March Update from MSHA President
What’s Been Happening . . . . . . . . . . . ?
- The MSHA Board has already held two meetings this year (January 20th (electronic meeting) and March 3rd (in person in Billings and electronic meeting). The newly expanded Board (17 members) has allowed MSHA to have a larger member representation at these meetings. Our next meeting will be an electronic meeting on May 5th. I want to thank all of the MSHA Board and MSHA Members for your enthusiasm, volunteer hours, expertise and dedication to your professions.
- As with previous face to face meetings, I am continuing to seek feedback on an Assistant Licensure Bill sponsored by MSHA during the 2019 Legislative Session.
- The MSHA Straw Poll and Opinion Survey are supportive of MSHA moving forward with a positions paper in support of Audiology and Speech – Language Pathology Assistants. You will see the information on the MSHA website prior to the MT Board of Speech-Language Pathologists & Audiologists receiving an update and a request for support at their next meeting on June 4th.
- We need member comments and questions regarding the Assistant Licensure Process. Please talk to your colleagues and supervisors as more information is provided on the MSHA website. The in-depth look at the Opinion Survey results will be posted on the website and sent out in an email blast when ready.
- New fee schedules for exhibitors and advertising were approved and will be posted on the website.
- At the February 21st meeting of the MT Board of Speech-Language Pathologists and Audiologists, I presented the MSHA Organization Award which was announced at the MSHA 2018 Fall Conference. The finances of the Board are stable at this time and they do not see any change to the most recent Licensure fee charge.
- The American Speech-Language-Hearing Association (ASHA) is awarding the Montana Speech Language & Hearing Association a $1,100 state association partial grant for our association’s assistant licensure bill project. Based on our proposal, ASHA recommends this funding be used towards travel and survey support. This grant is funded under ASHA’s Strategic Pathway to Excellence.
- “Creating Communication Connections” is the theme and title of our MSHA Fall Conference, October 18-20 at the newly remodeled Radisson Colonial Hotel in Helena.
- The state’s regional directors now have email addresses of most current MSHA members and addresses of most licensed professionals in the state. Please contact them is you have not heard from them in the coming months. You will find their contact information on the website.
- MSHA is in process of updating their website.
- Lezlie and Kathleen will attend the Council of State Association President’s Meeting in St. Louis May 17-19.
- Congratulations to Christina Hanson for graduating from the ASHA Leadership Development program. You will hear more on her project development in coming months.
- I recently attended an extremely helpful and educational Telepractice Webinar which was well attended and will be repeated soon by MSHA members. I want to thank Diane and Rachel for their contributions to MSHA and the clients who benefit.
- April 26 is the deadline for submissions for the MSHA May newsletter. Please send advertising or newsletter information to firstname.lastname@example.org
Medicare and Reimbursement Guidance from our StAMP and STAR Representative
STATE ADVOCATES FOR MEDICARE POLICY (StAMP)
STATE ADVOCATES FOR REIMBURSEMENT (STARs)
I am addressing some frequently asked questions:
“For Part B settings, is it acceptable to bill an evaluation code like 92526, and on that same day/for that same session bill a treatment code like 92507?
From my perspective, the simplest answer is that we should develop a plan of care that meets the patient’s clinical needs. This is regardless of the duration of the services needed or the estimated cost of care. I suggest the following plan:
- Development of the plan of care to meet the medical necessity of the patient.
- Document the clinical rationale (it’s helpful to reference evidence based practice).
- Assure medical record entries give evidence to the appropriateness and timeliness of the services provided.
With or without a therapy cap, it is possible you could find yourself having to appeal for payment of the services. If the plan is patient-centered and the clinical rationale is sound, you will be doing all you can to assure the patient gets appropriate care.
The CPT Code 97532 for cognitive treatment code has been discontinued as of 12/31/2017. ASHA report that this code has been discontinued due to over use by occupational therapy.
The replacement CPT Code is 97127. This is an untimed code.
CMS (Center for Medicare and Medicaid Services) reported that Medicare will NOT cover the 97127 CPT Code.
