Federal Report Probes Increased Demand for Services A federal report indicates that recent increases in the number of children receiving speech and language services through the federal Supplemental Security Income (SSI) program may be due to misuse of the program, but ASHA suggests that the increases may be related to advances in speech-language pathology and the increasing ... Policy Analysis
Free
Policy Analysis  |   August 01, 2012
Federal Report Probes Increased Demand for Services
Author Notes
  • Neil Snyder, director of federal advocacy, can be reached at 800-498-2700, ext. 5614, or nsnyder@asha.org.
    Neil Snyder, director of federal advocacy, can be reached at 800-498-2700, ext. 5614, or nsnyder@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   August 01, 2012
Federal Report Probes Increased Demand for Services
The ASHA Leader, August 2012, Vol. 17, 36. doi:10.1044/leader.PA2.17102012.36
The ASHA Leader, August 2012, Vol. 17, 36. doi:10.1044/leader.PA2.17102012.36
A federal report indicates that recent increases in the number of children receiving speech and language services through the federal Supplemental Security Income (SSI) program may be due to misuse of the program, but ASHA suggests that the increases may be related to advances in speech-language pathology and the increasing number of children who are living with complex conditions that require interventions.
In addition, communication disorders can be measured objectively to determine if children qualify for speech-language treatment through SSI, according to ASHA’s response to the report.
The General Accountability Office (GAO), the investigative arm of Congress, recently issued “Better Management Oversight Needed for Children’s Benefits,” a report requested by several Congress members after a series of Boston Globe articles cited SSI abuses. SSI provides monthly funds for food, clothing, and shelter to people with disabilities or who are elderly or blind and who have little or no income.
The Social Security Administration (SSA) administers the program and provides federal money; states supplement the amount.
The Boston Globe investigation found a large increase in the number of children deemed eligible for SSI over the past decade. The increase was for children in the category of “mental impairments,” the category that encompasses speech-language services; the Globe found a number of families that sought and received a mental impairment diagnosis for their children—with some placed on prescription medications—to gain SSI cash benefits.
The corresponding rise in speech-language referrals is of concern to ASHA and its members.
Report Results
In its report, the GAO indicated that:
  • The number of SSI child applicants and recipients with mental impairments has increased substantially for more than a decade. The SSA denied, on average, 54% of such claims from fiscal years (FY) 2000 to 2011. The rising number of children in poverty and increasing diagnosis of certain mental impairments have likely contributed to this growth.

  • In FY 2011, the most prevalent primary mental impairments among medically eligible children were (1) attention deficit hyperactivity disorder, (2) speech and language delay, and (3) autism, with autism claims growing most rapidly since FY 2000.

State disability determination services (DDS) examiners also consider the impact of additional, or “secondary,” impairments when making a decision. However, SSA has not consistently collected impairment data, limiting its understanding of how all impairments may affect decisions.
DDS examiners generally rely on four to five key sources of medical and nonmedical information—such as medical records and teacher assessments—to determine a child’s SSI medical eligibility. Being on medication was never the sole support for decisions. Examiners cited information about medication and treatment—such as reports of improved functioning—to deny benefits in more than half the cases GAO reviewed, despite some parents’ perception that medicating would result in eligibility.
Examiners sometimes lacked complete information to inform their decisions. For example, several DDS offices reported difficulties obtaining information from schools. Examiners also do not routinely receive information from SSA field offices on multiple children who receive benefits in the same household, which SSA’s fraud investigations unit has noted as an indicator of possible fraud or abuse.
From FY 2000 to 2011, follow-up reviews to confirm continued eligibility of children with disabilities fell from more than 150,000 to about 45,000 (70%) overall; in the category of mental impairments, reviews for children dropped from more than 84,000 to about 16,000 (80%). More than 400,000 reviews were overdue—some by as many as 13 or more years—for children with mental impairments.
SSA’s process for issuing waivers from the legal requirement for follow-up reviews lacks transparency; without these reviews, SSA could continue to forgo significant program savings.
ASHA worked with the GAO during its investigations, connecting investigators with ASHA members with expertise in the field of childhood and adolescent disabilities, and providing Census Bureau and U.S. Department of Education historical data on incidence and prevalence rates for specific disabilities.
ASHA’s Response
A team of ASHA staff prepared responses to issues in the report, sent in a letter to the GAO. In general, ASHA supports funding for competent and frequent reviews; in these reviews, objective measures can be used to determine if children with communication disorders qualify for SSI. The letter made the following points in response to issues raised in the report:
Diagnoses of children with speech and language disorders are based on measurable factors.
  • Standardized tests provide objective measurement of speech and language development. Progress is indicated by improvements on specific goals for speech, language, and behavior; analysis of conversation and reading samples; and classrom performance.

  • Multiple data sources are used to diagnose speech and language disorders (a child’s history, data from assessment tools such as standardized tests and performance measures, and the child’s response to intervention and instruction). Assessment tools need to be appropriate for a child’s culture, language, and age; conducted with fidelity; and repeated over time.

The increased number of children receiving benefits for speech and language disorders may be due to advances in the field of speech-language pathology, including the availability of more sophisticated and research-based assessment tools that allow speech-language pathologists to make more accurate diagnoses. Also, as a result of medical advances, an increasing number of children are surviving with more complex conditions that require intervention.
ASHA supports easier access to school records for examiners. SLPs are well versed in documentation—a critical responsibility of school-based SLPs—because it can affect outcomes for students receiving services. Documentation practices and procedures are outlined in key ASHA documents that describe SLPs’ scope of practice and roles and responsibilities in schools.
It’s not surprising that siblings have similar speech and language disorders. Case histories often reveal that communication disorders run in families. Between 28% and 60% of children with a speech-language deficit have a sibling and/or parent who is affected. SLPs educate and counsel families and provide intervention for children who may have a genetic predisposition for a speech-language disorder.
Progress is monitored and measured by outcomes on specific speech, language, and learning goals, including speech production, voice, resonance, fluency, understanding and use of oral and written language, and classroom performance.
Early identification and treatment are critical. Left untreated, children with early oral language problems will have difficulties speaking, listening, reading, writing, succeeding in school, and forming friendships.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
August 2012
Volume 17, Issue 10