The Centers for Medicare and Medicaid Services (CMS) has published proposed rates for home health agencies for calendar year 2007. The 3.1% proposed increase applies to the base rate for each 60-day episode and reflects the estimated home health market basket inflationary rate.  Under the home health prospective payment system (PPS), rates are higher for patients identified as having greater care needs.  The base episode rate for 2007 is proposed at $2334 (before case-mix adjustment).  The case-mix adjustment for each 60-day episode is determined by a comprehensive patient assessment tool, the OASIS (Outcome Assessment Information Set).  Added to the episodic rate is a "high-therapy case-mix adjustment" of approximately $2,500 if a patient receives at least ten therapy visits.

Is it my turn already? Taking the helm as ArSHA President is like being the captain of a ship.  I’m not the sea-faring type but the inspiration for this analogy grew from a presentation by Dr. Tom Jackson at the Council of State Association Presidents (CSAP).  Dr. Jackson is the Co-founder of takt X, LLC, a business that  helps  companies with policy management, strategic planning and execution process.  Dr. Jackson espouses Hoshin Kanri.  Hoshin Kanri is a Japanese term that when translated to English would evoke an image of a ship’s compass.  When the ship’s compass is properly calibrated and distributed to other ships, the desired result would be that all ships through independent action arrive at the same destination, as the requirements of the “voyage” may require.  

Hoshin Kanri provides a planning structure to business systems.  A business system is a set of coordinated processes that accomplish the core objectives of the business.  For every business system there are measures of performance and desired levels of performance. Hmmm….sound familiar? Evidence-based practice….standards….strategic planning.

The Office of Special Education and Rehabilitative Services (OSERS), U.S. Department of Education (ED), has released an unofficial copy of the long-awaited final Part B regulations to implement the Individuals with Disabilities Education Improvement Act of 2004 (commonly known as IDEA 2004).  The final regulations can be found at OSERS’ web site at www.ed.gov/idea.  The official copy of the final regulations is scheduled to be published in the August 14, 2006 Federal Register, and the regulations become effective 60 days after it is published in the Federal Register.

SLP104 Speech/Language/Hearing Development
SLP205 Intro to Communication Disorders
SLP214 Speech Disorders and Rehabilitation
SLP216 Aural Rehabilitation

As part of its June report to Congress entitled “Increasing the Value of Medicare”, the Medicare Payment Advisory Commission (MedPAC) called for better data collection by the Centers for Medicare and Medicaid Services (CMS) in order to assess a beneficiary’s need for outpatient rehabilitation services.  MedPAC reviewed four assessment tools for the purposes of the report, including ASHA’s National Outcomes Measurement System (NOMS), in Chapter 6 of the report entitled, “Toward Better Value in Purchasing Outpatient Therapy Services”. The other three tools were predominately physical and occupational therapy oriented and used patient-self reports. MedPAC recognized that patient self-report tools would be clinically inappropriate for beneficiaries receiving speech-language pathology (SLP) services.

The Centers for Medicare and Medicaid Services (CMS) proposed fiscal year (FY) 2007 rates for inpatient rehabilitation facilities (IRFs) in the Federal Register on May 15, 2006. The rates are per stay and vary according to primary diagnosis, comorbidities, and functional status.  
 
A 0.5% overall increase in payments is proposed. This updating of rates is not directly related to the “75 percent rule” which has been challenged by the rehabilitation hospital industry, but affirmed in the Deficit Reduction Act.

Effective May 23, 2007, a National Provider Identifier (NPI) will be required for all electronic claims. Speech-language pathologists and audiologists who file claims electronically or use a clearing house for that purpose must obtain an NPI by this date. All health care providers are encouraged to apply for an NPI even if they currently do not file claims electronically.
 
Speech-language pathologists and audiologists can learn more about NPI and how to apply by visiting www.cms.hhs.gov/NationalProvidentStand/. CMS has indicated that it will update this page with new information and recourses as they become available.

The Health Insurance Marketplace Modernization Act (S. 1955) was recently pulled from the Senate calendar after a vote to limit debate on the bill failed 55 to 43. Although ASHA believes that Congress should enact legislation that makes health insurance more affordable for small business owners and their employees, it opposed two provisions of the bill that would be detrimental to individuals receiving speech-language pathology and audiology services ─ preemption of state mandates and differentiation in premiums.
 
The legislation would have created new health insurance plans that would not be required to provide state mandated coverage of speech-language pathology or audiology services, such as screening and early intervention for newborn hearing loss, hearing aids, and autism-related services. After years of fighting to enact these health care safeguards on a state level, S. 1955 could have preempted these state mandated covered services.