National Speech-Language-Hearing Month
Each May, the American Speech-Language Hearing Association (ASHA) provides opportunities to raise awareness about the impact of communication disorders and services available to support individuals with them.
Key Takeaways
Summary
Medicaid programs play an important role in ensuring children with communication disorders have access to medically necessary speech-language and hearing services through the EPSDT benefit. As states design coverage and reimbursement policies, balancing access to effective interventions with responsible program administration remains critical to improving long-term outcomes.
National Speech-Language Hearing Month
May is National Speech-Language Hearing month. Each May, the American Speech-Language Hearing Association (ASHA) provides opportunities to raise awareness about the impact of communication disorders and services available to support individuals with them. Effective communication is an important life skill that provides access to independence and improved outcomes. Communication is a broad domain which covers many areas, including the following:
Early and Periodic Screening, Diagnostic and Treatment
For individuals with communication disorders, best practice interventions are typically initiated as soon as the disorder has been identified. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit was designed to provide comprehensive and preventative health care services for children under the age of 21 who are enrolled in Medicaid. [1] States are required to provide all Medicaid coverable, appropriate, and medically necessary services to address health conditions based on federal guidelines. EPSDT provides broad coverage because it operates under the philosophy that children’s health problems should be addressed before they become advanced, and treatment is more difficult and costly. [2]
Vision and hearing screenings are one critical component covered by EPSDT. Vision and hearing screenings are vital to promoting access to the necessary visual and auditory information children need to become effective communicators in both spoken and written modalities. [3] Early intervention, can significantly improve communication outcomes for individuals with communication disorders.
Reimbursement Design
While states are required to provide these critical services to improve health outcomes, they are allowed flexibility in reimbursement for these services. States can use a variety of cost managing strategies to mitigate misuse of services, such as placing service limitations on specific services. When designing service limitations on these critical services, it is important to consider if any service limitations may unintentionally impact the efficacy of the service offering.
For example, if a state elected to include speech-language therapy, occupational therapy, physical therapy, and self-directed personal care services into a service bundle on a waiver. If the service bundle was limited to 30 hours per week across all services, this may have unintentional consequences. By grouping habilitative and therapeutic services together and limiting the hours available across the services, this could impact the efficacy of the therapeutic services offered. This may put some individuals in the position of having to choose between receiving the personal care services they need to live safely now, and services that may help them to become more independent in the future.
How We Can Help
Myers and Stauffer offers specialized clinical, policy, and reimbursement expertise to identify potential barriers and design programs and systems that promote improved health outcomes for consumers. If you have any questions about how Myers and Stauffer can support you, please reach out to our consulting team.
[1] Medicaid. Early and Periodic Screening, Diagnostic, and Treatment.
[2] Medicaid. EPSDT – A Guide For States: Coverage in the Medicaid Benefit for Children and Adolescents.
[3] Medicaid. Vision and Hearing Screenings.
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The considerations discussed in this article extend beyond EPSDT and touch many aspects of Medicaid program administration. Explore how we support agencies through School-Based Services, Behavioral Health initiatives, and Provider Reimbursement & Financing approaches designed to promote access, accountability, and improved outcomes.