State Advocates for Reimbursement (STARs) Network Minutes -4/8/11

  1. I.      Welcome & Roll Call: 7 STARs

Meghan Krodel (CT), Kim Lich (CO), Susan Rockafellow (IN), Marie Noplock (MD), Teresa Bierig (OK), Laura Phillips (VA), Dana Braswell (WA)

Guests: Wendy Burton (CA – CSHA Executive Board Member), Katheryn Boada (CO – CSHA Public Policy Committee Co-Chair), Christine Gibson (MS – MSHA VP for Healthcare) 

ASHA Staff: Kate Fry (Director of Political Advocacy), Laurie Alban Havens (Director of Private Health Plans and Medicaid Advocacy), Janet McCarty (Private Health Plans Advisor), Kate Romanow ( Director of Health Care Regulatory Advocacy)

  1. II.      Reaching Your Federal Legislators at Home (Kate Fry)
  • Unique, frustrating, uncertain time and predict it to continue through the next Presidential election campaign
  • Republican plan was just dropped by Paul Ryan – 6 trillion dollars’ worth of cuts – of this, one trillion is removed from Medicaid alone. Bill also recommends Medicaid block granting to the states which would result in less federal cost sharing to the states and therefore reduce coverage, eligibility requirements. There are some knee jerk concerns with what has been put forth and unlikely that this will get passed in its current form, but will result in other changes
  • Every bill that comes out – first concern is the cost. Some silver linings for speech-language pathologists and audiologists
  • We have “good” issues, which get bi-partisan support, so that if cost can be minimized there is a  greater likelihood of passage
  • Health reform has a major focus on prevention and wellness which would also work in our favor
  • This makes advocacy even more important – decisions about which providers to cut, so need to be at the table. There is a popular saying that “If you’re not at the table, you’re on the menu.” If you’re not there getting your message heard, someone else is there, and legislators will rely on what other groups say about you if you don’t say it yourself.
  • ASHA is launching a new program being launched called, “Speak Out, Be Heard,” with grassroots and federal advocacy combined – direct lobbying, grassroots, will involve members in ways they haven’t been involved previously. This will occur in DC as well as in the states, aiming at greater involvement with members of congress. The information will be out in the next few months and info will be sent to the STARs
  • Capitol office – staff
  • Ingrida Lusis – Director of Federal and Political Advocacy
  • Neil Snyder – Director of Federal Advocacy
  • Catherine Clarke – Director of Education and Regulatory Advocacy
  • Kate Fry – Director of Political Advocacy
  • Open – grassroots
  • Referred to recent new article from CNN Money identifying where GOP money would bite – affecting Medicare and Medicaid and increasing age to 67 to begin getting Medicare benefits; also, increase in premiums, move to private plans and to subsidies – http://money.cnn.com/2011/04/05/news/economy/house_gop_budget_cbo/index.htm

 

