STAR Report 9/24/11

Dear MSHA EB and Members,

I would like to first thank each and every one of you for asking me to represent our organization and you as our STAR.  For those of you who may not be aware of what the STAR position is, I have included some helpful information about the position.

The State Advocates for Reimbursement (STARs) Network is comprised of individual Audiologists and Speech Language Pathologists from each state’s association who has been chosen to represent them as part of ASHA’s Focused Initiative on Health Care Reimbursement. It is our role to advocate the needs our state as it relates to private health plan’s and Medicaid advocates.

The STAR Network was established in 2003 as part of ASHA’s Focused Initiative on Health Care Reimbursement. Since that time, these state
association leaders have played a critical role in advocating for consistent coverage and equitable reimbursement by private payers for speech-language pathology and audiology services. In 2011, Medicaid was added as a focus of the Network. Through the support of state speech-language-hearing associations and ASHA, STARs will have ongoing opportunities to enhance their knowledge of private health plan and Medicaid reimbursement issues and their ability to influence priority issues of state associations and their members.

I look forward to finishing out the year with Alex O’neal our current STAR and continuing on in 2012.  It is an honor to represent us.  I
am excited about all we can accomplish through this network.  I want to be available to each of you and keep you apprized of what ASHA is accomplishing through the STAR Network.  I also need to hear from you directly so I know what concerns and issues arise through out our state in the area of reimbursement.  Upon MSHA EB approval, over the next few months, I would like to work with Christine Gibson, VP of
Healthcare, and Kristine Johnson, upcoming SMAC, all members of the health care committee, and any other interested members to form a sub committee whose primary focus is on reimbursement. Please contact me directly via email at mshastar@gmail.com or on my cell phone
901-277-7712.

The STAR Network meets monthly via phone conference to discuss current focus issues as well as annually at ASHA’s annual conference.  After each conference I will write a summary of discussion for you to keep record of what are network is doing.  I also hope to have a display table with additional information for you at our Annual MSHA Conference.

Currently, the STAR Network has an initiative for professionals to “Tell Us Your Stories”.  Please help me represent MSHA by participating.  See attachment for additional information.

I recently attended my first STAR Network Conference Call, on Tuesday, September 20, 2011.  I was welcomed as a new member and am pleased to report to you what was discussed.  The first Topic of discussion reviewed the Medicaid Recovery Audit Contracts along with the regulations that are effective January 1, 2012.

Final rule on Medicaid Recovery Audit Contracts was posted in the Federal Register on 9/16/11, effective 1/1/12

Highlights

  • Most significant is that they won’t be reviewing claims provided through Medicaid managed care programs and because there are an
    increasing number of Medicaid enrollees who are part of managed care programs in all the states, the number of Medicaid recipient affected by this initiative will be limited.
  • There will be adequate opportunities for states to appeal decisions.
  • The States are directed to coordinate with other contractors and entities who are auditing as well as with State and Federal law
    enforcement agencies – e.g. Medicaid Integrity Contractors(MICs), to limit overlap and redundancy of effort
  • The auditors will review Medicaid claims submitted by providers for payment that may be made under state plan or waiver
    to identify overpayment and underpayment
  • The process is based on the Medicare RAC, but Medicaid RACs are state funded, designed, procured, operated, and administered
    while Medicare RACS are regionally operated and federally funded.
  • RACs will contract with states and will be paid on a contingency fee basis by the states.
  • Contractors must use consistent criteria, must have medical directors, coders, reviewers, and provide adequate customer
    service.
  • RACs won’t deny claims –they’re only reviewing post-payment claims

Please follow this link for additional information:  http://www.gpo.gov/fdsys/pkg/FR-2011-09-16/pdf/2011-23695.pdf

We also discussed ideas for agenda items for the STAR/SMAC Meeting at ASHA Convention in November.  Already on the agenda was Cognitive Rehab and coverage for it.  I suggested we also look at coverage for adult patients on Medicaid.  They have
added that to that meeting’s agenda.  Other state representatives agreed that they too see concerns with those services not being covered.

After we covered those specific items we then had state reports.  I found it very interesting that there is so much going on in our country that most of us our unaware of.  In Alaska, they are using a STAR grant to write their own provider manual especially for Medicaid.  In Idaho, they used grants to create web videos to promote our field. Please visit their link to learn more. www.idahosha.org . They also have begun
quarterly meetings with Medicaid.  This as shown me that there not only so much to be done, but so much that can and will be done.

Thank you again for this opportunity.  Let me leave you with a “Hammond Help Tip”; when writing to an insurance company to get approval for therapy or dispute a denial, always include a cc to our Insurance Commissioner.  Worst case scenario, ASHA could also write a letter. Our current Insurance Commissioner is Mike Chaney. He can be reached by phone at 1-601-359-3569 or visit their web site at  www.mid.state.ms.us .

Respectfully Submitted,

Leslie J. Hammond, M.S. CCC-SLP

MSHA STAR 2011, 2012

Advertisements

Comments are closed.

%d bloggers like this: