Schools Serving Students with Telepractice Deserve Parity in Medicaid Reimbursement

United

Aesop coined the phrase “United we stand, divided we fall.” But what do we do when we cannot find partners to stand with?

Nationally, a shortage of speech-language pathologists often prevents children from receiving services they desperately need.

The State of Telepractice

Spurred by ASHA’s 2005 recognition of telepractice, thousands of SLPs have participated in telepractice so far. Telepractice is thriving; more than 10,000 SLPs have applied to PresenceLearning alone and many more are interested in telepractice considering the many other providers like Visual Speech Therapy and Vocovision.

The fast adoption of telepractice was driven by the well known shortage of SLPs, offering clinicians new work/life and professional choices. However, as accumulated research–40 peer reviewed studies at last count–has shown that telepractice is just as, if not more, effective than traditional, onsite therapy, the uses of telepractice have broadened.

Telepractice is now used to bring children together for social pragmatic groups, connect kids with bilingual therapists, strategically alter the frequency and intensity of therapy, improve SLPs’ schedules, bring in specialists, and re-engage students in middle and high school.

The Problem With Medicaid

One obstacle remains in many states that prevents SLPs from working via telepractice: Medicaid reimbursement. This is a critical issue, as schools can receive reimbursement for up to 50 percent of costs from Medicaid and are often unable or unwilling to adopt telepractice services without this reimbursement. ASHA, to its credit, has been a leader in advocating for school-based Medicaid reimbursement.

State policies preventing Medicaid reimbursement are oversights rather than outright bans. Policy has simply not kept pace with advancements in our field. In fact, most state policies don’t even comment on telepractice.

Many states, including California, Colorado, Virginia, Minnesota, Ohio, have updated their regulations, creating a precedent for other states to follow. These states handle Current Procedural Terminology (CPT) coding in the same way as before, but with a modifier indicating tele-delivery.

In the remaining states, the impact is large and negative:

  • SLPs wanting to work via telepractice, many of them retirees or recent parents seeking flexible work, effectively cannot do so within their state.
  • Hundreds of thousands of students not receiving services because of the SLP shortage will continue without the care of a SLP and fall further behind in critical areas like reading, writing and communicating.
  • Schools struggling to fill their share of the 5,000+ unfilled SLP openings will remain at significant legal risk from non-compliance.

Unfortunately, underserved districts and their students in rural areas and the urban core will continue to be hit the hardest until this blind spot in Medicaid policy is remedied.

What Must Happen

Medicaid reimbursement inequality must be resolved in all 50 states. There are important issues of equity for rural and urban core students, as well as the viability of access to telepractice for SLPs and students alike.

How can you help?

The only way to help is, in the words of Aesop and others, stand together for this cause. Here’s how we can stand together:

  • Review your state’s current policies for Medicaid reimbursement regarding telepractice.
  • Contact your state administrator of Medicaid for education to express your concern on this issue.
  • Cite specific examples of how tele-therapy reimbursement would benefit students in your district and similar districts in your  state.

With a cohesive message and ample support from fellow educators, gaining Medicaid reimbursement for tele-therapy for school-based speech-language therapy services can be a reality sooner than you think.

 

Melissa Jakubowitz, MA, CCC-SLP, is the Vice President of SLP Clinical Services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than with more than 20 years of clinical and managerial experience. She is the past-president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.

The Time Has Come for Speech-Language Pathology License Portability

State map of USA

Photo by Kevin Hutchinson

Over the past decade, a chronic shortage of speech-language pathologists has left K-12 schools and healthcare settings in many parts of the United States struggling to provide speech therapy services. The problem has taken a financial toll, driving the cost of services up as institutions spend increasing time and funds searching for speech-language pathologists.

Telepractice offers a promising solution by enabling practitioners to conduct live therapy sessions with clients “anytime, anywhere” using real-time videoconferencing. Telepractice allows practitioners to flexibly “go where the work is” without actually having to physically travel or relocate. Speech-language pathologists who no longer engage in full-time practice but still wish to work part-time, can contract with school districts to provide speech therapy services via telepractice. Ultimately, telepractice addresses a labor problem that impacts many health professions.

