STAR and MICS Networks Work for You ASHA has two member networks that advocate for improved coverage of speech, language, hearing, and swallowing services in private health plans and public health care programs—the State Advocates for Reimbursement (STAR) Network and the Medicare Intermediary and Carrier State (MICS) Network. We invite you to take advantage of the resources ... Bottom Line
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Bottom Line  |   June 01, 2007
STAR and MICS Networks Work for You
Author Notes
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
  • Jan Peter Ozga, is director of private health plan advocacy. Contact him at jozga@asha.org, or call 800-498-2071, ext. 4431.
    Jan Peter Ozga, is director of private health plan advocacy. Contact him at jozga@asha.org, or call 800-498-2071, ext. 4431.×
Article Information
Hearing Disorders / Practice Management / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / Bottom Line
Bottom Line   |   June 01, 2007
STAR and MICS Networks Work for You
The ASHA Leader, June 2007, Vol. 12, 3-28. doi:10.1044/leader.BML.12082007.3
The ASHA Leader, June 2007, Vol. 12, 3-28. doi:10.1044/leader.BML.12082007.3
ASHA has two member networks that advocate for improved coverage of speech, language, hearing, and swallowing services in private health plans and public health care programs—the State Advocates for Reimbursement (STAR) Network and the Medicare Intermediary and Carrier State (MICS) Network. We invite you to take advantage of the resources these networks provide.
Q: Does either of the networks address private health plan issues?
The primary mission of the STARs is to help ASHA and state associations to increase coverage and reimbursement for communication and related services in private health plans. The network was formed as part of the ASHA Focused Initiatives on Reimbursement for Health Care and Education in 2003. Since then the group has met annually in conjunction with other ASHA events and in regularly scheduled conference calls.
Q: What about Medicare issues?
The mission of the MICS network, initiated in 2000, is to influence local public policy decisions that affect Medicare coverage and reimbursement of speech-language pathology and audiology services. This mission is accomplished by establishing or enhancing effective linkages (in collaboration with the state association) with the staff of Medicare intermediaries and carriers (contractors), state health agencies, consumer groups, other related professionals, and speech-language pathologists and audiologists in the state.
Q: How do I get involved with one of the reimbursement networks?
State association presidents appoint members to the networks. STAR members represent 48 of the 50 states; the 38 members of the MICS network currently represent 33 states. MICS representatives are needed for Alaska, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Oregon, Rhode Island, Utah, Vermont, and Virginia. Please contact your state association president if you are interested in becoming the MICS representative for one of these states.
Q: What do the STARs do?
The STAR network develops strategies to convince decision-makers—employee benefit managers, union representatives, health plan officials, regulators and legislators—to add or increase coverage and reimbursement for speech-language and hearing services. Members share information on the best responses to claim denials. STAR advises on national programs and legislative/regulatory initiatives. For example, the network has contributed to ASHA’s current initiative to improve coverage for speech-language pathology and audiology services in the health plans of the Federal Employee Health Benefits program, which covers 8 million individuals.
The STARs network is beginning to contact the leaders of some 70 business coalitions on health, which represent purchasers and (in some cases) providers and payers of health services in nearly every state. So far, contact has been made with coalitions in Florida, Ohio, Texas, and Missouri. Coalitions provide a forum for STARs and other ASHA members to deliver messages to those who make decisions about the types of benefits to be included in health plans and the level of payment for these benefits.
Members have been particularly active in attempting to correct an ongoing “medical-educational” problem created by the exclusionary language in many health plans that cover speech-language and hearing services, but deny claims for services to children eligible for care within the schools under programs such as the Individuals with Disabilities in Education Act. The network is seeking to remove language that creates this exclusion. ASHA has provided a total of $21,000 in grants to state associations to help STARs implement advocacy programs.
Q: What does the MICS network do?
MICS representatives monitor the local Medicare contractors’ speech-language pathology and audiology policies. Members collectively review Medicare draft local coverage determinations (LCDs) to help develop rationales for accepting or revising coverage requirements in comments submitted by state associations, ASHA, and MICS representatives. The comments include recommendations for the expansion of diagnosis codes allowable for coverage. The MICS network, with STAR participation, recently developed recommendations for new and revised current procedural terminology codes for consideration by the Association’s Health Care Economics Committee. Representatives can advise fellow SLPs and audiologists on claims denials based on their familiarity with national and local coverage policies.
Q: How do I use the STAR network to address my reimbursement concerns?
E-mail reimbursement@asha.org with any questions, or you may also contact your STAR representative. The list is available on ASHA’s Web site. You may also consider inviting a STAR member to speak at one of your meetings and learn how to be a part of the state’s advocacy project.
Q: I have a substantial Medicare caseload. How do I use the MICS network?
For Medicare issues, contact ASHA’s MICS staff coordinator Mark Kander, director of health care regulatory analysis. He will determine if your issue can be resolved on the basis of local or national Medicare policies. If the issue involves the interpretation and application of an intermediary or carrier’s LCD or the appeals process, Kander will determine if the MICS representative can be of direct assistance. You can also check with him about participating in a MICS conference call, held the last Tuesday of each month. Contact him at 800-498-2071, ext. 4139 or mkander@asha.org.
To contact your MICS representative directly, the MICS list is available on ASHA’s Web site.
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June 2007
Volume 12, Issue 8