ASHA SLPA CERTIFICATION EXAM STUDY GUIDE - PART 3
UPDATED ACTUAL Questions and CORRECT Answers
The Medicaid Program is 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 type, amount, duration, and scope of services covered, and payment rates.
establishes its own income eligibility standards;
For services to be considered medically necessary, they be reasonable and necessary for the treatment of illness, injury, disease, disability,
must or developmental condition.
Medical necessity is a critical factor for determining eligibility for Medicaid-reimbursable therapy and
treatment services.
Medicaid claims may be supported when providers - Reasonable
document the following basic elements: - Necessary
- Specific
- Effective
- Skilled
Reasonable: Appropriate amount, frequency, and duration of treatment in accordance with
standards of practice
Necessary: Appropriate treatment for the patient's diagnosis and condition
Specific: Treatment targeted to particular goals
Effective: Treatment expected to yield improvement within a reasonable amount of time
Skilled: Treatment requiring the knowledge, skills, and judgement of a speech-language
pathologist (SLP) or audiologist
Audiology and speech-language pathology services are speech-language, hearing, balance, swallowing, voice, fluency, and cognitive-
medically necessary to treat communication disorders.
Children who require services as part of their also generally considered to have met the requirements for services to be
individualized education programs (IEPs) and are medically necessary.
identified as having a disability under the Individuals with
Disabilities Education Act (IDEA) are
,Although each state established a state plan, including - medical history, such as pertinent medical history, brief description of functional
specific requirements, relevant documentation for status, and relevant prior treatment;
establishing medical necessity may include: - 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 - streamlining paperwork;
leadership, local education agencies, state education - establishing evaluation or IEP by a qualified professional as adequate to
agencies, and state Medicaid offices to address specific establish medical necessity and eliminating need for physician signature
topics or questions. Successful efforts to improve - expediting physician referral and examination process;
efficiency for professionals in some states include: - 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 i. Has a certificate of clinical competence from the American Speech and Hearing
the following conditions: 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 i. The State in which the individual furnishes audiology services meets or exceeds
master's or doctoral degree in audiology that maintains State licensure requirements in paragraph, and the individual is licensed by the
documentation to demonstrate that he or she meets one State as an audiologist to furnish audiology services.
of the following conditions: 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 1) the child receiving the service must be enrolled in Medicaid
to reimburse for IDEA-related services 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 provided free of charge to non-medicaid beneficiaries in schools.
, According to the School-Based Administrative Claiming if the screening leads to a child being identified as having a disability under the
Guide, IDEA and the development of an IEP, Medicaid could pay for services provided in
the IEP.
The most common differences between state Medicaid group size limits, documentation requirements, supervision requirements, and
programs include 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 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 to make Medicaid payment permissible.
Medicaid plan, or be furnished under the Early, Periodic,
Screening, Diagnosis, and Treatment (EPSDT) benefit,
State regulations and standards differ greatly in other - providing requirements for Medicaid participation, credentialing, and
areas of Medicaid, including: supervision;
- documentation requirements for plan of care approval, criteria for services,
authorization, and reimbursement justification;
- Medicaid audit process and penalties for errors;
- use of the Children's Health Insurance Program (CHIP)
Best practice standards recommend that states require meet the requirements stated in the Federal Register, Title 42, addressing the
that audiologists and speech-language pathologists Certificate of Clinical Competence (CCC), Clinical Fellowship (CF), and/or state
licensure.
Credentialing considerations - Determine whether different requirements apply to different practice settings in
the state
- Determine whether an NPI number is needed
- Determine if there are any ongoing requirements to maintain credentials
Advocate for CFs to become Medicaid providers in all - there will be an adequate number of providers, and
settings to ensure that - the state can meet the need for additional providers that may result from
Medicaid expansion or general increase in Medicaid roles.
