Healthcare

VISION: To provide a means for Louisiana speech-language pathologists and audiologists in private and medical settings to organize in order to:

Medicare Part B Supervision Requirements for Videostroboscopy and Nasopharyngoscopy Procedures Rescinded Effective October 1, 2011

Effective October 1, 2011, the Centers for Medicare & Medicaid Services (CMS) is rescinding the requirement that became effective January 1, 2011, that supervision of the videostroboscopy (CPT 31579) and nasopharyngoscopy (CPT 92511) procedures required a physician to be in the room. In March 2011, representatives from ASHA and the American Academy of Otolaryngology - Head and Neck Surgery met with CMS officials. Additionally, ASHA members protested the need for such supervision to members of Congress. As a result, the CMS Administrator issued a letter in June 2011, acknowledging that "while physicians perform these diagnostic procedures, speech pathologists also perform these procedures to evaluate and treat a patient's functional/use problems." The letter removed all supervision levels previously assigned to the procedures, effective October 1.

ASHA, in conjunction with Special Interest Group 3: Voice and Voice Disorders, has developed Frequently Asked Questions to clarify billing and supervision issues related to the CMS decision.

For additional information, please contact reimbursement@asha.org.

Effective October 1, 2011, 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, 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 (see slides 18–28, 33–34). CMS notes that ASHA (and the American Physical Therapy Association and American Occupational Therapy Association) provides recommended guidelines for student supervision. 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. See ASHA’s Billing & Reimbursement Web site for more information on Part B student supervision requirements.

For further information 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.

Boult, J., Robinson, G., & Stockman, I. (2008) Multicultural/Multilingual instruction in educational programs: a survey of perceived faculty practices and outcomes. American Journal of Speech-Language Pathology, 17, 241-264.

Donovan, N.J., Kendall, D.L., Moore, A.B., Rosenbek, & Rothi, L. J. G. (2007). Why consider impaired social language usage in a case of Corticobasal Degeneration? The Clinical Neuropsychologist, 21(1):190-203.

Donovan, N.J., Velozo, C.A., & Rosenbek, J.C. (2007). The Communicative Effectiveness Survey: Investigating its item-level psychometrics. Journal of Medical Speech Pathology, 15(4): 433-447

Donovan, N.J., Kendall, D.L., Heaton, S.D., Kwon, S., Velozo, C.A., & Duncan, P.W. (2008). Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22(2):122-35.

Jones, H. N., Donovan, N. J., & Rosenbek, J. C. (2007). Speech and swallowing disorders in patients with movement disorders. In H. H. Fernandez, R. L. Rodriguez, F. M. Skidmore, & M. S. Okun (Eds.), A Practical Approach to Movement Disorders: Diagnosis, medical and surgical management. Woodbridge, CT: Demos Medical Publishing.

Clancy, A.B. & Fitzgerald-DeJean, D.M. (2008, June). Merging language and cognition: A paradigm for developing and executing a Plan of Care for individuals with mild TBI and post concussion syndrome. Louisiana Speech- Language-Hearing Association, Shreveport, Louisiana.

Dugas-Taylor, D., & Fitzgerald-Dejean, D.M. (2008, June). Bargaining for Advantage. Louisiana Speech-Hearing-Language Association, Shreveport, Louisiana.

Fitzgerald-DeJean, D. (2008, May). Documenting for Medical Necessity. Louisiana Speech-Hearing-Language Association Healthcare Committee, via Conference Call.

Juengling-Sudkamp, J. (2008, February). ASHA NOMs. Louisiana Speech-Hearing-Language Association Healthcare Committee, via Conference Call.

Donovan, N.J. (2008, July). Speech and swallowing strategies for individuals with Parkinson’s disease. New Orleans Parkinson’s Disease Support Group.

Donovan, N.J. (2008, July). Get strong THEN get loud – a new treatment to improve speech intelligibility for individuals with Parkinson’s disease. Baton Rouge Parkinson’s Disease Support Group.

Donovan, N.J., Velozo, C.A., Wen, P., Heaton, S.C., Waid-Ebbs, K. (2008, May). Development of a Social Communication Construct for a Computerized Adaptive measure of Functional Cognition for Traumatic Brain Injury. Clinical Aphasiology Conference, Jackson Hole, Wyoming.

Kagan. A., Gibson, J., Simmons-Mackie, N. (2008, May) How Effective ‘Knowledge Transfer and Exchange’ Can Enhance Aphasia Research and Clinical Practice. Clinical Aphasiology Conference, Jackson Hole, Wyoming.

Simmons-Mackie, N., Kagan. A., Conklin, J. (2008, May) Review Evidence for Social Approaches to Aphasia Intervention: An Application of A-FROM. . Clinical Aphasiology Conference, Jackson Hole, Wyoming.

