Email from "Arlene Pietranton" <APietranton@asha.org> 11/24/03 02:33PM

Victory! Congress Approves Hybrid Professional Status
for VA Audiologists & SLPs

Congress approved legislation that has moved audiologists and speech-language pathologists into a hybrid "Title 38" status for professional personnel that permits a more streamlined recruitment and hiring process within the U.S. Department of Veterans Affairs (VA), increasing its ability to compete with the private sector for personnel. The Department of Veterans Affairs Long-Term Care and Personnel Authorities Enhancement Act of 2003 (S.1156) will now go to President Bush to be signed into law.

As previously reported, ASHA worked with the Academy of Federal Audiologists and Speech-Language Pathologists (AFASLP), American Academy of Audiology (AAA) and the Department of Veterans Affairs to include both professions in the legislation. For additional information, please contact Reed Franklin, ASHA's Director of Federal and Political Advocacy, by e-mail at rfranklin@asha.org or at 800-498-2071, ext. 4473, or Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, at ext. 4482 or via e-mail at ilusis@asha.org.

Email from Janet McCarty 01/06/04 02:01PM

Jim and Darlene: The attached note is for posting on ASHA's consumer web site. It is a message about MD's coverage of habilitation services, including SLP. Several members have noted that you must push for this coverage because health plans don't necessarily promote it. Also, it may get consumers visiting the site to start similar legislation in their states.

Janet McCarty, M.Ed., CCC-SLP Private Health Plans Advocacy 301/ 897-5700, ext. 4194 jmccarty@asha.org

Maryland Habilitation Coverage Jan. 6, 2004 For ASHA Consumer web page

Maryland Law Covers Habilitation Services For Children, But You Need To Ask

Since October 2000, Maryland law requires insurers, healthplans, and health maintenance organizations (HMOs) to cover habilitation services for children, including speech-language pathology treatment, and occupational/physical therapy (Maryland Code Annotated, Insurance, Section 15-835, 2002). The law covers services for children with congenital and genetic disorders, including autism and cerebral palsy (since 2002), but not developmental delays. However, clinicians and consumers must ask for this coverage because health plans do not always promote the benefit. Ask your health plan representatives about this law if you believe your child's speech-language treatment meets coverage criteria.

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Email From: Janet Brown [mailto:jbrown@Asha.org] Sent: Friday, January 09, 2004 2:49 PM To: Division 13 Discussion List Subject: Legislation Increases Payments Levels for 2004 Medicare Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released a revision to its 2004 Medicare Physician Fee Schedule for Part B services to include policy changes from the recently passed Medicare legislation that was published in the Federal Register on January 7 and can be found at: http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2004/03-32323.htm. CMS announced that the conversion factor will be $37.3374, which represents a 1.5% increase in overall reimbursement rates. The Medicare Prescription Drug, Improvement and Modernization Act (MPDIMA) of 2003, P.L. 108-173 saved providers from a 4.5% rate reduction. The best news is that the clinical and MBS dysphagia assessment rates increased to over $130, while audiology rates increased modestly in general. The 2004 payment rates apply to all speech-language pathology and audiology Medicare Part B services, except for those audiology services provided in a hospital.

ASHA's 2004 Medicare Fee Schedule for Audiologists and 2004 Medicare Fee Schedule for Speech-Language Pathologists are available to ASHA members on the ASHA Web site at: http://asha.org/members/issues/reimbursement/analysis-2004mfs. These two ASHA documents provide a listing of all the procedures used by audiologists and speech-language pathologists, cite the actual national average payment amounts, and describe three methods for accessing the exact payment figure based on your geographic location. To give speech-language pathologists and audiologists the most concise and accurate information available in one location, ASHA carefully analyzes over 1000 pages of CPT codes and payment policies from the Federal Register and AMA CPT Manual.

