New Congress Poses Challenges Divided 112th Congress Presents Obstacles to 2011 Public Policy Efforts Policy Analysis
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Policy Analysis  |   January 01, 2011
New Congress Poses Challenges
Author Notes
  • George Lyons Jr., MBA, director of government relations and public policy, can be reached at glyons@asha.org.
    George Lyons Jr., MBA, director of government relations and public policy, can be reached at glyons@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   January 01, 2011
New Congress Poses Challenges
The ASHA Leader, January 2011, Vol. 16, 1-4. doi:10.1044/leader.PA.16012011.1
The ASHA Leader, January 2011, Vol. 16, 1-4. doi:10.1044/leader.PA.16012011.1
It is fitting that ASHA’s Board of Directors approved the association’s 2011 public policy agenda (PPA) on Veterans Day—because the new divided Congress is set to do battle as it returns from its winter recess. The 2010 elections brought far-reaching change, with Republicans poised to control the House of Representatives and Democrats holding a slim majority in the Senate. This divided 112th Congress will present many challenges as ASHA seeks to implement the PPA mandates, which address the public policy concerns of audiologists, speech-language pathologists, and speech, language, and hearing scientists.
The Government Relations and Public Policy Board (GRPPB) developed the 2011 agenda in consultation with committees, staff, and members (2,700 of whom responded to the survey seeking input). The PPA ranks issues into four categories—highest priority, priority, monitoring, and planning—based upon their significance, available resources, and likelihood of advocacy success. The issues in each category are further divided based upon their funding, personnel, or policy characteristics.
Highest Priorities
Among the highest priorities requiring immediate intervention are coverage and reimbursement issues, comprehensive audiology benefit, recruitment and retention, and education law reform. ASHA will work to promote:
  • Private and public insurance coverage for habilitative coverage of speech, language, and hearing services and equipment when these services are performed in schools.

  • Improved public and private coverage policies and reimbursement rates for audiology and speech-language preventative, diagnostic, monitoring, habilitative, and rehabilitative treatment, services, and equipment across the age span.

  • Funding for programs to increase the recruitment and retention of SLPs and audiologists, including loan forgiveness, financial aid, and research funding opportunities.

Audiology Benefit
One of the highest priority issues is a comprehensive Medicare audiology benefit for the entire spectrum of services, from screening through diagnosis, monitoring, and rehabilitation and perhaps including direct access and telehealth services. Under current regulations, the Centers for Medicare and Medicaid Services (CMS) defines audiological services as diagnostic only; under this restriction, reimbursement for such services as aural and vestibular rehabilitation is not available to audiologists but is available to other health care professionals.
During the 2010 lame-duck congressional session, ASHA met with potential sponsors of comprehensive benefit legislation and is preparing to help advance a bill through the amendment process if Congress seeks to change the health care law or to introduce the provision as a stand-alone bill.
Education Reform
Another highest-priority area is reform of the Elementary and Secondary Education Act (also known as No Child Left Behind, NCLB) and the Individuals With Disabilities Education Act (IDEA). The PPA promotes regulations for these laws that reduce the paperwork burden, increase service delivery efficiencies, and address the role of SLPs and audiologists in general and special education and early intervention settings. ASHA will advocate for:
  • NCLB funds to be used for early-intervention speech-language and hearing services to support struggling learners in all school districts.

  • Funding for professional development of SLPs and audiologists in school settings.

  • NCLB and IDEA legislation to include “highest qualified provider status” for SLPs and audiologists.

High Priority
The 2011 PPA also identifies a number of important priority issues, including the extension of or alternatives to the Medicare therapy cap exceptions process and appropriate billing by IDEA providers for Medicaid reimbursement for speech, language, and hearing services and equipment.
ASHA is working with CMS as it seeks to develop a payment policy to replace the therapy caps. The 2011 PPA contains several other key priority issues. These include:
  • Monitoring and adjusting the Medicare fee schedule to reflect appropriately the professional work, time, and technology required to provide speech-language and audiology services.

  • Promoting access to, coverage of, and standards for audiology and speech-language telepractice services in health care and educational settings.

  • Supporting increased congressional funding of IDEA and NCLB for professional development and for services and equipment for students with speech-language and hearing needs.

  • Developing model language for states that defines the credentials, competencies, and roles for certified SLPs and for speech-language pathology assistants.

  • Informing legislators, regulators, and administrators about encroachment issues and the need to preserve high credentialing standards.

  • Supporting the adoption by the U.S. Access Board of regulations for classroom acoustics that are based on ANSI 2002 standards for new school construction.

ASHA will monitor many other issues throughout the year, including the effect of free trade agreements on the supply of qualified bilingual SLPs and audiologists in the United States, and will support federal policies to reduce noise-induced hearing loss.

EHDI Reauthorized

Advocacy by ASHA and other members of the hearing health community helped push Congress to pass—and President Obama to sign—legislation that reauthorizes the Early Hearing Detection and Intervention (EHDI) program for five years.

EHDI grants providing federal funds to states to develop infant hearing screening and intervention programs were first authorized in the Newborn Infant Hearing Screening and Intervention Act of 1999. Congress reauthorized the grants through the Children’s Health Act of 2000, and included provisions related to early hearing screening and evaluation for all newborns, coordinated intervention, rehabilitative services, and research.

EHDI has helped make great strides in the number of newborns screened for hearing loss, but significant work remains to ensure that newborns who fail screenings receive timely and appropriate follow-up services:

  • About half of those referred for diagnosis following a failed screening are “lost to the system.”

  • An estimated one-third of the infants who stay in the system do not receive diagnostic evaluations by 3 months of age.

  • More than half of the infants diagnosed with hearing loss are not enrolled in early intervention programs by 6 months of age.

The new law will go a long way to ensure that state EHDI programs become fully operational and properly link screening programs with diagnostic and early intervention services.

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January 2011
Volume 16, Issue 1