By: Mendi Lancaster, MS, CCC-SLP, TSHA StAMP

Telehealth Coverage

Thank you for everyone in Texas who signed the petition urging congressional action for extending Medicare telehealth coverage. There were more than 4,400 American Speech-Language-Hearing Association (ASHA) members who signed the petition, and Texas was the state with the most signatures at 500. This helps push things at a state level for support of telehealth reform. As it stands, Medicare coverage for telehealth benefits for audiology and speech-language pathology CPT codes will end at the end of 2024 unless action is taken. We must urge Congress and the Centers for Medicare and Medicaid Services (CMS) to recognize us as providers of telehealth for Medicare beneficiaries by adding our CPT codes for 2025 and beyond and, more importantly, to extend our ability as clinicians to provide these services. CMS controls the codes and types of services that Medicare will cover, but Congress controls who can perform those telehealth services. Many federally funded and private insurance plans follow Medicare’s guidelines and rules, so it is very important to advocate for what is best for all of our patients.

What can you do to help advocate? Here are some quick steps that are very important and timely:

1. Use the Take Action link on ASHA’s website for telehealth to send a pre-fabricated letter to members of Congress in support of the Expanded Telehealth Access Act (H.R. 3875/S.2880) using this link: https://www.votervoice.net/ASHAaction/Campaigns/106011/Respond
2. Meet with your state legislators by phone, virtually or in person to discuss this issue. Review this document to provide talking points: https://d3dkdvqff0zqx.cloudfront.net/groups/ashaaction/attachments/Medicare%20Access%20to%20Telehealth%20Services%20Issue%20Brief_July%202024.pdf
3. Educate your family, friends, colleagues, patients, and their family members on this important topic and the impact loss of telehealth has on many Medicare beneficiaries. 

Medicare Advantage Plans

Beginning on September 1, 2024, United Healthcare (UHC) Medicare Advantage Plans now require 100% prior authorization for PT/OT/ST services provided in a multi-disciplinary setting. Evaluations are covered, but the plan of care must be submitted listing out the number of visits and codes for each discipline using a special form for prior authorization. UHC is allotting three to 10 business days for approval, which, of course, puts a delay on care for patients. The place of service codes that require this are: 11 (office), 19 (off-campus outpatient hospital), 22 (on-campus outpatient hospital), 24 (ambulatory service center), 49 (independent clinic), and 62 (comprehensive outpatient rehabilitation facility). We also are seeing these requirements in Skilled Nursing Centers, even though this setting was not listed in the original rule. We are anticipating delays in approvals, denials, limited visits approved, confusion and upset patients, and additional administrative burden for many. ASHA is requesting details on any problems you or your facility are having with these claims, including copies of the denials you receive from UHC with the client's Healthcare Protective Information (HPI) marked out. Please email Mendi Lancaster at melancaster@BSWRehab.com, and she will forward your denial letters, complaints, and concerns to ASHA.

For more information on this change, please visit https://www.uhcprovider.com/en/resource-library/news/2024/outpatient-therapy-chiropractic-prior-auth.html.