ASHA SLPA CERTIFICATION EXAM
STUDY GUIDE - PART 3
The Medicaid Program is - Answer-jointly funded by the federal and state governments to assist states in
providing medical care to low-income individuals and those who are categorized as medically needy.
Each state administers its own medicaid program and establishes its own income eligibility standards; -
Answer-type, amount, duration, and scope of services covered, and payment rates.
For services to be considered medically necessary, they must - Answer-be reasonable and necessary for
the treatment of illness, injury, disease, disability, or developmental condition.
Medical necessity is - Answer-a critical factor for determining eligibility for Medicaid-reimbursable
therapy and treatment services.
Medicaid claims may be supported when providers document the following basic elements: - Answer--
Reasonable
- Necessary
- Specific
- Effective
- Skilled
Reasonable: - Answer-Appropriate amount, frequency, and duration of treatment in accordance with
standards of practice
,Necessary: - Answer-Appropriate treatment for the patient's diagnosis and condition
Specific: - Answer-Treatment targeted to particular goals
Effective: - Answer-Treatment expected to yield improvement within a reasonable amount of time
Skilled: - Answer-Treatment requiring the knowledge, skills, and judgement of a speech-language
pathologist (SLP) or audiologist
Audiology and speech-language pathology services are medically necessary to treat - Answer-speech-
language, hearing, balance, swallowing, voice, fluency, and cognitive-communication disorders.
Children who require services as part of their individualized education programs (IEPs) and are identified
as having a disability under the Individuals with Disabilities Education Act (IDEA) are - Answer-also
generally considered to have met the requirements for services to be medically necessary.
Although each state established a state plan, including specific requirements, relevant documentation
for establishing medical necessity may include: - Answer-- medical history, such as pertinent medical
history, brief description of functional status, and relevant prior treatment;
- diagnosed speech, language, swallowing, hearing, or balance disorder;
- identification of a child with a disability as eligible for services under the Individuals with Disabilities
Education Act (IDEA) or determination by an IEP team that services are required;
- date of onset;
- physician referral, if required (reauthorization may be required);
- initial assessment and date - the procedure(s) used by the audiologist or SLP to diagnose a speech,
language, voice, fluency, cognitive-communication, swallowing, hearing, or balance disorder and the
date the initial assessment is completed;
- plan of treatment or a treatment program and date established; and
- progress notes and/or reports
,Professionals may work with their state association leadership, local education agencies, state education
agencies, and state Medicaid offices to address specific topics or questions. Successful efforts to improve
efficiency for professionals in some states include: - Answer-- streamlining paperwork;
- establishing evaluation or IEP by a qualified professional as adequate to establish medical necessity
and eliminating need for physician signature
- expediting physician referral and examination process;
- clarifying medical necessity criteria and documentation requirements;
- updating states policy and procedure information
- advocating for services not covered (i.e., private practice and telepractice)
A "speech pathologist" is an individual who meets one of the following conditions: - Answer-i. Has a
certificate of clinical competence from the American Speech and Hearing Association
ii. Has completed the equivalent educational requirements and work experience necessary for the
certificate
iii. Has completed the academic program and is acquiring supervised work experience to qualify for the
certificate
A "qualified audiologist" means an individual with a master's or doctoral degree in audiology that
maintains documentation to demonstrate that he or she meets one of the following conditions: -
Answer-i. The State in which the individual furnishes audiology services meets or exceeds State licensure
requirements in paragraph, and the individual is licensed by the State as an audiologist to furnish
audiology services.
ii. Have a Certificate of Clinical Competence in Audiology granted by the American Speech-Language-
Hearing Association.
A. Have successfully completed a minimum of 350 clock-hours of supervised clinical practicum (or is in
the process of accumulating that supervised clinical experience under the supervision of a qualified
master or doctoral-level audiologist); performed at least 9 months of full-time audiology services under
the supervision of a qualified master or doctoral degree in audiology, or a related field; and successfully
completed a national examination in audiology approved by the Secretary.
, There are five conditions that must be met for Medicaid to reimburse for IDEA-related services -
Answer-1) the child receiving the service must be enrolled in Medicaid
2) the services are medically necessary
3) the services must be covered in the state Medicaid plan or authorized by the federal Medicaid statue
4) the services must be listed in the child's individualized education program (IEP)
5) the school district or local educational agency (LEA) must be authorized by the state as a qualified
Medicaid provider
Medicaid does not pay for screening services that are - Answer-provided free of charge to non-medicaid
beneficiaries in schools.
According to the School-Based Administrative Claiming Guide, - Answer-if the screening leads to a child
being identified as having a disability under the IDEA and the development of an IEP, Medicaid could pay
for services provided in the IEP.
The most common differences between state Medicaid programs include - Answer-group size limits,
documentation requirements, supervision requirements, and provider requirements. There may also be
differences related to documentation for services provided "under the direction of" - including "sign off"
by qualified personnel- and the payment rates for school-based providers.
An interagency agreement, which describes and defines - Answer-the relationships between the state
Medicaid agency, the state department of education, and/or the school district or local entity
conducting the activities must be in place in order to claim federal matching funds.
A service must be specifically identified in the state's Medicaid plan, or be furnished under the Early,
Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit, - Answer-to make Medicaid payment
permissible.
