Medicare Update: What we Know

A recent change the Centers for Medicare & Medicaid Services (CMS) made to the Medicare Benefit Policy Manual jeopardizes access to care for Medicare beneficiaries and undermines state laws designed to regulate provisional licensees such as speech-language pathology clinical fellows (CFs). It also threatens the livelihood of CFs whose employment relies on the ability to submit claims to payers like Medicare. 

Many are asking if this will affect other insurance besides Medicare. Caroline Bergner at ASHA provided the following statement: Right now it is difficult to predict whether state Medicaid agencies will make changes, but we do know that often times Medicare policy trickles down to Medicaid agencies. Here is our FAQ answer on this topic: Yes, ASHA is aware that other payers, such as Tricare, have independently made a similar decision to deny enrollment for provisional licensees like CFs. More insurers may follow Medicare’s lead. It is important to check directly with individual payers regarding their provider qualification requirements.

Further, we have been informed that CMS is not conducting audits to recoup funds for services that were delivered by CFs in recent years under the outdated guidance not updated by CMS. The goal is to Ensure that CMS develops a definition of licensure that recognizes the significant achievement of CFs including, but not limited to, graduating from a masters or doctoral program, and obtaining a state license (under which the scope of practice between a CF and "full" SLP is not different).

To reach that goal, ASHA is advocating for CMS to update its qualified provider requirements and has asked to meet with CMS staff to walk through the relevant federal and state legislative and regulatory history, explain why provisional licensure must be included in federal personnel qualifications for SLPs, and strongly advocate for their inclusion in Medicare. Keep an eye on ASHA Advocacy News for updates. You can also send an email to reimbursement@asha.org if you have questions about Medicare policy and advocacy.

NCSHLA is also joining this fight. By joining NCSHLA, you are taking part in advocacy for North Carolina Speech Language Pathologists, Audiologists, and Assistants. We will work closely with ASHA to harness the power of North Carolina's amazing grassroots advocacy network and will continue to provide updates as we receive them through email and social media.

There are things you can do today to push for change. First, please sign this petition by June 25 to join us in imploring CMS to revise its interpretation of the term "licensure" to include the provisional licensure states issue to new graduates in the process of completing their supervised clinical mentorship.

Moving forward, stay informed. The ASHA Advocacy webpage will you keep you informed of all the latest changes regarding this issue and many others. Further, you can always visit the ASHA website for advocacy opportunities that are as easy as clicking a button.

We know that this is a confusing, time and there is not a lot of information yet to determine what this means for our Clinical Fellows and their supervisors. We are asking you to not only help us through signing the petition, but also updating us on social media or through email at info@ncshla.org with resources to send out to membership and verified information. We have learned that change comes through working together and supporting each other. Thank you for standing with us.

In Solidarity,

NCSHLA Board