By: Mendi Lancaster, MS, CCC-SLP, ASHA State Advocate of Medicare Policy
TSHA Representatives Assist and Support ASHA in Advocacy
The American Speech-Language-Hearing Association (ASHA) devotes much time, effort, and resources to advocacy on behalf of audiology and speech-language pathology. There are three state-based advocacy networks that are appointed by their state association presidents, who are critical in this advocacy. These networks partner with ASHA staff, ASHA volunteer leaders, and other ASHA members on ASHA’s advocacy objectives and efforts. These networks also engage in direct advocacy with lawmakers and policymakers on behalf of our speech-language pathologists and audiologists. They serve to directly channel information between ASHA and Texas Speech-Language-Hearing Association (TSHA) members. They also raise awareness about public policy topics within our field. Our three networks are the State Education Advocacy Leaders (SEALs), State Advocates for Medicare Policy (StAMPs), and State Advocates for Reimbursement (STARs).
About Your ASHA StAMPs in Texas
We have two StAMP representatives for Texas due to our state’s size and needs. Mendi Lancaster and Lisa Milliken are our active Texas StAMP representatives. They meet monthly with the other state StAMPs led by the ASHA liaison, Sarah Warren, who is the ASHA Director of Health Care Medicare Policy. Sarah has more than 10 years of experience advocating on behalf of healthcare providers including analyzing proposed and final federal payment rules for Medicare beneficiaries, working with Congressional lobbyists on legislative proposals on the Medicare program related to speech-language pathology and audiology, and frequent advocacy with federal agencies including Centers for Medicare and Medicaid Services (CMS) and members of Congress related to these issues.
The agenda for each StAMP meeting includes discussion of hot topics and updates to coverage, reimbursement, and the delivery of services under Medicare. We provide feedback on coding issues and denials, proposed Medicare payment rules, documentation standards, and outcomes. We have guest speakers who hold leadership positions throughout ASHA on topics related to advocacy, healthcare reimbursement, outcomes, coding, public policy, and service delivery.
In Texas, we have close to 4.5 million people enrolled in Medicare: 2.2 million (49%) are enrolled in Original Medicare Parts A (hospital insurance) and Part B (medical insurance), and 2.3 million (51%) are enrolled in a Medicare Advantage plan (Medicare Part C). 2023 is the first year that Medicare Advantage enrollment has surpassed 50% of plan enrollments. The replacement plans have insurance companies contract with the Medicare program and receive payments for providing these services. The growth in enrollment in advantage plans is due to many factors, mainly the extra benefits of vision, hearing, and dental services and lower out-of-pocket spending. Choosing an advantage plan does not come without problems, mainly the inappropriate utilization management practices.
Did you know that the Medicare Administrative Contractors (MACs) regionally manage policy and payment related to reimbursement and act as the fiscal intermediary for Medicare beneficiaries? They manage provider claims for payment and establish regional policy guidelines, called Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs), which serve as rulebooks for Medicare clients. Many insurance companies and federally funded plans follow Medicare guidelines so it is important that we understand those guidelines. Annually ASHA updates the Medicare fee schedule for speech-language pathology and audiology services that includes updates to payment rates, coding, and the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (AAPMs) with an emphasis to a more value-based system of quality and outcomes-based reimbursement. The QPP transitions Medicare payments away from a volume-based fee-for-service payment to a more value-based system of quality and outcomes-based reimbursement.
A Note from Your Texas StAMPs
As Texas StAMPs, we are committed to stay on top of changes and updates to Medicare policies and to advocate for Medicare coverage and reimbursement of audiology and speech-language pathology services in Texas. We have both worked with Medicare policies and have taught courses on the Medicare updates for a combined 60 years, including annual courses we teach at the ASHA and TSHA conventions. As StAMPs, we respond to questions from our TSHA members from practice settings such as from hospitals, outpatient clinics, home health, skilled nursing facilities, inpatient rehab facilities, etc.
Such questions are often related to our members’ Medicare patients, and, if needed, we bring the topic or question to our meetings to get feedback from the other leaders throughout the country and from ASHA in order to help our members and Medicare beneficiaries. Please reach out to use with any questions or comments. Meanwhile, the following links may be helpful:
https://www.asha.org/siteassets/reimbursement/2023-medicare-fee-schedule-for-slps.pdf
https://www.asha.org/siteassets/reimbursement/2023-medicare-fee-schedule-for-audiologists.pdf
https://www.asha.org/advocacy/