Area
CMS Proposes Overhaul to the Home Health Prospective Payment System in 2020
Healthcare, Telehealth, Private Practice Practice Areas
FDA Approves Telepractice Option for Cochlear Implants
Audiology, Telehealth, Healthcare, DD, Private Practice Practice Areas
Medicaid and CHIP Payment & Access Commission (MACPAC) Publishes Update on Current Status of School-Based Services
Schools, Supervision Practice Areas
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