Speech therapy (a.k.a.
speech-language pathology) is defined as the evaluation and application of
principles, methods and procedures of measurement, prediction, non-medical
diagnosis, testing, counseling, consultation, rehabilitation and instruction,
related to the development of disorders of speech, voice, and/or language for
the purpose of preventing, ameliorating or modifying such disorder conditions
in children and/or groups of children. Speech
services shall be limited to speech-language pathology services. Speech services involving non-diagnostic,
non-therapeutic, routine, repetitive and reinforced procedures or services for
the student’s general good and welfare (practicing word drills) shall not
constitute speech-language pathology services within the School or Preschool
Supportive Health Services Program.
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The following must be in
place to claim Medicaid reimbursement for speech services:
·
Services must be provided by or under the direction of a NYS licensed
and registered and/or ASHA certified (updated 2/6/07) speech-language pathologist (SLP).
·
Medical referrals for formal evaluations must be from an appropriate
health care practitioner (see Page 3).
·
Services must be recommended by an appropriate health care practitioner
(see page 3).
·
Services must be on the IEP.
·
Services provided and billed must be documented, signed and dated by
the service provider.
·
Progress notes must be maintained.
Refer to page 12 for requirements.
“Under the
Direction of”
Speech services must be provided by a New
York State Certified Teacher of the Speech and Hearing Handicapped (TSHH). In order to claim Medicaid the speech
services must be provided by or under the direction of a New York State
licensed and registered or ASHA certified (updated 2/6/07) SLP.
"Under
the direction of" means that speech-language pathology services may be
provided by a TSHH under the direction of a New York State licensed and
registered or ASHA Certified (updated 2/6/07) SLP, as defined in the
New York State Social Services regulations, Chapter II, Part 505.11. The SLP must assume professional
responsibility for the services provided under his or her direction and monitor
the need for continued services (updated 2/6/07). The SLP providing the direction may be
in the employ of the local school district/§4201 school/county, or providing
direction on a contractual basis.
When providing direction to a TSHH, the
licensed SLP is responsible for documenting the following four major criteria:
1. Assure
the delivery of speech-language pathology services as per the student's (IEP);
2. Assure that the services are medically
appropriate. The New York State Social
Services Law, Part 365(a) 2 governs medical necessity and allows payment
through Medicaid for care, services or supplies which will either treat a
disability or overcome a condition which interferes with the capacity for
normal activity [Part 365 (a) 2 of NYSSL] (see Appendix A page A-3);
3 a. The SLP should be available,
as needed, to the TSHH for assistance and consultation but need not be on the premises; and
b. The SLP must have
regular scheduled meetings with the TSHH [Effective July 1, 2005].
4. Review periodic progress notes prepared by the TSHH, consult with
the teacher and make recommendations,
as appropriate.
5. Provide face-to-face contact with beneficiary at the beginning
of treatment and periodically thereafter
(updated 2/6/07).
1. Credentials of the
individuals that provide direction to a TSHH.
Credentials of the professionals
should be kept on file. Photocopy
of the License and/or ASHA Certification (updated 2/6/07) of the SLP.
2. Signed statement by the SLP with license #
or ASHA certification (updated 2/6/07) listing the TSHH for
whom direction is being provided as well as a statement of how accessibility
will be provided. Examples of this
are: team meetings, access by telephone
on a scheduled basis, regularly scheduled meetings with teachers, sign-off on
progress notes, or any other method where accessibility is demonstrated. This documentation should be on file in the
school district or county office.
Form included in Appendix C Page C 11 [CERTIFICATION OF UNDER THE DIRECTION AND
ACCESSIBILITY] of Guidebook #6 should be completed signed and dated. It must be updated as things change.
The
documentation must be updated by the SLP every time there is a change in
personnel which involves either the licensed SLP providing direction or the
TSHH to which "under the direction of" is provided. A copy of the documentation must be given to
each teacher being provided direction as well as the SLP. The school district/§4201 school/county
should retain the original copy.
3. Documentation
needed for face-to-face contact: Documentation
must show that the SLP has seen the beneficiary at the beginning of and
periodically during treatment, be familiar with the treatment plan as
recommended by the referring physician or other licensed practitioner, have
continued involvement in the care provided, and review the need for continued
services throughout the treatment (updated 2/6/07).
The five criteria of
direction listed in the preceding section must be documented. It is important that a school district or
county be able to prove that direction is being provided to their TSHH for the
purposes of Medicaid billing. What
follows are methods for documenting each of the four criteria:
1. Assure
the delivery of speech-language pathology services as per the student's IEP.
· SLP
signs or initials and dates a copy of the IEP, or documents through a
signature and date that the student's IEP was reviewed, and
· SLP
initials or signs and dates the monthly service report or
·
SLP signs and dates a copy of the schedule showing the students in each
class and when the day and time the class is scheduled.
2. Assure that the services are medically appropriate.
Part 365(a) 2 of New York State Social Services Law
defines medical appropriateness (Appendix A).
The definition is broad and covers all classified students with
disabilities with an IEP. Therefore, no
further documentation is needed by the SLP other than the IEP, which specifies
speech with frequency and duration.
However, a copy of 365(a) 2 of New York State Social Service Law should
be attached to the certifications of “Under the Direction of” and
accessibility.
3. Must meet with the TSHH on a regular
basis and be readily available, as needed, to the TSHH for assistance and
consultation but need not be on the premises.
When
contact is:
·
by phone, record the date and time of the call. Indicate to whom the SLP spoke and a brief
description of the call.
·
an individual or group meeting, provide the date, time and who attended
the meeting. Also provide the minutes of
the meeting, signed and dated by the SLP.
