ASHA SLPA CERTIFICATION EXAM STUDY GUIDE - PART 3 Exam
Questions and Answers Grade A+
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.
Questions and Answers Grade A+
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.
