Are You Ready to Shape the Future of Health Care? With the enactment of the Patient Protection and Affordable Care Act (ACA), the regulatory process is underway—and members need to understand the impact of the law on audiologists and speech-language pathologists and prepare to take action to make the legislation work for us and the individuals we serve. Various aspects ... From the President
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From the President  |   June 01, 2011
Are You Ready to Shape the Future of Health Care?
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Speech, Voice & Prosodic Disorders / Hearing Disorders / Regulatory, Legislative & Advocacy / ASHA News & Member Stories / From the President
From the President   |   June 01, 2011
Are You Ready to Shape the Future of Health Care?
The ASHA Leader, June 2011, Vol. 16, 9. doi:10.1044/leader.FTP.16062011.9
The ASHA Leader, June 2011, Vol. 16, 9. doi:10.1044/leader.FTP.16062011.9
With the enactment of the Patient Protection and Affordable Care Act (ACA), the regulatory process is underway—and members need to understand the impact of the law on audiologists and speech-language pathologists and prepare to take action to make the legislation work for us and the individuals we serve.
Various aspects of the law affect audiology and speech-language pathology, and one area in particular—the standardized definition of terms outlined in the ACA—demonstrates the positive role ASHA members can play during the law's implementation process.
ASHA is part of a working group developing a uniform explanation of coverage documents and standardized definitions of medical and insurance-related terms. Other members of the group include health insurance industry representatives, health care professionals, government officials, and consumer and patient advocate groups. Examples of insurance-related terms being reviewed by the group are “premium,” “deductible,” “co-payment,” “preferred provider,” and “excluded services.” Medical terms include “hospitalization,” “physician services,” “durable medical equipment,” “skilled nursing care,” and “rehabilitation services.”
ASHA succeeded in securing the inclusion of a definition of “habilitation services” because rehabilitation and habilitation products and services are listed as essential health benefits under the law. The working group defines habilitation services as “Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn't walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.” The U.S. Department of Health and Human Services and the U.S. Department of Labor will consider the working group's recommended definition as regulations evolve.
This issue is only one of many related to the ACA that ASHA is working on, but it illustrates an important point about advocacy on clinical issues. ASHA's involvement in the development of regulations is important, but we must accept the responsibility that accompanies involvement. For many years the Centers for Medicare and Medicaid Services (CMS) has indicated that rehabilitation goals must focus on “functional” outcomes, and that “there must be an expectation that the patient's condition will improve significantly in a reasonable and generally predictable period of time.” To that end, CMS has encouraged the use of ASHA's National Outcomes Measurement System (NOMS) Functional Communication Measures (FCMs) to assess functional progress and outcomes. CMS now endorses NOMS as an official registry for reporting outcome data to Medicare.
The message is clear. If we expect to be at the table with other health care providers as the details of the ACA are hammered out, we need to embrace the development of evidence that demonstrates our services are measureable and have positive outcomes.
I encourage all members to become knowledgeable about the impact of health care reform on our professions at the state and federal levels, and to be prepared to get involved when member action is needed. For example, you may not be aware that the new law does not allow insurers to restrict the providers of covered services if those services fall within the provider's scope of practice. We will need to be vigilant to ensure that SLPs and audiologists can participate if services related to speech, language, and hearing disorders are covered by the policy.
One way to participate is to join the State Advocates for Reimbursement (STAR) network, created by ASHA and state associations to advocate on issues related to private health plans and Medicaid. Members of the STAR network are working to ensure that individuals who need services will have access to them under state regulations being developed to meet ACA requirements.
Just as importantly, I urge you to champion the use of data to support the services you provide. Be prepared to show that speech-language pathology and audiology services make a difference. That evidence will be critical as we strive to secure the recognition and reimbursement for our services. Like poet Robert Frost, we have “promises to keep, and miles to go” before we sleep. Our journey may be long and arduous, but with effective advocacy, we can help make sure that the ACA is an opportunity to help ensure that individuals who need speech-language pathology and audiology services receive them. Be a STAR, be an advocate, be “ASHA strong” on behalf of our professions and our clients! Nothing less than our future is at stake.
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June 2011
Volume 16, Issue 6