Analysis of the 2004 Medicare Fee Schedule (MFS) reveals substantial increases for some undervalued speech-language pathology services. The 2004 rate for a clinical dysphagia evaluation is $131.43 (3.52 RVU), a remarkable increase over the 2003 rate of $42.30 (1.15 RVU). In addition, the motion fluoroscopic evaluation of swallowing has climbed to the same rate of $131.43 from the 2003 rate of $45.98 (1.25 RVU). ASHA aggressively lobbied CMS to rectify major reductions made in these procedures in the 2003 fee schedule. It appears that CMS crosswalked the swallowing evaluation rates with that for speech-language pathology evaluation because the 2003 rate for 92506 also increased significantly to the identical rate of $131.43 or 30% above the 2003 rate. This increase is attributable to updated survey data presented by ASHA's Health Care Economics Committee (HCEC). The survey data includes time with the patient, post-visit time and the cost of various supplies and equipment.

Conversely, reimbursement for speech-language pathology treatment was reduced to $62.35 from $77.25. Please remember that this rate is per session and not time-based, and can be adjusted appropriately. The reduction would have been worse, but CMS tentatively agreed with ASHA's position that the vignette used to determine the RVU was inappropriate because it reflected treatment with a child. ASHA is pursuing changes in the example case that describes the procedure and related practice expenses to reflect a more equitable reimbursement rate. Group speech-language treatment was also reduced significantly to $29.50 from $63.27. The new group therapy rate is somewhat more logical if consideration is given to the total reimbursement rate for seeing three patients in a group (3x $29.50 =$88.50) versus a single patient ($62.35).

For the most part, the audiology rates received modest increases because of the new conversion factor. For example, the comprehensive hearing test rate rose by 4% to $48.91 from $47.09, tympanometry is increased to $21.66 from $20.97 and electrocochleography rose to $100.81 from $99.32. There will be a new temporary procedure code (G0268 Removal of Impacted Cerumen, one or both ears) to be used by a physician on the same date of service as audiologic function testing. According to CMS, the new code is to be used only in those unusual circumstances when an employed audiologist who bills under a physician uniform provider identifier number (UPIN) performs audiologic function testing on the same day as removal of impacted cerumen requiring physician expertise for the removal.

The complete final rule with addendums also can be found on the CMS Web site at: http://cms.hhs.gov/regulations/pfs/2004fc/1372fc/1372fc.asp. For more information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or at 800-498-2071, ext. 4139; or Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, via e-mail at ilusis@asha.org or at 800-498-2071, ext. 4482.

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Email From: Anne Ver Hoef [mailto:annev@gci.net] Sent: Wednesday, January 14, 2004 9:16 AM To: State-Based Reimbursement Network Subject: RE: [statereimbursement] STAR Conference call January 13th

Hi to Maureen and others in Star Network,

I was actually listening in on part of the conference call yesterday. I didn't speak as I was driving across Anchorage and listening on my cell phone. These calls continue to be in the middle of my work day so I couldn't participate in the whole call. Anyway, I was interested in the information shared and benefitted from it.

In Alaska the BIG issue has been Medicaid and all else is on hold. Just on Monday we learned that the rates for treatment and group had been reduced by 20% and 50% respectively. We are trying to find out the basis for these cuts, but we suspect that it has to do with the Medicare rate changes since those were the codes that took a hit there. I hope ASHA can spend as much time fighting those changes as it did for the dysphagia Dx codes. I don't know about the rest of you, but I spend lots and lots more time providing treatment than evaluations. If anyone else if fighting decreases in Medicaid rates in your state, please let me know; or if you have done so in the past, I would appreciate any information on how to fight these changes.

Sincerely, Anne in ALASKA Anne Ver Hoef, MA CCC/SLP 5820 Yukon Road Anchorage, Alaska 99507 (907) 345-4422 ph / fax

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Email From: Therapyllc@aol.com [mailto:Therapyllc@aol.com]
Sent: Wednesday, January 14, 2004 1:15 PM
To: State-Based Reimbursement Network
Subject: Re: [statereimbursement] STAR Conference call January 13th


HI -how are you? I had noted that Medicaid in WV has just gone to the regular CPT codes and 92507 has been increased by almost $20.00 for the visit. The reimburement is still low, but we were surprised at the increase. We used to bill with Medicaid codes, 'WO.... Pat Ford


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