Medicaid Guidelines Issued for New York Clinical Supervision Requirements Clarified for State’s School-Based Services Policy Analysis
Policy Analysis  |   May 01, 2007
Medicaid Guidelines Issued for New York
Author Notes
  • Susan Boswell, an assistant managing editor of The ASHA Leader, can be reached at
    Susan Boswell, an assistant managing editor of The ASHA Leader, can be reached at×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   May 01, 2007
Medicaid Guidelines Issued for New York
The ASHA Leader, May 2007, Vol. 12, 1-20. doi:10.1044/leader.PA1.12072007.1
The ASHA Leader, May 2007, Vol. 12, 1-20. doi:10.1044/leader.PA1.12072007.1
The federal Centers for Medicare and Medicaid Services (CMS) recently issued guidance to the state of New York that clarifies requirements for billing school-based Medicaid speech-language pathology services provided “under the direction of” a supervisor.
The new guidelines, which became effective immediately, state that services provided “under the direction of” must be supervised by a speech-language pathologist with New York state licensure. The supervisor must assume professional responsibility for services and must monitor the need for continued services throughout treatment.
The supervisor must see the beneficiary at the beginning of and periodically during treatment, be familiar with the treatment plan as recommended by the referring health care practitioner, and have continued involvement in the care provided, according to the February 2007 letter of guidance from the New York State Education Department.
“Previously there really weren’t specific guidelines for services provided ‘under the direction of’ and this letter provided further clarification,” said Amy Lyle, director of educational support services in the Rochester City School District. “Clinicians were nervous about putting their licenses on the line in providing services under Medicaid, and supervisors weren’t always aware of the quality of services delivered based on the paper review.”
The recent guidance letter is a departure from previous guidelines, which required the supervisor to provide documentation that assured appropriate service delivery, to be available as needed for guidance and consultation, and to have regularly scheduled meetings with the service provider to review progress notes.
“There were no requirements for face-to-face supervisory contact (with students); it was more of a paperwork review,” Lyle noted. “I believe this guidance will improve service delivery to students. This letter tells us that a supervising clinician must see the student.”
There are 9,000 licensed SLPs in the state; each school district is allowed to establish ratios for the number of unlicensed personnel providing services under the direction of a licensed SLP. In the Rochester district, Lyle said, each licensed speech-language pathology supervisor will receive release time from other duties to meet one-half day each week per unlicensed provider to review all cases. Meetings will be scheduled to ensure that the supervising SLP sees all students on the unlicensed providers’ caseloads.
In a follow-up letter, the New York State Office of the Medicaid Inspector General immediately halted the submission of Medicaid claims in all school districts, counties, and 4,201 schools statewide that did not comply with the new Medicaid requirements.
“Medicaid reimbursement will not be provided until we have this under control,” Lyle said.
In New York, the state with the nation’s second-largest Medicaid program, the ramifications are far-reaching, Lyle said, noting that 60% of students in the Rochester City School District are eligible for Medicaid.
Ongoing Review
The recent guidance follows a scathing 2005 report from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG), which reviewed a sample of claims submitted by the New York State Medicaid program. As the result of the investigation, the OIG recommended that New York State implement corrective measures to comply with federal and state Medicaid regulations and return the federal portion of the Medicaid payments—nearly $436 million—of the total $870 million in payments the state received.
The audit report noted that services were not provided by or under the direction of an ASHA-certified individual, or an individual with substantially equivalent qualifications.
In response to Medicaid’s failure to clarify “under the direction of” for speech-language pathology services in states across the nation, ASHA has developed a position statement and technical report on providing Medicaid services “under the direction of.” In addition, ASHA’s School Finance Committee is charged with helping members understand complex funding mechanisms involved in school-based services from federal, state, and local perspectives (see resources below for more information).
The current guidelines are more in line with the ASHA document, Lyle said, and they will be distributed to superintendents, special education directors, and Medicaid contacts. In addition, an article will be published in the New York State Speech-Language-Hearing Association newsletter.
For more information, contact Amy Lyle, director of educational support services for the Rochester City School District, at 585-262-8477 or, or Ingrida Lusis, director of ASHA health care regulatory advocacy, at 800-498-2071 ext. 4482 or
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May 2007
Volume 12, Issue 7