States require documentation for all Medicaid services the state and the setting (e.g., school, clinic, or hospital) where the service is
provided; however, documentation requirements may provided.
vary depending on
UPDATED ACTUAL Questions and CORRECT Answers
The Medicaid Program is 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 type, amount, duration, and scope of services covered, and payment rates.
establishes its own income eligibility standards;
For services to be considered medically necessary, they be reasonable and necessary for the treatment of illness, injury, disease, disability,
must or developmental condition.
Medical necessity is a critical factor for determining eligibility for Medicaid-reimbursable therapy and
treatment services.
Medicaid claims may be supported when providers - Reasonable
document the following basic elements: - Necessary
- Specific
- Effective
- Skilled
Reasonable: Appropriate amount, frequency, and duration of treatment in accordance with
standards of practice
Necessary: Appropriate treatment for the patient's diagnosis and condition
Specific: Treatment targeted to particular goals
Effective: Treatment expected to yield improvement within a reasonable amount of time
Skilled: Treatment requiring the knowledge, skills, and judgement of a speech-language
pathologist (SLP) or audiologist
Audiology and speech-language pathology services are speech-language, hearing, balance, swallowing, voice, fluency, and cognitive-
medically necessary to treat communication disorders.
Children who require services as part of their also generally considered to have met the requirements for services to be
individualized education programs (IEPs) and are medically necessary.
identified as having a disability under the Individuals with
Disabilities Education Act (IDEA) are
,Although each state established a state plan, including - medical history, such as pertinent medical history, brief description of functional
specific requirements, relevant documentation for status, and relevant prior treatment;
establishing medical necessity may include: - 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 - streamlining paperwork;
leadership, local education agencies, state education - establishing evaluation or IEP by a qualified professional as adequate to
agencies, and state Medicaid offices to address specific establish medical necessity and eliminating need for physician signature
topics or questions. Successful efforts to improve - expediting physician referral and examination process;
efficiency for professionals in some states include: - 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 i. Has a certificate of clinical competence from the American Speech and Hearing
the following conditions: 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 i. The State in which the individual furnishes audiology services meets or exceeds
master's or doctoral degree in audiology that maintains State licensure requirements in paragraph, and the individual is licensed by the
documentation to demonstrate that he or she meets one State as an audiologist to furnish audiology services.
of the following conditions: 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 1) the child receiving the service must be enrolled in Medicaid
to reimburse for IDEA-related services 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 provided free of charge to non-medicaid beneficiaries in schools.
, According to the School-Based Administrative Claiming if the screening leads to a child being identified as having a disability under the
Guide, IDEA and the development of an IEP, Medicaid could pay for services provided in
the IEP.
The most common differences between state Medicaid group size limits, documentation requirements, supervision requirements, and
programs include 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 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 to make Medicaid payment permissible.
Medicaid plan, or be furnished under the Early, Periodic,
Screening, Diagnosis, and Treatment (EPSDT) benefit,
State regulations and standards differ greatly in other - providing requirements for Medicaid participation, credentialing, and
areas of Medicaid, including: supervision;
- documentation requirements for plan of care approval, criteria for services,
authorization, and reimbursement justification;
- Medicaid audit process and penalties for errors;
- use of the Children's Health Insurance Program (CHIP)
Best practice standards recommend that states require meet the requirements stated in the Federal Register, Title 42, addressing the
that audiologists and speech-language pathologists Certificate of Clinical Competence (CCC), Clinical Fellowship (CF), and/or state
licensure.
Credentialing considerations - Determine whether different requirements apply to different practice settings in
the state
- Determine whether an NPI number is needed
- Determine if there are any ongoing requirements to maintain credentials
Advocate for CFs to become Medicaid providers in all - there will be an adequate number of providers, and
settings to ensure that - the state can meet the need for additional providers that may result from
Medicaid expansion or general increase in Medicaid roles.
States require documentation for all Medicaid services the state and the setting (e.g., school, clinic, or hospital) where the service is
provided; however, documentation requirements may provided.
vary depending on