This cost-effective approach is being successfully employed by school districts across the United States, reducing costs while providing high-quality therapy. Research indicates that speech therapy delivered through telepractice has comparable quality and outcomes as speech therapy services delivered in-person (American Speech-Language-Hearing Association, 2005; Boisvert, Lang, Andrianopoulos, & Boscardin, 2010; Boswell, 2007; Grogan-Johnson, Alvares, Rowan & Creaghead, 2010; Grogan-Johson et al., 2011).

Although technology has removed geographic constraints, one major barrier remains: time consuming and expensive licensing practices due to a lack of state license portability. While the professional requirements for licensing speech-language pathologists are very similar from state to state, each state has its own licensing process. As a result, speech-language pathologists who want to practice in multiple states must complete applications in each state where a license is sought; submit required documentation; pay licensing fees; and, endure processing times that significantly vary by state. This duplicative process might be warranted if important state-to-state variations in professional requirements for licensing were to exist; however, there is a high degree of consistency in licensing requirements across states.

Though the professional requirements are typically similar, license application processing times and fees vary by state. Some states process applications electronically, while others use a paper-based format. Depending on the state, the processing times for applications range from weeks to months. All states charge licensing application fees (typically $150 and higher) for the initial application, with similar charges for annual license renewal. In some states, licensees must provide fingerprints along with their license application. States do not share fingerprint information; applicants must send fingerprints to the state where the license is requested through an approved process.

The importance of licensure portability was recognized fifteen years ago when the United States Congress passed the Telecommunications Act of 1996 which urged the healthcare industry to develop multi-state licensure models. Similarly, the US Federal Communications Commission called on state licensing boards to accommodate multi-state licensure for health care practitioners. In 2000, the National Council of State Boards of Nursing (NCSBN) instituted the Nurse License Compact (NLC). The NLC allows nurses licensed in a compact state (currently 24 states) to practice in other compact states through a mutual license recognition model. Physicians have labor mobility through an expedited license model.

True license portability for speech-language pathologists is long overdue. License portability would facilitate inter-state practice and thus enable speech-language pathologists who live near state lines to practice in adjacent states where personnel shortages may exist. Greater labor mobility is necessary to serve geographically shifting populations in the US.

It is time to remove the barriers to licensure portability! A national initiative that creates a model for licensure portability for the rehabilitation professions is needed. Licensure portability will enable speech-language pathologists to provide services wherever and whenever needed, thereby unleashing the full potential of telepractice to reduce costs and administrative burdens, increase access to services, broaden career opportunities for speech-language pathologists and improve outcomes for K-12 students and clients in diverse practice settings. A mobile, flexible workforce positioned to use telepractice for inter-state practice could alleviate the chronic shortage of speech-language pathologists.

References

1. 1. American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement]. Retrieved from www.asha.org/policy.
2. 2. Boisvert, M., Lang, R., Andrianopoulos, M., & Boscardin, M. (2010). Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 13, 423-432.
3. 3. Boswell, S. (2007, March 6). Ohio grant addresses personnel shortage: Innovative strategies meet short-and long-term goals. The ASHA Leader.
4. 4. Grogan-Johnson, S., Alvares, R., Rowan, L. E., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech-language intervention provided by telehealth and traditional side-by-side intervention. Journal of Telemedicine and Telecare, 16, 134-139.
5. 5. Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvares, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school–age children. International Journal of Telerehabilitation, 3(1), 31-42.

(This article was originally published in the International Journal of Telerehabilitation Vol. 3, No. 2, Fall 2011, DOI:10.5195/ijt.2011.6079 (http://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6079)

 

Melissa Jakubowitz, M.A., CCC-SLP is currently the Vice President of SLP Services at PresenceLearning and  has been a speech-language pathologist for more than 20 years, working in schools and  private practice before joining PresenceLearning in January 2010. She is a former president of the California Speech-Language-Hearing Association and has been an active member of ASHA serving on Legislative Council for 12 years and on the ASHA Board of Ethics.