Health-Care Professionals

The 2011 SLP Healthcare Committee

Vice-President:

Beverly Jaynes


   Committee Members:

Karen Al-Saadi
Lisa Bardach
Stacy Brown
Ann Comstock

Carolyn Doty

Julie Kiefer Eamon
Maria McElmeel
Margaret Tiner
Susan Tranquilla

 

The purpose of the SLP Healthcare Committee is to support and represent the needs of speech-language pathologists or audiologists working in the community, private practice, health care or medical settings. The SLP Healthcare Committee monitors and responds to issues affecting the provision of services in these settings.  In addition, the committee encourages and celebrates excellence in these settings through the conferring of the Clinical Service Award.

 To support and represent meet the needs of speech-language pathologist or audiologist members working in a community, private practice, health care or medical setting. affiliated with the Michigan Speech-Language-Hearing Association (MSHA). The Community and Hospital Services Committee (CHS) monitors and responds to issues affecting the provision of services in these settings. In addition, the CHS committee encourages and celebrates excellence in these settings through the conferring of awardsTo support and represent meet the needs of speech-language pathologist or audiologist members working in a community, private practice, health care or medical setting. affiliated with the Michigan Speech-Language-Hearing Association (MSHA). The Community and Hospital Services Committee (CHS) monitors and responds to issues affecting the provision of services in these settings. In addition, the CHS committee encourages and celebrates excellence in these settings through the conferring of awardsTo support and represent meet the needs of speech-language pathologist or audiologist members working in a community, private practice, health care or medical setting. affiliated with the Michigan Speech-Language-Hearing Association (MSHA). The Community and Hospital Services Committee (CHS) monitors and responds to issues affecting the provision of services in these settings. In addition, the CHS committee encourages and celebrates excellence in these settings through the conferring of awar

Announcements

SNF Medicare Rules Finalized for FY2012

The Centers for Medicare and Medicaid Services (CMS) issued final regulations for Part A services in skilled nursing facilities (SNFs) on July 29, 2011, effective October 1, 2011.  Overall payments to SNFs in FY2012 will be reduced by 11.1%, mainly due to the over utilization of therapy payment categories compared to expected projections.

Reduced supervision of therapy students.  CMS has removed specific student supervision restrictions in SNFs because hospitals have no such restrictions for Part A patients.   The objective was to promote greater conformity with other inpatient setting.  As stated in the proposed rule, the new requirement is that "each SNF will determine for itself the appropriate manner of supervision of therapy students consistent with applicable state and local laws and practice standards."  CMS emphasized that a new, different method of supervision would in no way alter the individual's basic status as a student operating under the therapist's supervison and   "the time the student spends with a patient will continue to be billed as if it were the supervising therapist alone providing the therapy.

Group therapy.  The CMS proposal that defines optimal group treatment as requiring four-persons remains unchanged in the final regulation.  Thus, if a group session consists of two or three patients, the session length must be divided by four (e.g., a 30-minute session with three patients yields 30 divided by 4=7 minutes counted toward the Resource Utilization Group (RUG) level of care).  The proposed four-person group treatment standard was protested by ASHA, noting that there is no research to support the assumption that four persons are optimal.  A longstanding SNF Part A rule remains, allowing up to 25% of therapy per discipline per week to be group therapy.

End of therapy OMRAs.  Changes also affect Other Medicare Required Assessments (OMRAs).  CMS proposed that an interruption of three days of therapy would require that the patient be discharged from therapy and require an OMRA when restarting therapy, whether or not the SNF maintained a five-day or seven-day therapy schedule.  For example, if the patient received no therapy on Friday, Saturday, and Sunday then an assessment would be required, even though such an OMRA serves no purpose as a clinical management tool.  ASHA pointed out that there are many reasons for a missed treatment on the last day of the work week-Friday (e.g., patient illness, therapist illness, patient refusal, visit to physician's office) extending the interrupted therapy to three days.  We recommended the requirement be revised to four days to avoid many unnecessary discharges and reassessments, but the minimum missed treament period will stand at three days.

