SMAC Update

Dear MSHA members,

I am Kristin Johnson from Memorial Hospital at Gulfport.  I was recently appointed co-chair with Carol
Cannon for the SMAC network for Mississippi. “ASHA’s State Medicare Administrative
Contractor Network (SMAC) enhances and perpetuates the advocacy, leadership,
and communication of ASHA members at the state level to influence
administrative and public policy decisions that impact the Medicare coverage,
reimbursement, and delivery of speech-language pathology services and audiology
services.” ASHA website  
was recently able to attend the August teleconference meeting. Here is a
summary of the topics that were discussed during this month’s SMAC meeting
headed by Mark Kander of ASHA.

ASHA Convention:

Mark Kander would like SMAC members nationwide to voice any
accomplishments made with MAC (Medicare Administrative Contractor) and/or
leadership goals attained with state associations and dissemination of
information to memberships.  This
information will be relayed to Mark during the SMAC meeting at the ASHA
convention in San Diego later this year.

Home Health Regulations:

  1.  CMS has instituted several regulations in
    regards to therapy services for home health patients.  The regulations are quite stringent and
    can be a bit confusing to interpret.
    CMS requires every patient to be reassessed by each treating
    therapist on regular, set intervals.
    When I originally wrote this letter, I tried and tried to explain
    it, even giving examples.  However,
    I came to the conclusion that:  if
    you are a home health therapist, you need to sit down with the assigned, Medicare
    regulation person at your agency and have he or she explain it to
    you.  It is up to your individual
    agency to insure that all the therapist understand the regulations.  It is also up to your individual agency
    to work out the best possible system to ensure these functional assessments
    are being performed at the right time.

Here are some websites I found that may give you some
helpful information.  However, please be
sure to consult with your home health agency be confirm you have the correct

  1.  A physician or non-physician practitioner
    (NPP) who certifies a patient as eligible for Medicare home health
    services must have a “face-to-face” encounter with the patient 90 days
    prior to the start of home health care, or within the 30 days after the
    start of care. There must be documentation how the patient’s clinical
    condition supports a homebound status and need for continued skilled

An article was printed in the ASHA leader 10/12/2010 regard
the above stated.  Please refer the ASHA
website under publications entitled Medicare Rule Affects Home Care.

SNF Regulations:

CMS now has no specified supervision requirements for
therapy students.  Each SNF should abide
by their state/location regulations.
ASHA stresses the importance of students having some type of supervision
for students.  Students in Part B
facilities continue to require to be supervised by an SLP that is in the room
and not engaged in other activities.

IRF Regulation:

Free standing SNF units and units attached to acute care
hospitals now use the same formula for payment.
There are approximately 200 free-standing units and more than 1,000
units attached to acute care hospitals.

CMS does not hint of group treatment restrictions in IRF
units thus far.  It is beneficial to look
at individual LCDs local regulations.
Lemmietta McNeilly, PhD, CCC-SLP, CAE posted an article on the above
under ASHA Headliners.   You can contact
her at

Other information discussed:

There was a question raised regarding what dysphagia code
should be used if a patient is being treated for impulsivity control, diet
texture analysis and/or usage of compensatory strategies during meals if oral and/or pharyngeal dysphagia is
not necessarily apparent.  No formal
answer given with certainty.  I am
curious to see what fellow MSHA members feel about this. If you have any
comments, please do not hesitate to email them to me at

Respectfully submitted,

Kristin Y. Johnson, MS CCC/SLP


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