How to become involved

  • Participate in Capitol Hill Days in DC
  • Members can have greater impact when staff are at home – Kate distributed calendars (http://nationaljournal.com/congress/2011-senate-calendar-20101207) so they know when senators and representatives are in their home districts. Start by calling office and asking to be added to their constituent mailing lists – these provide information on when they’re doing town hall meetings, holding constituent coffees, etc. Most Representatives have 2-3 offices in their district, and ASHA members can work with the scheduler to get in-person meetings set up. In person are the most effective types of meetings. ASHA can help to organize group meetings.
  • Sign up (http://takeaction.asha.org/asha2/home/) for ASHA alerts when bills come up and letters are needed to be sent. While letters are often discarded, tallies of the letters are reported on a weekly basis, so that members of Congress are aware of the magnitude of concern. A question was asked whether we can we make it mandatory so that all members are getting them and taking advantage of it? Response was that this is optional, but we should encourage members to sign up for this.
  • Goal of the Speak Out, Be Heard campaign is to reach out to more members and get them involved with letter-writing campaigns, writing op eds, etc.
  • Kate provided an online list of resources along with media organizations per member (http://takeaction.asha.org/asha2/dbq/media/) and offered to assist in drafting op eds to help with submission; work with press secretaries
  • Site visits – suggestion to invite members of Congress to come to clinics, hospitals noting that ASHA can help to facilitate that. If Members of Congress aren’t available, suggest inviting their staff since those are the people who drive policy agenda
  • Need to make sure to reach out and get coverage from each state – ASHA getting STARs involved, but also getting ASHA support. Discussion about sharing information provided in STAR reports/summaries, as STARs were told that this information is confidential and that notes weren’t to be shared – The information from the minutes can be shared, as appropriate, however, beware of the privacy of individuals named in documents. It is recommended that STARs do not do a blanket forward of documents, but rather select the relevant information to be shared. We also ask that the minutes are not posted on Web sites as is. Again, we encourage posting of summaries of the most relevant information from the minutes.
  • Comment from Beryl Fogel who stated that the STAR position is not a 2 year position, and that it takes a while to settle in to the position and determine the direction. Noted that CA did get a grant this year to develop a network – that she is sending out individual letters to private practice SLPs –asking for feedback, will get a networking group among CASHA members. Please also note that ASHA does not limit STAR network terms. If STARs are added or removed by states, ASHA should be notified.
  • Discussion about others submitting grants and recommendation to share what it is that’s being done so it doesn’t have to be reinvented. Comment that writing grant proposals is labor intensive so member should get other people involved, committed to the process.
  • Linking with ASHA – Laura Phillips (VA) has a meeting with ASHA while she’s in town
  • Laura Phillips stated that she got into the media about the autism bill as she had piggy backed with a parent group and was ultimately interviewed by a TV station
  • Teresa Bierig (OK) as part of BSHM has a government day – serve ice cream and brownies to members of Congress, and while Congressmen won’t be there, their staff will be there. They often include hearing screenings as part of the day’s activities. She noted that OSHA has an active government relations committee
  • If politicians have been particularly supportive of our initiatives – share that with Kate and govt relations so they can support campaigns, including providing financial support – Reminded members that ASHA provides  the “full spectrum” of advocacy
  • Kate meets with candidates to do candidate interviews and will work with the state to help in that capacity
  • Kate Boada (CO) asked another question about posting information – (talk to Neela about confidentiality) – discussion about disseminating info
  • The information from the minutes can be shared, as appropriate, however, beware of the privacy of individuals named in documents. It is recommended that STARs do not do a blanket forward of documents, but rather select the relevant information to be shared. We also ask that the minutes are not posted on Web sites as is. Again, we encourage posting of summaries of the most relevant information from the minutes.
  • Kate F. – asked states about whether they’ve contracted with ASHA to provide additional grassroots services?
  • Kate Boada reported that she spoke to Eileen Crowe about grassroots issues and Eileen had provided supported
  1. III.      Affordable Care Action (ACA) (Kate Romanow, Janet McCarty, Laurie Alban Havens)

Kate Romanow

  1. 1.       Quality

Physician Quality Reporting System (PQRS) (Medicare): Under PQRS, Medicare enrolled health care professionals who participate by reporting on approved quality measures are eligible for an incentive payment at year end. For 2010, this incentive is 2%. The bill extends the incentive payments for the program through 2014. The bonus level is set at 1% for 2011 and .5% for 2012-2014. 

Starting in 2015, eligible professionals that do not satisfactorily report on quality measures will be subject to a penalty. This penalty will be a reduction in payments of 1.5% in 2015, and 2% in 2016 and each subsequent year. 

Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs: By October 2012, the Secretary of Health and Human Services (HHS) will publish quality measures for these entities. In 2014, these entities must report on these measures or suffer a 2% reduction in payment.

Value-based payment modifiers under the physician fee schedule (Medicare): The Secretary shall establish a payment modifier that provides for differential payment to physicians or a group of physicians based on the quality of care furnished as compared to the cost of that care. Quality and care will be evaluated based on a composite of quality and cost measures. Such measures will be established by the Secretary by 2012. Quality measures could reflect health outcomes, while cost measure could reflect risk factors such as socioeconomic characteristics, ethnicity, and individual health status. Payment adjustments should begin by 2015 for physicians and physician groups, and after 2017, the Secretary may apply this modifier to other professionals including speech-language pathologists. 