The final rule is posted on the Office of the Federal Register's Website at http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf  For  additional information, please contact Mark Kander, ASHA's Director of Health Care and Regulatory Analysis by email at mkander@asha.org

Endoscopy Rules

Medicare is repealing its January 1, 2011 Endoscopy Rules requiring direct physician supervision of SLPs for videostroboscopy or nasopharyngoscopy.  The new rules will go into effect on October 1, 2011.  For more information please see the August 2, 2011 edition of the ASHA Leader

To view the rules

Integrating Care

The State of Michigan has launched an initiative for integrating care for individuals eligible for both Medicaid and Medicare.  This will eventually impact all levels of healthcare.  Please visit the following website for more information:

https://janus.pscinc.com/dualeligibles/

Submitting Reports to the State of Michigan

When providing reports to the State of Michigan, such as Disability Determination, in lieu of a licensure number you will need to add your Certification Number to the report.  If you work in the public schools you will need to add either your certification number or your teaching certificate number to the report.

Blue Cross Blue Shield Information

MSHA is pleased to relay a recent change in Blue Cross Blue Shield of Michigan's documentation requirements, effective February, 2011.  Per the Blue Cross Blue Shield Record, the requirements for speech-language pathology documentation and certification have been changed to more efficiently provide care to members.  The changes include increasing SLP therapy referral validity from 60 to 120 days; increasing the time-frame for re-certification to 90 days for longer term treatment plans, and elimination the face-to-face physician visit requirement for treatment plan re-certification (written documentation must demonstrate ongoing communication between the referring health care provider and SLP).  Please refer to the BCBS-Michigan Record for specific details.
MSHA representatives met last August with BCBS-Michigan to request a number of changes to documentation requirements to improve efficiency and reduce physician and SLP re-work.  We are very pleased that BCBSM was willing to analyze these requests and to approve them.  Their willingness to work with members of MSHA in the goal of improving service efficiency for patients with communication and swallowing disorders is greatly appreciated.

Direct Billing

Blue Cross Blue Shield of Michigan announced yesterday that in September, 2010, it will initiate a project to directly reimburse Speech-Language Pathologists.  Direct billing does not change the requirement that SLPs will need to receive a physician referral to initiate assessment and/or treatment and will continue to follow all requirements for physicians to certify the plan of care.  The project is expected to be implemented in the fourth quarter of 2011

Upcoming Events:

The Matlock Speech-Language Lecture Series.  The DMC Rehabilitation Institute of Michigan proudly presents Evaluation and Treatment of Vocal Fold Dysfunction in Patients with Neurogenic Diagnoses on Thursday, October 6, 2011, 4:00-7:15 p.m. presented by Alice Silbergleit, Ph.D., CCC-SLP.  For more information please see the Events section of the website.

Meeting Dates:

·                                October 27th, 6:00 pm-details to be announced

·                                 December 3rd, 10:30 am at the home of Karen Al Saadi in Ann Arbor.

Contact Bev Jaynes at craig_n_bev@yahoo.com for directions to the meetings.

SLP Healthcare Committee Meeting Minutes:

May 17, 2011
 


Clinical Service Award


The Clinical Service Award has been developed to give visible recognition to outstanding clinical speech, language and hearing programs in the state of Michigan, as well as those persons responsible for their development and implementation. The inaugural Clinical Service Award was given at MSHA's 2000 Conference in Grand Rapids. The Clinical Service Award is open to any speech, language and hearing program conducted in a clinical setting (such as speech and hearing clinic, hospital, subacute rehabilitation facility, etc.). This award is not open to public school programs. At least one member of the nominated program must be a MSHA member. A program may be nominated by anyone — client, caregiver, colleague, program director. The Community and Hospital Services Committee may conduct onsite visits in making the final determination for award recipients.  The deadline for the 2012 Clinical Service Award is September 15, 2011.  2012 Clinical Service Award nomination form.
 

SLP Healthcare


The SLP Healthcare Committee consists of speech, language and hearing professionals from across the state of Michigan. The functions of this committee include:
Monitoring issues affecting provision of services in medical speech pathology and audiology
Coordinating the Medical Speech Pathology Forum held at MSHA Annual Conference
Reviewing nominations and selecting recipients for the MSHA Clinical Service Award
Submitting suggestions to the Program Committee for invited speakers at the MSHA Annual Conference
Maintaining contacts with reimbursement agencies including Medicaid, Medicare and Blue Cross
Some issues the committee will be discussing in 2010 include:
Medical SLP Forum: Suggestions for topics and speakers
Clinical Service Award (CSA)
Reimbursement: State and national
The transition to licensure
Revision of the Committee's Policies and Procedures
Expanding the committee's membership
Transition to new governance model: How will it affect our functioning?