When contact during regularly scheduled
meetings with the TSHH is documented:
Record the date and time of the regularly scheduled
meeting. Indicate who attended and the
minutes of the meeting. Any
recommendations discussed, that the SLP considers substantive, should be
referred to the Supervisor or Committee on Special Education (CSE) or Committee
on Preschool Special Education (CPSE).
4. Review progress notes prepared, signed and dated by the
TSHH, consult with the TSHH and make recommendations, as appropriate (now
mandated in Part 200.4 of the Regulations of the Commissioner).
To
document, the SLP must:
·
Sign or initial and date the progress notes or
·
Prepare, sign and date statements of which students' progress notes
were reviewed and for what period.
5. Provide face-to-face contact at the beginning of
treatment and periodically thereafter.
·
To document, the SLP must provide evidence of face-to-face contact
(updated 2/6/07).
NOTE: The suggestions for
documentation indicated above under each of the four criteria do not preclude
other forms of documentation.
Medical Referral for Speech Evaluation
Effective
July 1, 1998 a written medical referral signed by a physician,
physician’s assistant or nurse practitioner or NYS licensed and/or
ASHA certified (updated 2/6/07) SLP
is required for a formal speech evaluation only, dated on or before the
initiation of the evaluation. A
formal evaluation requires parental permission each time it is conducted. An assessment does not require a medical
referral. A speech referral is any
document that indicates that the child should be reviewed for need of speech
services signed and dated by an appropriate health practitioner. A speech referral may include multiple
students (a manageable list is acceptable).
If the school district
CSE/CPSE or parent determines that a formal evaluation is required, IDEA
requires parental consent for the evaluation.
A formal evaluation is the administration of a standardized test to the
student to determine the need for services.
A medical referral from a SLP,
Physician, Physician’s Assistant or a Nurse Practitioner is required whenever a
formal speech evaluation is
conducted.
Progress assessment reviews
of the Speech Services provided take place during the scheduled Speech Therapy
sessions. These progress assessments
measure progress in meeting current IEP goals and are provided to the Committee
on Special Education (CSE) during a review process. They may be done at any time and are done
usually at Annual Review. These
assessments do not require a medical referral. In these instances, a formal evaluation may
not be required.
Medical
Recommendation for Services
A
written medical recommendation for speech services must be completed. The recommendation must be completed using
one of the following three alternatives:
1. A written medical recommendation is signed
and completed by a physician, physician’s assistant, nurse practitioner, or a
New York State registered and licensed or ASHA certified (updated
2/6/07) SLP for speech services only, dated on or before the initiation of
the speech services
2. A written medical recommendation is signed
and completed for all health related support services indicated on the students
IEP by a physician, physician’s assistant, or nurse practitioner in accordance
with the frequency and duration indicated on the student's IEP. However,
3. The
SLP can sign and date the formal speech evaluation or assessment (both of which
identify the recommendation with frequency and duration).
Note: The
recommendation must include the frequency and duration of the service or state
that the service must be provided as per frequency and duration as indicated on
the IEP.
The
New York State Health Department (DOH) defines a medical recommendation as an
order.
Codes and Fees:
SSHSP
Monthly Fee 5326 $ 432
PSHSP
Individual Monthly Fee 5331 $ 410
OFFICE
OF THE PROFESSIONS
PRACTICE
GUIDELINES
FOR
PROVIDING DIRECTION TO TSHH
The New York State Education Department’s (SED) Office
of the Professions has issued practice guidelines regarding the provision of
direction by a licensed and registered SLP, effective July 1, 2005.
Practice
Guidelines
Providing Direction for Medicaid Reimbursement in the
School Setting
In
order for school districts to receive Medicaid reimbursement for the speech and
language services they provide, those services must be provided by a NYS
licensed and registered speech-language pathologist or a teacher certified to
provide speech and language services who works under the “direction” of a
licensed and NYS registered SLP. The
following guidelines provide a framework for providing such direction.
·
The
licensed speech-language pathologist is under no obligation to provide this
direction to the teacher of speech and hearing handicapped.
·
When
a speech-language pathologist indicates that s/he has provided direction to a
teacher certified to provide speech and language services, s/he is signing off
on having reviewed the IEP and treatment notes and on having been accessible to
the teachers under his/her direction.
·
The
degree of direction and frequency of contacts should reflect the education and
experience of the teacher certified to provide speech and language services.
·
If
the licensed speech-language pathologist disagrees with the implementation of a
student’s IEP, s/he should request a Committee on Special Education (CSE)
review.
·
Time
should be allotted to the licensed speech-language pathologist to review
documentation and to allow for conference, meeting and communication time with
the teacher of speech and hearing handicapped.
SLPs should document how they are providing access to the teachers under
their direction.
·
School
districts cannot utilize license numbers for third party reimbursement or ask
the licensed speech-language pathologist to sign reports for cases for which
they neither provided services nor direction.
·
Speech-language
pathologists should only sign Medicaid Authorizations if:
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the
student who received services was in that SLP’s caseload; or
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the
teacher certified to provide speech and language services who provided those
services was under the direction of the SLP, and the SLP provided direction in
accordance with the definition of direction (below).
Definition of direction:
·
Consultation
activities should include review of IEPs and progress notes. Student progress
notes should be reviewed at least quarterly.
·
Feedback should be given through regularly scheduled meetings and
communications between the teacher certified to provide speech and language
services and the licensed speech-language pathologist. You should maintain written documentation of
these contacts.
· Recommendations
regarding modification of therapeutic services made by the licensed speech-language
pathologist should be documented as well as discussed during regular meetings.
The SLP providing direction is encouraged to maintain regular contact with the teachers under his/her direction.
http://www.op.nysed.gov/speechguidemedicaid.htm
Please refer to the
2/6/07 Terry Savo letter for information regarding the face-to-face contact
requirement.