MSHA Day 2
Here we are! Day 2. Today we have been busy with our Silent auction and presentations. At lunch, we met as regions to discuss how to connect and move forward! Regional Reps are tasked to encourage conversation amongst MSHA members and professionals. Reach out to your Regional Reps to discuss what you’d want to see at MSHA or what you’d like to learn more about throughout the year for webinars. The MAG luncheon also took place today to connect our AUDs.
MSHA Convention Day 1
Today was our first day of the conference! We are at the Delta Hotels by Marriott Helena Colonial. We have had a range of speakers presenting on Differences vs Disorders for ELL, Genomics of Hearing Loss, Suicide Prevention, Students First: Role of Related Service Professionals, Documentation for Maximum Reimbursement, Growing Telepractice in MT, Throw me a LINE- Throw me a SIGN, and Supervision of Aides and Services! It has been a fun-filled day where we were able to recognize exceptional members and providers who serve MSHA and Montanans during our MSHA Business and Awards Meeting.
Awards were given to:
- Meritorious Award is presented for outstanding professional achievement in the area of communication disorders of a non-technical nature or exemplary service to our organization, profession, and the communicatively impaired. Kristy Foss
- Achievement Award is presented for technical and/or professional achievement in the fields of speech-language pathology, audiology or any other related area concerned with the treatment of communication disorders. This award is presented to a person who has made a major contribution to the knowledge base within our professional fields, and/or to the methods or materials for the treatment and/or prevention of communication disorders. Their devotion and effort far exceed standard performance. Annalee Anderson
- Service Award is presented for outstanding dedication and excellence in service to the MSHA organization. Anne Juel
- Organizational Award is presented to an organization that has made a major contribution to increasing our knowledge of the disorders of communication, developed a new clinical tool or techniques for the treatment of communicative disorders or had exhibited virtuous attitudes and behaviors in the delivery of services to the communicatively impaired. Kalispell Regional Medical Center, First Interstate Bank of Helena
- Laura Jo McKamey Award (aka “Big Purse Award”) is presented to someone who has provided exemplary service to MSHA. This is someone that exemplifies a spirit of volunteerism. Carol Morse
- Undergraduate Student Clinical Achievement is presented for outstanding work in the area of undergraduate level clinical practice. Rob Wycoff
- Graduate Student Clinical Achievement is presented for outstanding work in the area of graduate-level clinical practice. Lisa Kilsdonk, Kathleen Cotter
- Undergraduate Research Award is presented for outstanding work in the area of undergraduate level research. Carley Stone
- Graduate Research Award is presented for outstanding work in the area of graduate level research. Anya Leyhe
- Off-Site Supervisory Award is presented for exemplary mentorship and supervision for the professional development of communication disorders students. Carol Morse
This evening we have the Poster session spearheaded by our University of Montana Speech-Language and Hearing Sciences students and professors.
Later this evening, we have Hor d’oeuvres and beverages while we listen to Bruce Anfinson play music for us!
SLPA Draft Bill
Hello MSHA members!
We are fast approaching our Fall Convention. Here is the final proposal SLPA bill draft for the licensure board meeting on 10/17/18. Click on the link to access the whole document.
The following are comments received by MSHA following the email blast and posting of the Assistant Draft Bill. The responses are not from the MT Board of Speech-Language Pathologists & Audiologists, but will be sent to them. Please continue to send your comments and questions on this topic to MSHA.
Thank you, Lezlie Pearce-Hopper, 2018 MSHA President
“Who will be carrying the bill?”
“Change bill title to SLPA and AuDA Licensure Bill”
The title is prescribed by legislative drafting manual
“I have a question regarding the telemedicine component. Can you specify the requirements of a “facilitator?” I’m thinking specifically of clients who participate in telemedicine due to travel restrictions or remote locations. I may have read it wrong. The document is not suggesting that these clients would need to find a licensed “facilitator” to supervise their sessions on site, correct?”
The bill makes no changes to telemedicine.
“The biggest thing I noticed was that you could just repeal all of section 7 which talks about registration. Once the license is created this becomes obsolete as the “registration” was the minimal authority granted to board as opposed licensing. If assistants are licensed then they would fall under normal renewal statutes. Registration ceases to exist.”
I agree with this. We could repeal registration.
“What are the anticipated requirements for SLPA? What would the testing entail?”
That would be set by rulemaking by the board. Statute is not the appropriate place to put this, as requirements may change as the profession develops, and we don’t want to have to go back to the legislature every time we need to change the licensing and testing requirements. Most other professions are governed by rule setting testing and licensure requirements.
“I’m not sure that the term “non-medical diagnosis” is appropriate in the description of what SLPs and AuDs may diagnose. For example, dysphagia, and receptive or expressive aphasia are commonly used in the medical setting and are appropriately diagnosed by a speech-language pathologist.
I supervise a very excellent speech aide. Is the board giving consideration to a grandfather clause for already established speech aides?”