Hot Topics

New Medicare Rules for Student Supervision in Skilled Nursing Facilities

New Medicare regulations remove line-of-sight supervision requirements for therapy students in skilled nursing facilities (SNFs) but other restrictions remain, according to recently released guidance.  The regulations state “each SNF would determine for itself the appropriate manner of supervision of therapy students consistent with applicable state and local laws and practice standards.” However, in guidance on adherence to the new regulations [PDF] (slides 18–28, 33–34), the Centers for Medicare and Medicaid Services (CMS) clarifies that the supervising clinician cannot treat another resident or supervise another student while the student is treating a resident. CMS notes that ASHA (and the American Physical Therapy Association and American Occupational Therapy Association) provides recommended guidelines for student supervision [ZIP]. ASHA’s guidelines are reproduced below.

The CMS restrictions on billing students’ services are based on two principles; for billing purposes, the student is considered an extension of the therapist and only one billable service can be provided at one time by the student/supervisor. Billing guidance includes the following:

Code as individual therapy when the speech-language pathologist (SLP) or student is treating one resident, while the other is not treating/supervising any other residents/students.
Code as concurrent therapy (i.e., patients are performing different activities) if the SLP is treating two residents while the student is not treating any residents or if the student is treating two residents while the SLP is not treating any residents.
Code as group therapy (i.e., patients are performing similar activities) if the full group is conducted by either the supervising SLP or the student; the other may not be supervising any other students or treating residents.

 

These regulations apply only to Part A residents in SNFs; more restrictive student rules for Part B services (i.e., 100% supervision in the room) in SNFs and other settings remain unchanged.

For more information, please contact Mark Kander, director of health care regulatory analysis, at mkander@asha.org. 

ASHA's Student Supervision Guidelines

ASHA submitted the following guidance on supervision of students to CMS; the guidelines are not included in the regulation, but are references in implementation guidelines.

Graduate students who have been approved by the supervising speech-language pathologist to practice independently in selected patient situations can perform the selected clinical services without line-of-sight supervision by the supervising speech-language pathologist. The supervising speech-language pathologist must be physically present in the facility and immediately available to provide observation, guidance, and feedback as needed when the student is providing services.
The amount of supervision must be appropriate to the graduate student’s documented level of knowledge, experience, and competence.

When the supervising speech-language pathologist has cleared the graduate student to perform medically necessary patient services and the student provides the appropriate level of services, the services will be counted on the MDS as skilled therapy minutes.

The supervising speech-language pathologist is required to review and co-sign all graduate students’ patient documentation for all levels of clinical experience and retains full responsibility for the care of the patient.  Supervising speech-language pathologists are required to have one year of practice experience.

Graduate students who have not been approved by the supervising speech-language pathologist to practice independently require line-of-sight supervision by the qualified speech-language pathologist during all services. In addition, the supervising speech-language pathologist will have direct contact with the patient during each visit. The graduate student services will be counted on the MDS as skilled therapy minutes.

Useful Links


http://www.asha.org/practice/reimbursement/SLP-Medical-Review-Guidelines/

http://www.asha.org/Practice/reimbursement/modules/ -Coding, Reimbursement and Advocacy

National Aphasia Association (NAA) - Promotes public education, research, rehabilitation and support services to assist people with aphasia and their families 800.922.4622

National Institute of Neurological Disorders and Stroke (NINDS) - Supports and conducts research on the brain and nervous system; fosters the training of investigators in the basic and clinical neurosciences; and seeks better understanding, diagnosis, treatment and prevention of neurological disorders 800.352.9424

National Rehabilitation Information Center (NARIC) - Provides information to the disability and rehabilitation community through online publications, searchable databases and timely reference and referral data 800.346.2742

National Stroke Association (NSA) - Provides information and resources for stroke survivors, their families and caregivers 800.787.6537 (STROKES)