Medicare will cover the following for cognitive treatment G0515. This CPT Code is a timed code reported in 15-minute units.
The confusion is which code private payers will reimburse. Both CPT Codes can be billed by any payer.
This will mean each company will need to be contacted to discover which code can be billed to determine your reimbursement; which creates confusion and extra work for you in your treatment and business.
Montana Medicaid covers the G0515 CPT Code rather than the 97127.
Stay tuned to the latest updates on the therapy cap. As of the time that I am writing this report, the therapy cap is in the 20th year. ASHA is addressing abolishing the cap on therapies. To date the ability to appeal for additional sessions is nixed; however, my ASHA resources expect this to be appealed allowing for appeals for additional treatment sessions.
Montana Medicaid will NOT cover the 97127 for cognitive treatment.
I reached out to clarify the cognitive coverage for Montana Medicaid. I was contacted by Rena Stayaert, Montana Medicaid Program Officer, School Based Services, Optometric therapies.
She reported that the code that will be reimbursed for cognitive treatment by Medicaid is G0515 and the charge will be reimbursed in 15-minute units with a maximum charge per day is 8 units for a two-hour session.
For clarification Rena can be contacted by the following:
No new issues.
StAMP and STARs both are influenced by the following:
Multiple Procedure Payment Reduction (MPPR)
MPPR is a per-day policy that applies across disciplines and across settings. For example, if an SLP and a physical therapist both provide treatment to the same patient on the same day, the MPPR applies to all codes billed that day, regardless of discipline. Under MPPR, full payment is made for the therapy service or unit with the highest practice expense value (MPFS reimbursement rates are based on professional work, practice expense, and malpractice components) and payment reductions will apply for any other therapy performed on the same day. For the additional procedures provided on the same day, the practice expense (i.e., support personnel time, supplies, equipment, and indirect costs) of each fee will be reduced by 50% (effective April 1, 2013) for Part B services in all settings. The professional work and malpractice expense components of the payment will not be affected. ASHA has developed three MPPR scenarios to illustrate how reductions are calculated.
MPPR primarily affects physical therapists and occupational therapists because they are professions that commonly bill multiple procedures or a timed procedure billed more than once per visit. Eight speech-language pathology procedures are designated as applicable to MPPR.
Speech-Language Pathology Codes Subject to MPPR
- 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- 92508 – Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals
- 92521 – Evaluation of speech fluency (eg, stuttering, cluttering)
- 92522 – Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
- 92523 – Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
- 92524 – Behavioral and qualitative analysis of voice and resonance
- 92526 – Treatment of swallowing dysfunction and/or oral function for feeding
- 92597 – Evaluation for used and/or fitting of voice prosthetic device to supplement oral speech
- 92607 – Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour
- 92609 – Therapeutic services for the use of speech-generating device, including programming and modification
- 96125 – Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
Please contact me if you have any issues/challenges with coding, documentation and reimbursement.
Congratulations MT Licensure Board!
October 12, 2017
Lucy Richards and the entire Montana Board of Speech-Language Pathologists and Audiologists were instrumental prior to and during the process of passage of HB 347 (Limited Speech-Language Pathologist License). MSHA wants to thank Lucy and the Board for their commitment, professionalism and many hours of dedication. In addition MSHA members consistently attend Board Meetings and are welcomed and provide information as well as provide feedback and suggestions. The Board has been open to communication and working with the MSHA members.
Lucy Richards and the Board have provided timely and helpful updates on the website, there is now a quarterly newsletter. FAQs appear on the website as do approved CE coursework. Questions left on the phone or via email are answered in a timely manner.
Lucy has paperwork prepared in advance for the board to perform their duties in a cost effective and timely manner. Budgets were available and many needed revisions to rules were completed this year in part to the administrator’s organization prior to each meeting where discussion was orderly and easily understood by audience members who frequently included our members and graduate students.
The Board worked to determine a reduction in cost for initial renewal licenses. Lucy
Richards will be attending the first day of the MSHA Fall conference in Missoula and be available to answer questions at an exhibitor table.