Quality measure development: The Secretary, in consultation with CMS and the Agency for Health Care Research and Quality, shall identify gaps where no quality measures exist and identify measures that need updating. The Secretary shall then award grants, contracts, or intergovernmental agreements to develop, improve, update or expand quality measures identified by the Secretary. There will be $75 million available every year from 2010 to 2014 for these grants, contracts and agreement. To be eligible, an entity has to demonstrate expertise and capacity in the development and evaluation of quality measures. Priority will be given to development of certain measures, including outcome measures and care coordination.

Multi-stakeholder group input: A consensus-based entity that has a contract with CMS (NQF) must convene multi-stakeholder groups to provide input on the selection of quality measures endorsed or to be endorsed and national priorities for health care performance measurement. This input will be provided to HHS to assist in the development and selection of quality and efficiency measures.  

HHS will publish every year the list of measures it is considering. HHS will also periodically review current measures to determine whether to maintain them or phase them out. There will be $20 million available every year from 2010 to 2014 for all these purposes.

Medicaid:  The Secretary must develop a set of quality measures for Medicaid-eligible adults. A core set of measures must be published for comment by January, 2011. 

  1. Patient-centered outcomes research:The bill authorizes the establishment the ‘Patient-Centered Outcomes Research Institute’, a private nonprofit corporation to identify national priorities for comparative effectiveness research and establish a research agenda to address the priorities. The nonprofit will also conduct research and contract with federal agencies, academic research sectors and the private sector to conduct research. This initiative is moving slowly they are just starting to set priorities
  2. Therapy caps exceptions process (Medicare): The bill extends the therapy cap exceptions process for medically necessary outpatient services through December 31, 2010. A bill has been dropped to repeal the caps, but Kate feels this is unlikely. They are looking at alternative payment mechanisms. Unsure as to what will happen – ASHA will get together with APTA and AOTA.

 

  1. Overpayment: Providers and suppliers must report and return a Medicare or Medicaid overpayment within 60 days of identifying the overpayment, or be subject to the False Claims Act and civil monetary penalties. Overpayments that were identified on or before the effective date (March 23, 2010) must be reported and returned by May 22, 2010.

 

  1. Creation of the Center for Medicare and Medicaid innovation:  Created within CMS to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care to individuals. Some of the models that might be tested are below:

 

Payment alternatives: Contracting directly with groups of providers of services and suppliers to promote innovative care delivery models, such as through risk-based comprehensive payment or salary-based payment. 

Care coordination: Promote care coordination between providers of services and suppliers that transition health care providers away from fee-for-service based reimbursement and toward salary-based payment.

Telehealth: Looking at the provision of telehealth services in rural areas for behavioral issues and stroke. Kate reported that there has been an initiative brought to CMMI for this with a model of care. 

Post-acute care: Improving post-acute care through continuing care hospitals that offer inpatient rehabilitation, long-term care hospitals, and home health or skilled nursing care during an inpatient stay and the 30 days immediately following discharge. Kate reported that there is not a whole lot going on with this right now.

Direct access: Promoting greater efficiencies and timely access to outpatient services (such as outpatient physical therapy services) through models that do not require a physician or other health professional to refer the service or be involved in establishing the plan of care for the service, when such service is furnished by a health professional who has the authority to furnish the service under existing State law. APTA has actually gone to CMMI with a proposal for this. 

