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Current Legislative/Regulatory Activity
60-Second Advocacy Update - June 2020
OH Dept of Education Revised Operating Standards
Audiology, Schools, Telehealth Practice Areas
On June 15th, the Ohio Department of Education (ODE) filed a new draft of the operating standard. Amendments are proposed for ORC Chapter 3301-51, titled “Education of Students with Special Needs.” The majority of the revisions are for clarity purposes.
Delivery of Services: 3301-51-09
(I) Service provider workload determination for delivery of services
- Workload for an individual service provider shall be determined by the following processes, which incorporates the following components:
- All areas of service provided to children with and without disabilities, including, but not limited to school duties, staff meetings, professional development, supervisions, travel/ transitions, screening, assessment, evaluation, progress documentation and reporting, secondary transition service planning, conferencing/consultation pertaining to individual students, collaborative planning, documentation for individual students, and third-party billing requirements.
**While the term ‘workload’ is written in the language/wording, using the term, ‘caseload/workload determination calculation’ would be a stronger and more committed statement. Also with the wording “shall be” should be changed to “must be.”
Other points of interest:
- The ‘caseload’ maximum of 80 is not a weighted max using the caseload/workload determination calculator.
- Each service provider must have access to an office or room space suitable for private consultation or intervention ; access to a telephone in an area where scheduling, parent contacts, and confidential conversations regarding children can be completed; and adequate office equipment including a locking file cabinet with a key and supplies.
- An educational agency may be granted a waiver through the Ohio Department of Education, Office for Exceptional Children if the workload exceeds the maximum caseload as required by this rule. When submitting a waiver, the educational agency must give the rationale for the request, specific period of time for which the waiver is being requested and identification of the specific rule for which the waiver is being requested. The waiver should be reviewed annually and plans given by the education agency to meet the requirements for service delivery.
- Currently, there are no negative consequences for educational agencies ( districts and schools) for not complying to the rules for service delivery.
Call to Action: Please Read the complete document on the Ohio Department of Education Website, the section pertaining to Delivery of Services is 3301-51-09. If you have any questions, please contact Linda Wellman, an OSLHA representative for the General Affairs Coalition (GAC).
Send your comments to [email protected] by July 31st.
ASHA Resources for Caseload/Workload Determination
Audiology, Schools, Telehealth Practice Areas
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
Error Identified in the Recently Published NCCI (National Correct Coding Initiative) Manual
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