State regulations and standards differ greatly in other areas of Medicaid, including: - Answer-- providing
requirements for Medicaid participation, credentialing, and supervision;
STUDY GUIDE - PART 3
The Medicaid Program is - Answer-jointly funded by the federal and state governments to assist states in
providing medical care to low-income individuals and those who are categorized as medically needy.
Each state administers its own medicaid program and establishes its own income eligibility standards; -
Answer-type, amount, duration, and scope of services covered, and payment rates.
For services to be considered medically necessary, they must - Answer-be reasonable and necessary for
the treatment of illness, injury, disease, disability, or developmental condition.
Medical necessity is - Answer-a critical factor for determining eligibility for Medicaid-reimbursable
therapy and treatment services.
Medicaid claims may be supported when providers document the following basic elements: - Answer--
Reasonable
- Necessary
- Specific
- Effective
- Skilled
Reasonable: - Answer-Appropriate amount, frequency, and duration of treatment in accordance with
standards of practice
,Necessary: - Answer-Appropriate treatment for the patient's diagnosis and condition
Specific: - Answer-Treatment targeted to particular goals
Effective: - Answer-Treatment expected to yield improvement within a reasonable amount of time
Skilled: - Answer-Treatment requiring the knowledge, skills, and judgement of a speech-language
pathologist (SLP) or audiologist
Audiology and speech-language pathology services are medically necessary to treat - Answer-speech-
language, hearing, balance, swallowing, voice, fluency, and cognitive-communication disorders.
Children who require services as part of their individualized education programs (IEPs) and are identified
as having a disability under the Individuals with Disabilities Education Act (IDEA) are - Answer-also
generally considered to have met the requirements for services to be medically necessary.
Although each state established a state plan, including specific requirements, relevant documentation
for establishing medical necessity may include: - Answer-- medical history, such as pertinent medical
history, brief description of functional status, and relevant prior treatment;
- diagnosed speech, language, swallowing, hearing, or balance disorder;
- identification of a child with a disability as eligible for services under the Individuals with Disabilities
Education Act (IDEA) or determination by an IEP team that services are required;
- date of onset;
- physician referral, if required (reauthorization may be required);
- initial assessment and date - the procedure(s) used by the audiologist or SLP to diagnose a speech,
language, voice, fluency, cognitive-communication, swallowing, hearing, or balance disorder and the
date the initial assessment is completed;
- plan of treatment or a treatment program and date established; and
- progress notes and/or reports
,Professionals may work with their state association leadership, local education agencies, state education
agencies, and state Medicaid offices to address specific topics or questions. Successful efforts to improve
efficiency for professionals in some states include: - Answer-- streamlining paperwork;
- establishing evaluation or IEP by a qualified professional as adequate to establish medical necessity
and eliminating need for physician signature
- expediting physician referral and examination process;
- clarifying medical necessity criteria and documentation requirements;
- updating states policy and procedure information
- advocating for services not covered (i.e., private practice and telepractice)
A "speech pathologist" is an individual who meets one of the following conditions: - Answer-i. Has a
certificate of clinical competence from the American Speech and Hearing Association
ii. Has completed the equivalent educational requirements and work experience necessary for the
certificate
iii. Has completed the academic program and is acquiring supervised work experience to qualify for the
certificate
A "qualified audiologist" means an individual with a master's or doctoral degree in audiology that
maintains documentation to demonstrate that he or she meets one of the following conditions: -
Answer-i. The State in which the individual furnishes audiology services meets or exceeds State licensure
requirements in paragraph, and the individual is licensed by the State as an audiologist to furnish
audiology services.
ii. Have a Certificate of Clinical Competence in Audiology granted by the American Speech-Language-
Hearing Association.
A. Have successfully completed a minimum of 350 clock-hours of supervised clinical practicum (or is in
the process of accumulating that supervised clinical experience under the supervision of a qualified
master or doctoral-level audiologist); performed at least 9 months of full-time audiology services under
the supervision of a qualified master or doctoral degree in audiology, or a related field; and successfully
completed a national examination in audiology approved by the Secretary.
, There are five conditions that must be met for Medicaid to reimburse for IDEA-related services -
Answer-1) the child receiving the service must be enrolled in Medicaid
2) the services are medically necessary
3) the services must be covered in the state Medicaid plan or authorized by the federal Medicaid statue
4) the services must be listed in the child's individualized education program (IEP)
5) the school district or local educational agency (LEA) must be authorized by the state as a qualified
Medicaid provider
Medicaid does not pay for screening services that are - Answer-provided free of charge to non-medicaid
beneficiaries in schools.
According to the School-Based Administrative Claiming Guide, - Answer-if the screening leads to a child
being identified as having a disability under the IDEA and the development of an IEP, Medicaid could pay
for services provided in the IEP.
The most common differences between state Medicaid programs include - Answer-group size limits,
documentation requirements, supervision requirements, and provider requirements. There may also be
differences related to documentation for services provided "under the direction of" - including "sign off"
by qualified personnel- and the payment rates for school-based providers.
An interagency agreement, which describes and defines - Answer-the relationships between the state
Medicaid agency, the state department of education, and/or the school district or local entity
conducting the activities must be in place in order to claim federal matching funds.
A service must be specifically identified in the state's Medicaid plan, or be furnished under the Early,
Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit, - Answer-to make Medicaid payment
permissible.
State regulations and standards differ greatly in other areas of Medicaid, including: - Answer-- providing
requirements for Medicaid participation, credentialing, and supervision;