Donovan, N.J. (2008, May). Speech and swallowing strategies for individuals with Parkinson’s disease, Baton Rouge Parkinson’s Disease Support Group, 05/2008

Donovan, N.J. (2008, April). Using the Principles of Evidence-Based Treatment in Daily Practice: Pitfalls and Promises, Louisiana Board of Examiners for Speech Pathology and Audiology Spring CEU Symposium, Baton Rouge, LA

Fisher, J.H., Fitzgerald-DeJean, D.M., & Rubin, S.S. Intensive University Based Program for Adults with Chronic Brain Injury. National Aphasia Association Conference, New York, New York.

Fitzgerald-DeJean, D.M., Rubin, S.S., Carson. R.L., & Fisher, J.H. (2008, May). Utilizing the “Experience Sampling Method” to Monitor Communicative Quality of Life during Treatment for a Single Subject with Chronic Aphasia. Clinical Aphasiology Conference, Jackson Hole, Wyoming.

Boult, J., Collins, A., Cox, E., Hartwell, J., & Tugwell, A. (2007, February). Actual and perceptual differences in the rates of Spanish and English speech. Poster session presented at University of Louisiana at Monroe – Department of Communicative Disorders’ Spring Conference, University of Louisiana at Monroe, Monroe, Louisiana.

Boult, J., Collins, A., Cox, E., Hartwell, J., & Tugwell, A. (2008, November). Actual and perceptual differences in the rates of Spanish and English speech. Poster session presented at the annual American Speech-Language-Hearing Association Convention, Chicago, IL.

Boult, J., McCandlish, C., Miller, S., & Tarrance, T. (2007, February). Children with autism’s neglected attribution of animate beings’ intentionality. Poster session presented at University of Louisiana at Monroe – Department of Communicative Disorders’ Spring Conference, University of Louisiana at Monroe, Monroe, Louisiana.

Boult, J., McCandlish, C., Miller, S., & Tarrance, T. (2008, November). Children with autism’s neglected attribution of animate beings’ intentionality. Poster session presented at the annual American Speech-Language-Hearing Association Convention, Chicago, IL.

Bryan, L., Hayes, S., Mathis, S., & Swillie, S. (2008, November). Literacy roles of speech-language pathologists in public schools. Poster session presented at the annual American Speech-Language-Hearing Association Convention, Chicago, IL.

Bryan, L., Mathis, S., Swillie, S., & Tucker, F. (2007, February). Literacy background and attitudes of honors vs regular education high school students. Poster session presented at University of Louisiana at Monroe – Department of Communicative Disorders’ Spring Conference, University of Louisiana at Monroe, Monroe, Louisiana.

Bryan, L., Noble, M., Latino, L., & Ennis, D. (2007, February). Parents’ perceptions of the effectiveness of the accelerated reader program for second and third grade students. Poster session presented at University of Louisiana at Monroe – Department of Communicative Disorders’ Spring Conference, University of Louisiana at Monroe, Monroe, Louisiana.

Research Presently Underway by LSHA Private Practitioners/ Medical SLPs/AUDs

Specialty/Certification: Adult Neurological Conditions; Reimbursement, Quality Standards, and Documentation (ecspeically Medicare).

Advocacy: Across career, has advocated for regulatory change working with SLPs to appeal or overturn denied claims for patients in need of our services. Feels that the recent passage of the SLP provider status is an important step that can be used for further important improvements in coverage and reimbursement.

State needs: This sector needs more active participation in advocacy if greater goals are to be met. Specifically, access to individuals of influence in the state insurance/reimbursement sector.

Current research: Investigation of Intensive Treatment of those with Chronic CVA and TBI; The Use of the Experience Sampling Method in COMD; Environmental Symbol Recognition in Brain Damaged Adults; and Environmental Symbol Recognition Training. Research has been done at LSU with departments COMD, Psychology and Kinesiology with Scott S. Rubin, PhD and numerous faculty and students.

Evidenced based practice concerns: Bridging the gap between efficacy studies and reimbursement. As research continues to demonstrate benefit of treatment strategies across the life span and stages of recovery, managed care has systematically decreased reimbursement for services. We must continue to seek new, creative models which will efficiently and effectively allow us to provide the necessary services to the communicatively impaired in order to assist them in reaching or recovering to their highest potential.

Setting: Hospital Inpatient Rehab
Specialty/Certification: VitalStim certified
Evidenced based practice concerns: Cognitive Retraining

Setting: Outpatient, Rehabilitation Center of Thibodaux Regional Medical Center

Specialty/Certification: Certified Brain Injury Specialist/Trainer through the American Academy for the Certification of Brain Injury Specialists, member of the Board of Governors of the American Academy for the Certification of Brain Injury Specialists, member of the Brain Injury Association of America.

Community Involvement: Member of the Lafourche Mayor's Committee on Disability Issues, Coordinator for the Brain Injury Education Support Group, Thibodaux, LA, Member of the Louisiana Health Force Commission-Allied Health subgroup representing LSHA.

Advocacy: "I focus on community reintegration/resources for persons with brain injury."