According to an examination, one in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing loss in both ears.

Nearly 5% of the children in the age group of 3-17 detected a speech disorder, and little more than 3% of children in the same age group detected some form of language disorder.

ASHA is a non-profit company set up with the aim of making effective communication, a basic human right, and make it accessible and achievable to all.

What is ASHA?

The American Speech-Language-Hearing Association (ASHA) was established in 1925 and has headquarters in Rockville, Maryland. With over 220,000 members and associates, it is a nationwide credentialing, scientific, and professional association. Also, they include speech-language pathologists, support staff for audiology, hearing, language, and speech scientists, speech-language pathologists, audiologists, and students.

ASHA’s Mission

ASHA’s mission is to empower and support hearing, language and speech scientists with speech-language pathologists and audiologists.

Indeed, for them, providing work-life balance, a positive and nurturing environment, and diversity for its employees is equally important.

Furthermore, ASHA’s National Office is a LEED-certified green building.

They have audiologists who are experts in detecting and diagnosing hearing and balance issues. Additionally, they offer audiology services that include hearing aids.

Their speech-language pathologists (SLPs) treat after identifying and assessing swallowing, language, and speech disorders.

School-Based Medicaid

Medicaid is a medical care program for low-income as well as medically needy individuals and included in that is school-based services (SBS), which are Medicaid-coverable services provided for students and adolescents in school. It is jointly funded by the federal and state governments to assist states in providing medical care. Individuals can seek billing and reimbursement help from Medicaid, and NEMB is one of the top industry leaders in being able to provide school-based, Medicaid billing. ASHA is involved with these SBS initiatives because it works closely with students, educators and speech, language, and hearing professionals. So, here is all the information that is needed to seek billing and reimbursement help with respect to Medicaid.

1. Who is eligible to bill Medicaid for speech-language pathology and audiology services?

Any qualified provider is eligible to bill Medicaid for speech-language pathology and audiology services. Hence, they are professionally responsible for all the services that are provided under their direction.

2. What’s the eligibility for a qualified provider under Medicaid for speech-language pathologists?

The following are the qualifications to be a qualified provider for a Speech-language pathologist. So, they should meet one of them.

  • They should have a Certificate of Clinical Competence from ASHA.
  • The person should have completed the equivalent educational requirements and also have the work experience necessary for the certificate.
  • Or, they should have a degree in the program plus supervised work experience to qualify for the certificate.
  • In the state of Mass to participate in school-based Medicaid they must also have a SLP state license licensed by the MA Board of Registration in Speech-Language Pathology and Audiology pursuant to 260 CMR 10.02.

3. What’s the eligibility for a qualified provider under Medicaid for an audiologist?

The following are the qualifications to be a qualified provider under Medicaid for audiologists.

They must have a master’s or doctoral degree in audiology. Moreover, they must meet one of the following conditions.

  • They must possess an audiology license issued by the necessary state.
  • They should have finished at least 350 hours of supervised clinical practice if a license is not required in the state in question.
  • They must either possess a Certificate of Clinical Competence in Audiology issued by the American Speech-Language-Hearing Association

4. What are the mandatory and optional services under Medicaid?

Under the Social Security Act, you will find some mandatory services that one should provide to “categorically needy” individuals. For instance, some of them are:

  • Inpatient hospital services
  • Outpatient hospital services
  • Vaccines for children
  • Physician services
  • Prenatal care
  • Family planning services and supplies
  • Rural health clinic services
  • Laboratory and x-ray services

Besides mandatory services, states can provide optional services too. For example, some of the optional services are:

  • Physical and occupational therapy
  • Diagnostic services
  • Clinic services
  • Intermediate care facilities for the mentally retarded
  • Prescribed drugs and prosthetic devices
  • Optometrist services and eyeglasses
  • Transportation services
  • Rehabilitation services

5. Who decides the Medicaid payments made to providers?

The states decide the Medicaid payments for the providers and the way to make them. Further, the federal government has decided there is no floor payment. So, states have flexibility in their decisions about the payment structure.

6. Why do schools bill Medicaid for audiology and speech-language pathology services performed in classrooms?

As long as federal regulations are followed, the Federal Medicaid program encourages states to use money from their Medicaid programs to assist pay for specific medical treatments that are provided in schools. Many kids’ first access to necessary health and social assistance comes through their schools. Health-related services’ medicaid coverage provided to children under the Individuals with Disabilities Act is now permitted by an amendment to Section 1903(c) of the Social Security Act (IDEA).

7. How are schools spending the Medicaid funds they receive?

How a district may spend Medicaid income is described in each state’s Medicaid plan. The district’s general fund may receive Medicaid reimbursement, which it may employ in a number of ways, such as:

  • Application of IEP School health services
  • Recruiting personnel or paying wages for services rendered
  • Books, supplies, and other costs associated with education
  • Assisted-living equipment or FM systems
  • Feeding tubes costs

Additionally, money can be given back to the initiative that brought in the money. Some school districts will pay SLPs and audiologists to cover licensing and association costs, continuing education/professional development, staff technology, or the development of creative intervention programs.

For more information, visit NEMB Group.


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