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
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