  1. Provider screening and other enrollment requirements:  In an attempt to address enrollment fraud, the bill had new requirements for provider and suppliers participating in Medicare and other federal health care programs. A final rule on enrollment requirements set forth the particulars: providers and suppliers are placed in three screening categories (limited, moderate, or high) and screening procedures vary depending on categories. Non-physician practitioners other than physical therapists (who are placed in the moderate category) are in the limited category, and enrollment requirements remain similar. Question about provider enrollment issue from Kate B (CO) –to ask if this is going to happen? The answer is that it will depend on the state, and since CO doesn’t have licensure, will have decide at a state level to set those requirement

Janet McCarty

  1. Definitions and Essential Health Benefits
    • Definitions – ASHA was able to get a seat at the table through the National Association of Insurance Commissioners (NAIC) – told the story about how ASHA got to do this, thanks to the efforts of Amy Hasselkus. Defining essential benefits as part of the healthcare reform. Amy H went and reviewed the statute and found the section re: ACA and contacted them with and as a result got involved on this committee.
    • Rehabilitation and Habilitation – worked very hard to get those definitions included
  • definitions per NAIC, keep, get back and improve skills – fighting to keep terms
    • Essential Health Benefits – Department of Labor is surveying employers to find out what their typical benefit looks like to determine what’s covered – and since SLP aren’t typically covered; trying to get reliable, valid statistics to submit to consider habilitation under essential health benefits, provision of information (Marie Noplock (MD) commented that Maryland is limited because of ERISA, self-funded plans). Dana Braswell (WA) commented that WA has habilitation through age 7, have it for all state employee plans. Christine Gibson (MS) noted that for MS it is not on the state employee plans. Smaller plans have the habilitative/neurodevelopment. Laura Phillips (VA) noted that Virginia commissioners are signed partners in defining these terms. Here’s the charge – need to get to the commissioners, truth in advertising for insurance plan. Need to get to regulators so that health plans that are covered state are accurate (e.g. provided, except in schools).

 

Laurie Alban Havens 

  1. Other areas in the ACA – Key Provisions
    • Provider non-discrimination – A group health plan and health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” – effective date 1/1/2014
    • Plans must not exclude children from coverage based on pre-existing conditions -9/23/10
    • Health plans in the group or individual markets may not impose any pre-existing condition exclusion 1/1/14
    • Essential health benefits – includes ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.
  • o   IOM[NRS1] /DOL study –ASHA has submitted a letter, and will be providing additional statistical information for consideration under the essential health benefits consideration of speech language pathology and audiology services
  • o   Sebelius letter – the Secretary issued a letter (to State Governors) in which she describes consideration for flexibility in coverage for services and specifically identifies speech therapy as optional. ASHA has submitted a letter to clarify this. Refer also to Steve White’s article in the April 5 issue of the Leader (http://www.asha.org/Publications/leader/2011/110405/Speech-Language-Services–Not-Optional.htm).
  • o   Initially designed for the (currently) uninsured individuals, about 24 million people, most of whom are self-employed or who work for small employers (the employers aren’t small, their businesses are), e.g. 50-100 employees depending on the state
  • o   States are required to either set up their own exchange, participate in a regional exchange, or an exchange will be thrust upon them – national.
  • o   Plans are to be development now, with implementation by 2014.
  • o   Some states have already started offering them, e.g. Utah and Massachusetts, and recently 7 additional grants were issued for other states to develop their plans
  • o   The exchange will serve as a marketplace for the purchase of health insurance.
  • o   Some guidance about what the plans must include, but implementation is left to the state
  • o   Important for SLP/A
    • Health Insurance Exchanges – Laurie has article coming out in the 4/26 Leader about this – some highlights
  1. 1.      You may be personally a part of this group (e.g. self-employed, small employer) and will want to know your own choice of plans
  2. 2.      You may want to find out what insurers are bidding for, being considered, or being solicited to participate in this
  3. 3.      You want to find out about the plan, what benefits they’re including
  4. 4.      There will be an interface with the Medicaid because of change in income level – some plans may cover both populations so benefits would be important
  • ·         Discussion about insurance exchanges with concerns about creating another Medicaid. Katheryn Boada noted that there may be some lack of participation by providers/plans because it appears that the penalty for not participating may be lower than the cost of participating.
  1. IV.      Quality Assurance Measures – Medicaid and Beyond (Kate Romanow)

Refer also to Kate’s comments above under ACA discussion.

