by Ingrida Lusis
The Centers for Medicare and Medicaid Services (CMS) has released its final rule addressing Medicaid provider qualifications for audiologists in the May 28 issue of Federal Register. The regulation takes effect on June 28.
The final rule recognizes audiology as a separate profession, strengthens state licensure requirements to reflect the wide use of the Certificate of Clinical Competence in Audiology (CCC-A), replaces the "or equivalent" clause with the Medicare standards, and requires supervision by audiologists for medicaid audiology services performed by less-qualified providers. A chart summarizing these changes can be found on page 12.
Payment Requirements
To qualify for Medicaid payment, the new regulations will require that state audiologist licensure standards meet or exceed the CCC-A or the Medicare statutory standards (the 1993 CCC-A requirements). CMS clarified its policy further by saying, "We do not believe recognition of State licensure as the sole national standard for defining qualified audiologists is in the best interests of the Medicaid population."
The new regulation also eliminates the "or equivalent educational requirements and work experience" clause, replacing it with the Medicare standard.
"The new regulation addresses complaints we have received from many audiologists that less- qualified providers were directly billing Medicaid for audiology services, since the term 'equivalent' was widely interpreted by some states," said ASHA President Larry Higdon, an audiologist.
Audiologists who reside in some states-those that lack licensure, have less stringent licensure standards, or exempt audiologists from licensure by institution or setting (such as schools)-also will be required to document that they have the CCC-A or meet the Medicare standard.
In comments made in the final rule, CMS states, "Our revised standards continue recognition of ASHA certification, not only because it is a recognized industry quality standard, but more importantly because it ensures continuity and reciprocity…" and would "limit the administrative burden to states." CMS also noted that American Board of Audiology certification would not be cited as a qualifying standard.
"CMS has upheld the rigorous standards developed by audiologists for audiologists by using the CCC-A as the basis for evaluating state licensing standards," Higdon said. "This is a victory for the thousands of audiologists who worked to earn the CCC-A, and for the patients that benefit from their high level of professional preparation and expertise."
Guidance for "Under the Direction of..."
CMS agreed with ASHA's comments to the proposed rule to further strengthen its guidance on what constitutes providing audiology services "under the direction of" a qualified audiologist. The final rule stipulates that employment terms should provide for supervisory ratios that are reasonable and ethical and that reflect professional practice act requirements. In addition, CMS expects that individuals working under the direction of a qualified audiologist will be provided information to permit direct contact with supervising audiologists.
"The new supervision guidance is a great step forward to ensure that Medicaid audiology service by less-qualified providers are appropriately supervised and directed by audiologists, said Higdon.
Impact on SLP Qualifications
The Medicaid provider qualifications for speech-language pathology are not affected by this ruling. However, CMS has indicated that they are likely to apply the supervision guidance portion of the rulemaking to Medicaid speech-language pathology services.
"We are pleased that CMS staff and Secretary Thompson agreed with our policy positions on behalf of audiologists and Medicaid beneficiaries," said Higdon.
The final rule is available on the ASHA Web site. For more information contact Ingrida Lusis by e-mail at ilusis@asha.org, or by phone at 800-498-2071, ext. 4482.