This would be a better question for the board.
What is MSHA Doing Right Now?
OUR TOP 5
- We are gearing up for fall convention, and we are excited for all SLPs and AUDs to attend our conference. We have a fantastic line-up of presenters and events throughout the convention. Register and see more here: Fall Convention
- MSHA is working on a Bill with the State of Montana Legislature for Speech-Language Pathology and Audiology Assistants. This bill will enact licensure and registration of SLP and AUD Assistants. Please feel free to contact our MSHA President, Lezlie Pearce-Hopper if you have any questions or concerns. You can reach her at firstname.lastname@example.org
- We are looking for nominations for MSHA Awards during our convention. Please email email@example.com if you have a nomination you’d like recognized for one of our many awards. To see last year’s winners and a description of each of the awards click here: MSHA Awards
- Check your mail for the last paper version of the Communicator. You can request a paper copy by emailing MSHA.
- We hope to see all of you in Helena in October!
Music with Bruce Anfinson Thursday Evening @ MSHA Fall Convention
“Montana’s Musical Ambassador” — that’s what the Bozeman Chronicle called Bruce Anfinson. With the state’s natural wonders and rich cultural heritage portrayed so well in his songs, it’s a well-deserved title.
Bruce Anfinson grew up along the Missouri River, in Great Falls, Montana, where the Great Plains meet the Rocky Mountains. His father loved to sing old Sons of the Pioneers tunes as well as classics by Bob Wills, Eddy Arnold and the like. Bruce was nine years old when his father bought him his first guitar and he learned to accompany his dad on these old tunes at family reunions and friendly get-togethers. He started writing a few songs as a teenager and later found that music is a great vehicle for traveling and seeing the country.
Bruce now lives near Helena, Montana. He has built his own home and state-of-the-art recording studio, where he makes recordings and raises huckleberries, horses and children, but as the Great Falls Tribune said, “What…Bruce Anfinson cultivates best are music and good times.” Anfinson’s five recordings Ballad of Minnie and Pearl, Handmade Saddle, Huckleberry Hill, Home is Where Montana Is, and A Cowboy Christmas attest to that. Anfinson often writes and performs songs about a universal subject: Food! He is known throughout the country for singing food tunes, such as Fresh Bread, Huckleberry Hill, and Homegrown Tomatos. His shows are filled with wonderful story telling and bad jokes, as well as his original and traditional songs.
The August 2018 edition of Big Sky Journal features an article on Bruce: “Local Knowledge: Home Is Where Montana Is”.
STATE ADVOCATES FOR MEDICARE POLICY (StAMP) STATE ADVOCATES FOR REIMBURSEMENT (STARs) HABILITATION AUGUST 2, 2018
LANGUAGE EQUALITY AND ACQUISITION FOR DEAF KIDS
LEAD-K (Language Equality and Acquisition for Deaf Kids) is a national campaign to promote language acquisition for children who are deaf and hard of hearing (DHH). LEAD-K focuses primarily on efforts to pass state legislation that would require prescriptive and duplicative efforts that may undermine the authority of IFSP/IEP team. This team focuses on ASL only typically and does not support cochlear implant, auditory perception and language therapy. According to Eileen Crowe, ASHA Director of State Associations Relations this organization is a threat to SLP’s and undermines parent choices. She is urging state associations to be aware of how quickly this association is gaining momentum and how powerful they are in moving to get legislation passed.
ASHA believes that communication access and educational placement must consider a variety of factors:
Emotional and Social development
In addition, ASHA supports early access to language either visual and/or listening-spoke, as well as a parent right to choose the most appropriate language and communication modality based on evidenced based information and the needs of the family.
ASHA has been a long-time supporter of early intervention services to support the acquisition of language for communication of the child’s critical years with qualified personnel providing appropriate assessment and intervention strategies.
WHAT IS ASHA DOING TO COUNTER THE LEAD-K MOVEMENT?
ASHA has opposed legislation in 12 states in 2018.
ASHA has developed a white paper outlining the issue. concerns and policy statement for the Board of Director approval.
ASHA is creating a HOT Topics page for the ASHA website with a summary statement. opposition talking points, an issue brief, sample letters to legislators and sample legislation.
ASHA is developing messaging to communicate with members, state legislators and consumers.
ASHA is scheduling meetings with other stakeholder groups=American Cochlear Implant Alliance, ASG Bell. AAA and the American Academy of Pediatrics to formulate a coordinated strategy and garner support.
ASHA lobbyists met with members of the Congressional “Baby” Caucus to discuss EHDI/Parents right to choose and LEAD-K
Members are reporting ongoing and more attempts to pass legislation by the ABA
ABA are acting as gatekeepers to insurers.
ABA has been reported recommending SLP services without an evaluation or input from a SLP.
ABA have been recommending AAC devices without an evaluation.
WHAT IS ASHA DOING?