  • PQRI – changed to PQRS –now it’s a system, no longer an initiative – under Medicare, e.g. one of the measures for speech is stroke, part of the NOMS – expressive language, attn., requirement to administer and instrument and looking at outcome measures – we’re on the cutting edge with this – Kate can connect people who want to participate in this initiative – will verify that can be billed
  • Value-based payment modifiers – just for physicians so far – differential for quality of care vs. cost of care
  • Multi-stakeholder group input – National Quality Forum (NQF) – measure application partnership for the group – hospital, clinician workgroup and ASHA will be a part of this
  • Medicaid – under ACA – had to develop a set of quality measures under the ACA – we made comments on the published measures that did not include speech (note comments on Sibelius letter) The NQF also looking to endorse some child health measures
  1. V.      Speech-Language Pathology Medical Review Guidelines (Janet McCarty)
  • ·         The Medical Review Guidelines should be available soon at www.asha.org/practice/reimbursement/SLP-medical-review-guidelines/ – as they have been approved by the ASHA board. It is for providers, employers, insurers, legislators, claims reviewers, medical directors developing coverage policy, State insurance commissioners, ASHA members advocating for better coverage and policy changes, etc.
  • ·         Several STARS were on the committee: Diane Ross, Gretchen Bebb, Lynne Harmon, and Pat Ford. Becky Cornett chaired.
  • ·         It goes over assessment, dismissal, documentation
  • ·         It is broken into SLP treatments/procedures, diagnoses/related medical conditions, instrumentation, prosthetics, billing codes
  • ·          We want to get it into the hands of others to use
  • ·         It will be a somewhat fluid document and we will make changes as needed
  • We will continue to take feedback
  1. VI.      Medicaid Issues (Laurie Alban Havens)
  • Medicaid Ad Hoc Committee Report
  • The Ad Hoc committee on Medicaid was convened to develop strategies for improving the availability of reasonable and necessary speech-language and audiology services to children under state Medicaid programs.
  • Concerns varied wide from state to state – consistent were issues surrounding the decline of the number of providers willing or able to see Medicaid beneficiaries and related low reimbursement rates. Additionally, interpretation of EPSDT “medical “necessity” and execution of the two Medicaid waiver programs – Managed Care Waiver Program and Freedom of Choice. For waivers problem with the implementation and the monitoring of the programs
  • Regulations and standards differ greatly in other areas included:
  • Provider requirements for participation, credentialing, and supervision
  • Documentation requirements for plan of care approval, criteria for services, authorization and reimbursement justification
  • Medicaid audits and penalties for errors
  • Use of the SCHIP
  • MICs  – audits and extrapolation of penalties for errors
  • No clinical effectiveness criteria in the contractual definition of medical necessity under the HMO Act e.g. accordance with prevailing community standards of care, consistent with generally accepted principles of professional medical practice, effective in improving health outcomes, treating physician determines it should be provided. Effectively, no policy that would ensure a preventive or pediatric level of care is implemented – as was intended in federal statute
  • Telepractice – Where Medicare acknowledges telepractice SLP/A aren’t included in providers. Medicaid has left this to the states. As an aside, discussed with Linda Peltz in our meeting at CMS (noted below).
  • Reimbursement – variability in states (chart) as well as location in which service is provided
  • Recommendations – extend the ad hoc committee
  • Policy recommendations
  • Advocate that utilization review doesn’t include fiscal considerations in determining medical necessity
  • Advocated regulation of medical groups
  • Advocate for CMS to provide oversight of MCO
  • Advocate for transparency in posting rates
  • Member recommendations
  • Provide info/support for state speech/language associations in advocacy efforts
  • Provide materials to individual members/associations re resources about state and federal Medicaid regulations
  • Initiate “call to action” to increase awareness
  • Data Collection
  • State specific data regarding best practices
  • Collect reimbursement rates from each state
  • Report on meeting with Linda Peltz, Director of Benefits and Coverage  at CMS, and members of her staff, Friday, April 1, 2011
  • Implementation of HMOs and how they comply
  • Issues of medical necessity – purpose – how to ensure that those needing speech and language would get services – what barriers prevent
  • Credentialing of staff within the HMO
  • Range of rates
  • EPSDT workgroup – out of Cindy Mann’s office
  • Emphasis on quality and appropriateness of service
  • Increased interest by DOJ and OCR – tension between Medicaid and States – rights violations
  • MIC – integrity contractors
  • NPRM draft – will address access/rates
  • Telemedicine – while Medicare doesn’t cover, the states will have the ability get coverage under Medicaid
  • We provided a copy of our Medicaid Ad Hoc report, and will be sending our newly revised Medical Review Guidelines
  • Sibelius letter – they let us know that they weren’t so thrilled with it either
  • Encouraged members with problems to contact the regional office – dedicated admin for Medicaid problems and also suggested contact the State Attorney General’s office