I enthusiastically support this MSHA Organization Award for Lucy Richards and the entire Montana Board of Speech-Language Pathologists and Audiologists. We look forward to working with them in the future and during the next Montana Legislative Session in 2019.
Lezlie Pearce-Hopper, M.S., CCC-SLP
Montana Speech Language and Hearing Association (MSHA)
Montana Telepractice Turns 5: Webinar March 13, 2018
MSHA is committed to bringing educational opportunities! Keep your calendar available for a webinar on Tuesday March 13, 2018 to participate in Montana Telepractice Turns 5 by Rachel Stansberry and Diane Simpson. Attend and find out about what’s changed and where we’re going in Telepractice. Resources and recommendations will be provided! More details to come!
Survey Extended! Please complete this short survey by January 31st!
We want all Montana SLPs and AUDs to complete a survey on your opinions regarding aides and assistants. Please click the link below and complete this short survey! Please complete this survey by this Friday January 19, 2018! This will take less than 5 minutes to complete!
FEES Course Coming this June!
Check out this continuing education opportunity!
Carolina Speech Pathology has a comprehensive Two Day FEES® Training Course “Fiberoptic Endoscopic Evaluation of Swallowing: A Procedure for Evaluating Oropharyngeal Dysphagia” coming to Great Falls, Montana June 9-10 2018. Get registered now!
This course will be taught by Kristin Sears-Kopp, M.A., CCC-SLP and Selena Reece, M.S., CCC-SLP, BCS-S. These energetic instructors have competed thousands of FEES across a variety of settings and have been deemed competent in supervision and training in FEES by board certified Otolaryngologists.
Thanks to Bridget Loomis, SLP for organizing this opportunity!
Telepractice Law and Rules
MSHA is committed to supporting telepractice by providing training and information to practitioners and consumers. Practitioners should be familiar with both the law and the rules prior to initiating services via telepractice.
The complete law can be found by searching the Montana Code Annotated
37-15-102 (relevent portions)
(5) “Facilitator” means a trained individual who is physically present with the patient and facilitates telepractice at the direction of an audiologist or speech-language pathologist. A facilitator may be but is not limited to an audiology or speech-language pathology aide or assistant.
(6) “Patient” means a consumer of services from an audiologist or speech-language pathologist, including a consumer of those services provided through telepractice.
(11) “Telepractice” means the practice of audiology or speech-language pathology by an audiologist or speech-language pathologist at a distance through any means, method, device, or instrumentality for the purposes of assessment, intervention, and consultation.
37-15-314. Telepractice — authorization — licensure. (1) An audiologist or speech-language pathologist who is licensed under and meets the requirements of this chapter may engage in telepractice in Montana without obtaining a separate or additional license from the board.
(2) Except as provided in 37-15-103, an audiologist or speech-language pathologist who is not a resident of Montana and who is not licensed under this chapter may not provide services to patients in Montana through telepractice without first obtaining a license from the board in accordance with this part.
(3) An audiology aide or assistant or a speech-language pathology aide or assistant may not engage in telepractice. This section does not prohibit an audiology aide or assistant or a speech-language pathology aide or assistant from serving as a facilitator.
37-15-315. Scope of telepractice — requirements. (1) The quality of services provided through telepractice must be equivalent to the quality of audiology or speech-language pathology services that are provided in person and must conform to all existing state, federal, and institutional professional standards, policies, and requirements for audiologists and speech-language pathologists.
(2) Technology used to provide telepractice, including but not limited to equipment, connectivity, software, hardware, and network compatibility, must be appropriate for the service being delivered and must address the unique needs of each patient. Audio and video quality utilized in telepractice must be sufficient to deliver services that are equivalent to services that are provided in person. A person providing telepractice services is responsible for calibrating clinical instruments in accordance with standard operating procedures and the manufacturer’s specifications.
(3) A person providing telepractice services shall comply with all state and federal laws, rules, and regulations governing the maintenance of patient records, including maintaining patient confidentiality and protecting sensitive patient data.
(4) A person providing telepractice services shall conduct an initial assessment of each patient’s candidacy for telepractice, including the patient’s behavioral, physical, and cognitive abilities to participate in services provided through telepractice. Telepractice may not be provided only through written correspondence.