ASHA has a HOT topics web page:
Considering a media effort to address the importance of Audiology and SLP services for children with ASD.
Developing of a clinical Claims Review page on ASD for payers.
Conferring with Autism organizations about collaborative efforts.
Monitoring/opposing legislation and regulation the defines/expands the scope of practice of ABA therapist.
Monitoring autism service mandates:
Ongoing concern is the scope of practice and use of billing codes by music therapists. Ten states now certify, register or license music therapists. The trend is for licensure which then permits use of SLP CPT billing codes.
OCCUPATION LICENSURE LEGISLATION ELIMINATION
A major trend has emerged to eliminate occupational licensure and legislation has been introduced in 8 states and passed in Missouri. Missouri will replace licensure with 3 certifications.
This legislation is moving to get rid of licensure. In Nebraska a law was passes to review 20% of occupational registry to meet least restrictive requirements.
Colorado. Kansas, Kentucky, Nevada, North Dakota, Oklahoma, Pennsylvania, Vermont, Louisiana and Nebraska along with Missouri have been faced with this legislative effort.
Seven million dollars has been allocated for the analysis of licensure requirements to develop action plans for alternative approaches to licensing for profession certification. Speech/Language Pathology and Audiology are main targets and many states are going up to Medical Doctors licenses as well.
This initiative is at the state levels. ASHA is strongly urging state associations to be aware of the danger. This will allow treatment in our professions by less skilled individuals and will undermine our ability to collect insurance and Medicaid reimbursement.
INTERSTATE COMPACT UPDATE:
Speech-language-hearing interstate compact (SLHIC)
Drafting team timeline:
Met in Washington, DC on May 21-22
Role of drafting team:
-Develops draft compact based on thoughts, ideas sand suggestions of the Advisory Group
-Use their own thoughts and expertise through the process
Finalize draft compact (2018-2019)
-Brief state legislators on compact
-Work with states to find sponsors, pass legislation.
-Reach threshold for enactment
-Set up compact commission to run compact
SPEECH-LANGUAGE-HEARING INTERSTATE COMPACT WEBPAGE:
StAMP: 2018 CODING AND REIMBURSEMENT UPDATES
Key Components of Payment Success include:
Merit-Based Incentive Payment System is here! Fee-for-service reimbursement is being discontinued. This is an outcome-based reimbursement and we all need to prepare for the change.
Fraud, waste and abuse are being followed by Medicare and private insurers. This included providing more therapy visits than needed for a specific condition or providing therapy for a condition that is not deemed medically necessary.
The following is website with further information:
- “CAN I BILL FOR THE 15-20 MINUTES THAT I SPEND ON PATIENT EDUCATION AND TREATMENT RECOMMENDATIONS AFTER THE EVALUATION?”
NO, NO, NO!
The time spent on service related to evaluation and treatment session are captured in the value of the CPT Code for that session.
Do not use treatment codes to capture time spent on patient/caregiver education or initial treatment recommendations.
- “HOW MUCH TIME SHOULD I SPEND ON AN UNTIMED CODE IN ORDER TO BILL IT?”
There is no hard and fast rule regarding length of time for an untimed code–
HOWEVER, there are underlying times associated with each CPT Code, as determined by a group of your peers, (through ASHA/AMA).
You may locate this information:
CY 2018 PFS Rule Physician Time File on CMS website.
The new is not encouraging at this time even though I have no hard and fast new item.
I traveled to Baltimore, Maryland for the ASHA Connect and attended some amazing presentations on documentation, reimbursement and preparing for an audit. I would be willing to share this in a presentation to MSHA members.
I am traveling to Boston to be a part of 3 STARs presenting on Medicaid.
Graduate Student Scholarship Opportunity!
The Montana State Hearing Association believes strongly in supporting graduate students who are committed to serving the people of Montana. We are pleased to offer the MSHA Memorial Scholarship award in the amount of $750 for the 2018-19 school year. Two awards will be given. Learn more under Student > Scholarships or access and download the application here: 2018 MSHA Scholarship Application
MSHA and Better Hearing and Speech Month
It’s May, and we are so happy the weather has finally turned around in Montana! MSHA is excited to offer a $10 reduction in membership fees beginning now and lasting until end of June in recognition of May as Better Hearing and Speech Month. Please sign up now and take advantage of the benefits of being a MSHA member as well as
- Multiple opportunities each year to earn Continuing Education Units (CEUs)
- Discounted registration fees at Fall Convention and Summer Institute
- Our Web Site (www.mshaonline.org) with information for members, students and consumers that is frequently updated
- A quarterly newsletter, The Communicator, covering professional activities and information needed by audiologists and speech-language pathologists
- A committee structure that monitors virtually every aspect of the professions and offers numerous opportunities for participation.
- Bi-monthly webinars, please email if you have a speaker or topic you’d like to hear about
- Online payment options for conferences and membership
- Liaison with the American Speech-Language-Hearing Association
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.