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ASHA SLPA CERTIFICATION EXAM STUDY GUIDE - PART 3 NEW UPDATE
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ASHA SLPA CERTIFICATION EXAM STUDY GUIDE - PART 3 NEW UPDATE
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ASHA SLPA CERTIFICATION EXAM STUDY GUIDE -PART 3 NEW UPDATE
The Medicaid Program is-Answer jointly financed by the federal and state governments
to help states provide medical care to low-income individuals and those classified as
medically needy.
Each state operates its own medicaid program and determines its own income eligibility
standards;-Answer type, amount, duration, and scope of services covered, and payment
rates.
For services to be medically necessary, they must - Answer be reasonable and
necessary for the treatment of illness, injury, disease, disability or developmental
condition.
Medical necessity is - Answer a critical factor for determining eligibility for
Medicaid-reimbursable therapy and treatment services.
Medicaid claims may be supported when providers document the following basic
elements: - Answer - Reasonable
- Necessary
- Specific
- Effective
- Skilled
Appropriate: - Response Of appropriate amount, frequency, and duration in relationship
to standards of practice
Necessary: - Response Treatment which is needed for the patient's diagnosis and
,condition
Specific: - Response Treatment directed to specific goals
Effective: - Response Of treatment that is likely to achieve results in a reasonable period
of time
Skilled: - Response Treatment that requires the expertise of an SLP or audiologist
Audiological and speech-language pathology services are medically necessary to treat
speech-language, hearing, balance, swallowing, voice, fluency, and
cognitive-communication disorders.
Children who require services as part of their IEPs, and are identified as having a
disability under the IDEA, are generally also considered to have met the requirements
for services to be medically necessary.
Although each state instituted a state plan including its own set of requirements,
relevant documentation to establish medical necessity may include: - Answer - medical
history, including pertinent medical history, brief description of functional status, and
relevant prior treatment;
-diagnosis of a speech, language, swallowing, hearing or balance disorder;
Determination that a child with a disability is eligible for services under the Individuals
with Disabilities Education Act, (IDEA) or it is determined by an IEP team that services
are necessary;
Date of onset;
Physician referral, when necessary (it may be necessary to reauthorize)
Initial assessment and date: the procedure(s) used by the audiologist or SLP to
diagnose a speech, language, voice, fluency, cognitive-communication, swallowing,
hearing, or balance disorder and date the initial assessment is completed;
Treatment plan or a treatment program and date established; and
Progress notes and/or reports
,Professionals may work with their state association leadership, local education
agencies, state education agencies, and state Medicaid offices to address specific
topics or questions. Successful efforts to improve efficiency for professionals in some
states include: - Answer - streamlining paperwork;
-establishing evaluation or IEP by a qualified professional as adequate to establish
medical necessity and eliminating need for physician signature
-expediting physician referral and examination process;
-Clarification of criteria for medical necessity, the required records
-Updating policy and procedure information for states
-Advocating for services not covered, such as private practice and telepractice
A "speech pathologist" is any of the following: - Answer i. Has a certificate of clinical
competence from the American Speech and Hearing Association
ii. Has completed the equivalent educational requirements and work experience
necessary for the certificate
iii. Has completed the academic program and is gaining supervised work experience to
qualify for the certificate
A "qualified audiologist" is defined as an individual possessing a master's or doctoral
degree in audiology who maintains records to prove that he/she meets one of the
following criteria: -Response i. The State in which the individual furnishes audiology
services has licensure requirements equal to or greater than State licensure
requirements contained in, and the individual is so licensed by the State to furnish
audiology services.
ii. Hold a Certificate of Clinical Competence in Audiology from the American
Speech-Language-Hearing Association.
A. Can demonstrate the completion of no less than 350 clock-hours of supervised
clinical practicum, or are accumulating that supervised clinical experience under the
supervision of a qualified master or doctoral-level audiologist; have completed no less
than 9 months of full-time audiology services under the supervision of a qualified master
or doctoral degree in audiology, or a related field; and have passed a national
examination in audiology approved by the Secretary.
, There are five requirements that must be met in order for Medicaid to reimburse for
IDEA-related services. 1) the child receiving the service is enrolled in Medicaid
2) the services are medically necessary
3) the services must be covered in the state Medicaid plan or authorized by the federal
Medicaid statue
4) the services must be listed in the child's IEP
5) the school district or LEA must be authorized by the state as a qualified Medicaid
provider
Medicaid does not pay for screening services that are - Answer provided free of charge
to non-medicaid beneficiaries in schools.
School-Based Administrative Claiming Guide According to the, If the answer is yes, the
screening leads to the identification of a child as having a disability under the IDEA, and
results in the development of an IEP, then Medicaid may cover services included in the
IEP.
The most common differences between state Medicaid programs include - Answer
group size limits, documentation requirements, supervision requirements, and provider
requirements. Additional differences may exist related to documentation for services
provided "under the direction of" - including "sign off" by qualified personnel - and
payment rates for school-based providers.
An interagency agreement describes and defines-Answer the relationships between the
state Medicaid agency, the state department of education and/or the school district or
local entity conducting the activities. There must be one in place in order to claim
federal matching funds.
The service must be distinctly identified in the state's Medicaid plan, or be furnished
under the Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit -
Answer for Medicaid payment to be allowable.
State rules and standards vary significantly in other areas of Medicaid, including -
Answer - in providing requirements for Medicaid participation, credentialing, and
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