A Scramble to Preserve Medicaid Arkansas organizations work together to stop proposed cuts to Medicaid reimbursement and to preserve professional autonomy. State of Success
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State of Success  |   February 01, 2018
A Scramble to Preserve Medicaid
Author Notes
  • Jeffrey C. Adams, EdD, CCC-SLP, immediate past president of the Arkansas Speech-Language-Hearing Association, is a consultant and training coordinator with the Easterseals Arkansas Outreach Program. jadams@eastersealsar.com
    Jeffrey C. Adams, EdD, CCC-SLP, immediate past president of the Arkansas Speech-Language-Hearing Association, is a consultant and training coordinator with the Easterseals Arkansas Outreach Program. jadams@eastersealsar.com×
Article Information
Practice Management / Professional Issues & Training / State of Success
State of Success   |   February 01, 2018
A Scramble to Preserve Medicaid
The ASHA Leader, February 2018, Vol. 23, 46-47. doi:10.1044/leader.SOS.23022018.46
The ASHA Leader, February 2018, Vol. 23, 46-47. doi:10.1044/leader.SOS.23022018.46
When a state task force recommended $835 million in cuts over five years to the Arkansas Medicaid program, the Arkansas Speech-Language-Hearing Association (ArkSHA) and other stakeholders joined together to fight the effects of these massive reductions—and won.
The Arkansas effort began in 2015, when Gov. Asa Hutchinson and the Arkansas Healthcare Reform Legislative Task Force examined the long-term viability and sustainability of the traditional and expansion components of the state’s Medicaid program. The final recommendation called for drastic cost controls to ensure the program’s long-term solvency.
The recommendation proposed cuts to reimbursement rates for treatment services, a new managed care organization to control expenditures and the development of evaluation centers for all diagnostic services. The proposal would affect reimbursement rates and clinicians’ professional autonomy to diagnose and provide treatment to the same Medicaid recipient.
To respond to these threats, ArkSHA joined forces with the state occupational and physical therapy associations, lobbyists, and many other stakeholders to form the Arkansas Alliance for Pediatric Health Professions (AAPHP). Representatives from the Arkansas Developmental Disabilities Provider Association contacted the three therapy associations, realizing that voices from multiple organizations represented a larger political presence. AAPHP sought to identify an alternative cost-savings plan that would prevent Medicaid rate cuts for therapy services, and to preserve the autonomy of clinicians to diagnose and treat the same patient.

Admittedly, there were initial challenges, including misinformation and trust among participating groups.

Collaboration
The AAPHP hosted several in-person and online meetings to gain input and perspectives from stakeholders across Arkansas. We employed a collaborative leadership approach that:
  • Engages collective intelligence to deliver results across organizational boundaries.

  • Emphasizes teaming and focuses on a belief that all of us together can be smarter and more competent than any of us alone.

  • Calls on leaders to use the power of influence instead of positional power.

  • Depends on an environment of trust and mutual respect.

AAPHP met bimonthly and recruited representatives from other stakeholder agencies across the state, including developmental preschools, child health management agencies, private therapy clinics, university therapy programs and hospitals.
Admittedly, there were initial challenges, including misinformation and trust among participating groups. To manage these issues we forged a shared purpose, clarified roles, managed inaccurate social media posts and informally built relationships. ArkSHA and AAPHP representatives provided in-person presentations and online conference meetings so that all regions of Arkansas could receive accurate information. Lobbyists from involved organizations arranged meetings with key senators and representatives on public health and finance committees.
Throughout the six-month collaborative process to develop an alternative plan, AAPHP shared the cost-containment proposal with the director of the Arkansas Department of Human Services-Division of Disabilities Services. She shared the AAPHP proposal with the governor and key legislators, garnering further political support.
AAPHP representatives met with state legislators to describe the benefits of the plan over managed care or therapy rate reductions. One of the greatest hurdles was educating legislators on the value of our services, and why early intervention is so important. The AAPHP showed up in significant numbers to legislative meetings, and that mattered.
AAPHP’s alternative plan was accepted by the Arkansas Department of Human Services as the agency’s cost-containment measure for therapy services. The plan includes:
  • No reduction in the hourly rate for speech-language pathology, occupational therapy and physical therapy diagnostic and treatment services.

  • Preserved professional autonomy: Providers may diagnose and treat the same Medicaid beneficiary. Instead of an independent assessment for therapy for all Medicaid recipients, the AAPHP plan includes an “independent assessment” where added screening for developmental concerns occurs at pediatric clinics.

  • Prior authorization for treatment services beyond 90 minutes per week, per discipline. This provision is key: The projected cost savings from this plan over five years will be met by significantly reducing the number of Medicaid recipients receiving therapy services beyond 90 minutes (the initial 120 minutes AAPHP proposed would not have provided sufficient savings). This plan requires speech-language pathologists to do more for clients in less time.

One of the greatest hurdles was educating legislators on the value of our services, and why early intervention is so important.

Poised for change
Advocacy efforts like this one are necessary in our professions of audiology and speech-language pathology to maintain the occupational growth we have enjoyed for decades. The health care and education environments are changing rapidly, requiring that we rise to challenges related to scope of practice, caseloads, documentation and demonstrating the value of our services.
It’s understandable that many of us are less inclined to engage in legislative advocacy that affects our professions—after all, most of us don’t have strong backgrounds in economics, law, political science or sociology. But rapid changes in the sociopolitical climate require us to stay abreast of changes.
Many of these changes have been viewed as threats to the professions. An important question for us to consider is: How can we individually and collectively respond to the threats of the present, while also anticipating the threats of the future?
As our experience in Arkansas indicates, collaborative problem-solving and organizational adaptation can help us meet the economic, professional and other threats inherent to the rapidly changing environment.
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February 2018
Volume 23, Issue 2