(5) At a minimum, a person providing telepractice services shall provide a notice of telepractice services to each patient and, if applicable, the patient’s guardian, caregiver, or multidisciplinary team. The notification must provide that a patient has the right to refuse telepractice services and has options for service delivery and must include instructions on filing and resolving complaints.
The Rules can be found by searching the rules
Rule I definitions
(1) “Asynchronous” means a method of exchanging information that does not require the patient and the provider to be available at the same time. Examples of such communication, also known as “store-and-forward” transmission, include e-mails, faxes, recorded video clips, audio files and virtual technologies and e-learning programs.
(2) “Synchronous” means interactive transmission of data occurring bi-directionally in real time and requiring the patient and the provider be available at the same time.
Rule II provision of telepractice serives
(1) The provision of speech-language pathology or audiology services in this state through telepractice, regardless of the physical location of the speech-language pathologist or audiologist, constitutes the practice of speech-language pathology or audiology and is subject to state licensure requirements and regulation by the board.
Rule III limits on telepractice
(1) No person licensed as a speech-language pathologist or audiologist in another state may engage in the practice of speech-language pathology or audiology in Montana, including telepractice services, unless a license to practice has been issued in Montana.
(2) A person located outside this state who provides speech-language pathology or audiology telepractice services to any patient in Montana shall be appropriately licensed in the jurisdiction in which the person providing telepractice services is located.
(3) All telepractitioners must abide by any statute or rule of this state governing the maintenance of patient records and patient confidentiality, regardless of the state where the records are maintained.
Rule IV delivery of telepractice serices
(1) Telepractice services may be delivered in a variety of ways, including:
(a) Asynchronous transmission:
(i) store-and-forward model/electronic transmission of stored clinical data from one location to another usually by the Internet via e-mail or fax; and
(ii) video and audio transmission through regular mail service delivery and express delivery services; and
(b) Synchronous transmission:
(i) clinician interactive model is a real time interaction between provider and patient that may occur via audio or audio/video transmission over telecommunication links such as telephone, Internet, or other methods for distance communication, including:
(B) remote control software applications;
(C) computer applications;
(D) e-mail correspondence, including attachments; or
(E) self-monitoring/testing model, which refers to the patient who receives the services and provides data to the provider without a facilitator present at the site of the patient.
(2) Live versus stored data refers to the actual data transmitted during the telepractice. Live, real time, and stored clinical data may be included during the telepractice.
Rule V quality of telepractice services
(1) Elements of quality assurance include the competency of licensees, selection of patients, appropriateness of technology to the service being delivered, identification of appropriate outcome measures, collection of data, and satisfaction of the patient, caregiver, and provider.
(2) Telepractice services must conform to professional standards, including all appropriate and applicable codes of ethics.
(3) Licensees shall not engage in false, misleading, or deceptive advertising of telepractice services.
(4) Telepractice services may not be provided solely by correspondence, e.g., mail, e-mail, and faxes, although such may be adjuncts to telepractice.
(5) Licensees shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience.
(6) Telepractice services must be in compliance with safety and infection control policies and procedures.
Rule VI establishing the practitioner-patient relationship
(1) A practitioner-patient relationship may commence via telepractice following a practitioner’s in-person evaluation of the prospective patient to assess the patient’s:
(a) need for services; and
(b) candidacy for telepractice, including behavioral, physical, and cognitive abilities to participate in telepractice services. Telepractice services may be provided by the patient’s evaluator or another qualified speech-language pathologist or audiologist by the board.
