Medicaid Rules to Change

Submitted by Julee Neuhart

December 23, 2002

During the summer, 2002, the Medicaid reimbursement program for the state of Washington was reviewed by staff from the Office of the Inspector General (OIG) in Washington, D.C.. The staff visited several of school districts in the state, which have received large amount of Medicaid funds.

The qualification to be a Medicaid services provider was reviewed. Currently the Department of Social and Health Services (DSHS) considers any school SLP and audiologist who hold the ESA certificate to be qualified. The OIG staff did not agree. They require Medicaid providers who seek reimbursement to be in one of the following 3 categories:

speech pathologist or audiologist who currently holds the ASHA CCC or has held it in the past;
speech pathologist or audiologist who is licensed by the Washington Department of Health; (this refers to the new license which will be available after January 1, 2003);
speech pathologist or audiologist who holds a masters degree in speech and hearing sciences and disorders, has had a year of mentoring such as the Clinical Fellowship Year and holds the continuing level ESA certificate.

Carol Nolan, who is the program supervisor at OSPI for the Medicaid reimbursement program for Washington school districts, has suggested that school districts determine who on the staff meets these qualifications. Carol reported that it may be several months before DSHS distributes written guidelines regarding the qualifications to be a Medicaid service provider. However, districts may be putting their Medicaid funds in jeopardy if they continue to request reimbursement for services provided by a staff member who does not fall into any of the 3 categories above. Carol also reported that the service by a “non-provider” can be billed, if the billing ticket is signed off by a staff member who does meet the qualifications above.