 

 

Comments

  • Laura Phillips  – VA has different rates per site e.g. early intervention gets a higher rate, and also per provider by comparison to OT/PT –Noted that  in Virginia are only allowing one code – Janet said should be able to bill the two codes, e.g. speech and dysphagia, if both diagnoses are documented
  • Marie Noplock (MD) – Maryland is not getting the differential for early intervention.
  • Kate B – CO – also having a problem with billing only one code – finding that many providers are no longer providing service for Medicaid clients. As a hospital based provider, they are finding increase in waiting lists for therapy because so many private practice providers can no longer accept Medicaid patients.
  1. VII.      State Reports

Laura Phillips (VA)

  • The Autism bill is the most exciting piece of news. SHAV wasn’t responsible for getting this through, but rather piggy-backed onto the autism group and their attorney/lobbyist, legislators to get this pushed.
  • Virginia’s grant is developing an advocacy that mirror’s ASHA’s —called STARTERs – organizing two training sessions and the lobbyist will be talking about bills that will be tracked; regulatory, insurance commissioner – opening to any members – also opening to allied groups OT, PT, even ABA therapists, as well as to families – grant money will only cover expenses team members of the grant and the second will be the advocacy day and implementing and meeting with the team members.
  •  In January will start the advocacy team on their own – and will fight Medicaid. She has pulled together a team and it has taken 5 years. She always does a STAR exhibit table at state association meeting – she initiative a petition format to get state’s support of the autism bill
  • Notes that regions in Virginia are varied so they represent many different issues.
  • She’ll now be the VP of government affairs for SHAV. Uses “constant contact” as a source

Marie Noplock (MD)

  • Two grants previously – got a network together from different organizations including private practice, and other related organizations, met 3-4 times, strategic planning, got two people to take over – but MSHA leadership didn’t embrace the issue so it was a difficult to get this pushed through, so haven’t accomplished anything this year, but hopefully with new state association leadership. Something will develop.
  • Notes problems of disconnect between state board and STAR initiatives 

 

General Group Comment: Concern from the STARs that the Board presidents aren’t all getting the message about the importance of the STARS – and if the President doesn’t buy into the issue then that becomes part of the problem

Beryl Fogel (CA)

  • Part of the grant to develop education sessions and from that will develop printed materials.
  • Her personal goal is to be in this position for at least two more years so that she can put together a package to hand over to the next person.
  • They have 10 districts in CA and within districts they have presentation meetings so hopefully they will get into the budget for attendance at these meetings.
  • There is a major California concern because their lobbyist is leaving and this will create a big gap. Beryl showed examples of the detailed legislative updates provided by their current lobbyist

 

General Comment about a CD put together a few years ago by Katrina and its availability –This CD is several years old and probably needs to be updated.

Meghan Krodel (CT)

  • Noted that she’s one of the “newer” STARS
  • Working with VP for government affairs  and  hoping to write a grant 
  • They previously held a student lobby day – others offered to share what’s already been created.

