Business Leaders Support CSD Services A major business organization agrees with ASHA that services provided by speech-language pathologists and audiologists are cost-effective additions to employer-based health plans. The National Business Group on Health (NBGH), a non-profit association of large U.S. companies, has recommended a maternal and child health benefit plan model that includes in its ... On the Pulse
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On the Pulse  |   January 01, 2008
Business Leaders Support CSD Services
Author Notes
  • Carol Polovoy, production editor of The ASHA Leader, can be reached at cpolovoy@asha.org.
    Carol Polovoy, production editor of The ASHA Leader, can be reached at cpolovoy@asha.org.×
Article Information
Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / Audiologic / Aural Rehabilitation / On the Pulse
On the Pulse   |   January 01, 2008
Business Leaders Support CSD Services
The ASHA Leader, January 2008, Vol. 13, 1-6. doi:10.1044/leader.OTP.13012008.1
The ASHA Leader, January 2008, Vol. 13, 1-6. doi:10.1044/leader.OTP.13012008.1
A major business organization agrees with ASHA that services provided by speech-language pathologists and audiologists are cost-effective additions to employer-based health plans.
The National Business Group on Health (NBGH), a non-profit association of large U.S. companies, has recommended a maternal and child health benefit plan model that includes in its minimum benefits preventive audiology screening and treatment services, speech-language treatment services, and hearing aids and cochlear implants.
In partnership with the Health Resources and Services Administration of the U.S. Department of Health, the NGBH released a 310-page report, “Investing in Maternal and Child Health.” It outlines the business case for investing in maternal and child health; offers a cost analysis of incorporating the minimum benefits into typical HMO and PPO plans; and recommends that employers shoulder the cost of added benefits.
According to the report, “Improving the health of women and children and improving the quality of the care they receive will benefit an employer’s bottom line” through reduced health care costs, increased productivity, improved retention/reduced turnover, and a healthier future workforce.
Health Plan Benefit Model
The report focuses on the Maternal and Child Health Plan Benefit Model, which it describes as “an evidence-informed, standardized, equitable, and comprehensive health benefits package” that “emphasizes prevention and early detection, aims to reduce employees’ cost barriers to essential care services, and strives to balance employee affordability with employer sustainability.”
The report emphasizes that the model is not a “gold standard,” but rather a baseline recommendation of benefits that all large employers should cover in all of their health plans.
ASHA is one of 28 professional organizations, health care groups, and federal health agencies whose clinical guidelines were used to develop the recommended minimum benefits.
“Employer’s Toolkit”
NBGH is a non-profit organization that represents large employers’ perspective on national health policy issues and provides practical solutions to its members’ most important health care problems. Its members, primarily Fortune 500 companies and large public sector employers, provide health coverage for more than 50 million U.S. workers, retirees, and their families.
The report—called a “toolkit”—offers guidance for the implementation of the health plan benefit model, including the financial impact of including each benefit in a typical (“benchmark”) PPO or HMO plan. Employers can use this information to estimate the cost implications of adopting the recommended benefits in their own plans.
Speech-Language Benefits
The recommended plan groups speech-language treatment with occupational and physical therapy, and includes a combined total of up to 75 visits per year. It defines treatment as “medical services for beneficiaries with speech, hearing, and language disorders,” and specifically includes services to “help people develop skills inhibited by a problem present at birth or a developmental delay.” The services may be diagnostic, rehabilitative, or corrective.
Audiology Benefits
The benefit model calls for preventive audiology screening, defined as “medical services to detect and diagnose speech, hearing, and language disorders,” and recommends three visits from birth through 19 years of age.
The model also includes audiology services, defined as “medical services specifically designed to address hearing loss” that may be “diagnostic, therapeutic, or rehabilitative in nature”:
  • Audiological, tinnitus, vestibular, and balance assessment

  • Central auditory, cochlear implant, assistive listening device (ALD), and hearing aid assessment and fitting

  • Treatment of aural rehabilitation/habilitation, vestibular and balance, auditory processing, and cerumen management difficulties

The plan also calls for coverage of hearing aids, ALDs, and cochlear implants, including replacement earmolds four times per year for children up to 7 years old; a cochlear implant speech processor every five years; and an ALD for use with a cochlear implant every five years.
Cost-Sharing
The report cautions employers that high cost-sharing—specifically high premiums—prices some families out of the health care market, and that high deductibles and copayments force families to delay or forgo care.
The plan supports access to essential care services by removing beneficiary cost barriers whenever possible, and recommends:
  • Zero beneficiary cost-sharing for preventive services

  • Employee premium contribution of 20% of the total plan cost

  • No deductibles

  • A cap on out-of-pocket expenditures

  • Copayments (HMO model) and coinsurance (PPO model)

  • No annual or lifetime benefits cap

According to the report, a large employer that adopts the minimum benefits and implements the cost-sharing shifts would incur a 6.2% increase in the cost of an HMO plan and a 10% increase in the cost of a PPO plan.
For a downloadable copy of “Investing in Maternal and Child Health” [PDF], go to the National Business Group on Health’s Web site. For more information, contact reimbursement@asha.org.
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January 2008
Volume 13, Issue 1