(2) Prior to initiating services, a speech-language pathologist or audiologist shall:
(a) make reasonable attempts to verify the identity of the patient;
(b) obtain alternative means of contacting the patient other than electronically;
(c) provide to the patient alternative means of contacting the licensee other than electronically;
(d) document whether the patient has the necessary knowledge and skills to benefit from the type of telepractice provided by the licensee;
(e) determine the availability of a facilitator, if needed, with the necessary level of training to assist at the patient’s location;
(f) provide orientation and training to the patient in the use of telepractice equipment and the telepractice protocol at an appropriate level for the patient; and
(g) inform the patient in writing of the following:
(i) the limitations of using technology in the provision of telepractice;
(ii) the potential risks to the confidentiality of information due to technology used in telepractice;
(iii) the potential risks of disruption in the use of telepractice;
(iv) when and how the licensee will respond to routine electronic messages;
(v) in what circumstances the licensee will use alternative communications for emergency purposes;
(vi) who else may have access to patient communications with the licensee;
(vii) how communications can be directed to a specific licensee;
(viii) how the licensee stores electronic communications from the patient; and
(ix) that the licensee may elect to discontinue the provision of telepractice services.
(3) The written document required by (2)(g) shall be signed by both the licensee and the patient and maintained in the clinical record. If the patient is a minor, the document shall be signed by the patient’s parent or guardian.
Rule VII competence-practice limits-maintenance and retention of records
(1) A licensee using telepractice to deliver services shall:
(a) complete four hours of board-approved telepractice training prior to engaging in telepractice in Montana;
(b) limit telepractice services to the licensee’s scope of practice;
(c) maintain continuing competency or associate with a group who has experience in telepractice delivery of care;
(d) use methods for protecting health information that include authentication and encryption technology;
(e) limit access to protected health information to only those necessary for the provision of services or those required by law; and
(f) ensure that confidential communications obtained and stored electronically cannot be recovered and accessed by unauthorized persons when the licensee disposes of electronic equipment and data.
(2) A speech-language pathology or audiology aide or assistant may function as a facilitator, but may not provide telepractice services.
Coming soon….SPARK Communication™ Billings, MT — June 8-9, 2016
Designed specifically for early childhood intervention providers,
SPARK Communication™ offers:
- research-based responsive interaction strategies – drawn from the world-renowned It Takes Two to Talk® Program – that have been shown to accelerate children’s language use.
- a coaching framework for helping parents apply these strategies during everyday interactions with their child.
- a comprehensive set of resources to structure, plan and implement SPARK strategies with families (valued at over $100)
Learn more and register at the link below, or feel free to contact me at email@example.com.
Sign Up Now for Workshop Notifications
Click Here and follow the instructions to be the first to know when registration opens!
Join us at an It Takes Two to Talk® Certification Workshop in Billings, MT on June 10-12, 2016
It Takes Two to Talk is a 3-day workshop that offers hands-on, interactive training on parent-implemented, family-centered early language intervention for Speech-Language pathologists who work with young children with language delays (birth to 5 years) and their families. You’ll learn effective, research-based strategies for involving parents in the early intervention process to ensure the best possible outcomes for their child.
When you take It Takes Two to Talk, you get:
- 2.2 ASHA Continuing Education Credits
- An effective teaching methodology for coaching parents to use responsive interaction strategies
- An overview of learning styles and principles of adult education and their application to facilitating parents’ learning to be effective language facilitators
- The stages of learning in terms of self-awareness, attitude and behavior change and how to adapt the use of coaching and videotaping with feedback to each stage in order to facilitate parents’ learning and application of strategies
- Guidelines for leading It Takes Two to Talk– The Hanen Program® for Parents of Children with Language Delay
- An overview of It Takes Two to Talk’s three clusters of responsive interaction strategies – child-centered, interaction-promoting, and language modeling strategies
- A comprehensive set or resources to use within your It Takes Two to Talk Programs, as well as in your everyday work with families(valued at $270)
- Access to the member-only It Takes Two to Talk Parent workbook designed specifically for use in one-to-one therapy
- A one-year, renewable Hanen membership offering ongoing opportunities to enhance your clinical skills
You can find out more about the It Takes Two to Talk workshop by visiting the Hanen website at www.hanen.org/ITTTworkshop.
Don’t wait! Be the first person to sign up to receive notifications as soon as this workshop or any otherIt Takes Two to Talk workshop in this area becomes open for registration.
To receive these notifications, click here, then go to the bottom of the page where it says “Add me to the Notification List” and follow the simple steps!
Please pass along this email to others who may be interested. Thank you and we’ll see you in June!