 

Christine Gibson (MS) Christine is actually not the STAR, but rather the MSHA VP Healthcare, and had just attended a Leadership Training Seminar

  • In MS the current president C. Higdon and president-elect had worked on grant for infrastructure
  • She had submitted a leadership project – (she’s not a STAR ) but doing leadership training – she’s the first VP healthcare – putting together a guide on committee structure – who should take responsibility as she realized that the state association needs a facelift – recognizes P&P, ultimate goal will help with advocacy –
  • Her VP position is tied to the STAR and the SMAC networks.
  • She has a health care committee.
  • MS is a “Work in Progress” – setting up a private list serve – trying to revamp the website – approved for a pilot project – with customized emails – special presentation at convention.
  • As of 4/1, adult outpatient Medicaid (21 and up) are covered in free-standing clinic, where before was only covered in hospital based.

Teresa Bierig (OK) 

  • OSHA – had a tri-alliance committee for several years – school issues/medical issues are actually supported in their trip – with an expectation that she’ll presence at state conference, and write for the quarterly newsletter
  • She has tried to pull more people into a committee.
  • The health care side is well-represented at their state.
  • When they started their committee, they had a great webmaster who got information from ASHA to help create link, and they’re trying to continue this. A comment was made that the ASHA media person- Maggie McGary is a great resource)
  • Discussed use of social media, Facebook

Dana Braswell (WA)

  • Has a grant proposal for organizing advocacy efforts – to get network started and finding people and hope to increase WASHA
  • Using ProSearch to get to people involved in a project to watch insurance companies and practice
  • Noted that for cognitive-rehab- assisting members with difficult appeals, going to billing/reimbursement  precedence.
  • Conference calls to start in June – possibly survey prior to first call to get agenda – first seeking people with private billing.
  • They’ll publish the conference calls on the list serve and quarterly WASHA newsletter.
  • Current Medicaid status – retained pediatric services except in schools and for adults, limited to 6 visits

Susan Rockafellow (IN)

  •  Medicaid cut for adults for 25 visits/12 month ruling period. Will expire providers other than speech. The state president has written a letter.
  • She also expressed concerns about disconnects between the State association leadership and the STAR initiative and Susan continues to try.
  • She’ll provide a summary of information for association.
  • She has spoken to exec committee of the state association. Need to get leadership beyond someone who is just involved with school.

Katheryn Boada (CO)

  • Her problems are much different, but it is hard to get anyone interested in being a STAR – several people have moved in and out of the position – In role as administrator, she has identified that there are four people who are interested – so will do some training and try to create this.
  • Major focus in Colorado is on licensure. They have written grants to get a lobbyist
  • They had been losing members in association – writing a one-page brief, What has CSHA done for me lately? – trying to focus on not just the board – recruiting additional people – and while the education committee is small, the public policy/licensure has 45 people on it. 
  • She is now on another committee to change to by-laws and even though 55-60% of the association members are school based, they see CSHA as healthcare oriented.
  •  Most of the audiologists are going to CAA and only 12 are members of CSHA.  Audiologists are licensed, and that law is about to sunset, and they will need to reinstitute so may possibly pair in the efforts to gain licensure for speech and language.
  • Grassroots efforts underway have been combined with other activities – March of Dimes Walk. Campaign to raise money to get people to the walk – community awareness.
  • Trying to do a policy day –with effort to meet legislators. Will then try to make small efforts/projects to expand the numbers of people they’re in contact with.
  • Since becoming more active they now been invited to join the Medicaid collaborative, autism outreach group, and asked to be involved in state level bill for tuition forgiveness if willing to work in rural areas, so one of therapists went down to testify for the state.
  • They have turned the association around from being mainly a conference planning board to becoming active in about three years.

Other Comments

  • Teresa (OK) isn’t in private practice, but her name is given out as expert – so she tries to get the information and distribute, so she represents herself as an intermediary. Concern by some STARs that they don’t have anything to offer.

Marie (MD) – Noted that there used to be a STAR manual (which is under revision) and also mentioned a “boot camp” for STARS and a “constellation meeting” – would be really helpful.

Next Conference Call – Tuesday, May 17, 2011 – 5:00 – 6:00 PM Eastern

Call-In Information:

Phone: 888-897-5640

Passcode: 914 551

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