ASHA SLPA CERTIFICATION EXAM STUDY GUIDE -
PART 3 | PERFECT PREP FOR EVERY PAPER |
PRECISION IN EVERY ANSWER!
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
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, 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.
4
APPHIA - Crafted with Care and Precision for Academic Excellence.
PART 3 | PERFECT PREP FOR EVERY PAPER |
PRECISION IN EVERY ANSWER!
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
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
,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.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, 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.
4
APPHIA - Crafted with Care and Precision for Academic Excellence.
