School Audiology Services and Medicaid - PowerPoint PPT Presentation

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School Audiology Services and Medicaid

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    1. School Audiology Services and Medicaid October 2-3, 2007

    3. School Audiology Services Audiology services shall be rendered by an Audiologist with a current license in Audiology issued by the Board of Audiology and Speech-Language Pathology.

    4. Provider Enrollment Requirements: Schools must employ qualified professionals whose qualifications or licensures have been certified by the Virginia Department of Education; Schools may only bill Medicaid for services provided by qualified staff who are employed or contracted with the schools;

    5. Provider Enrollment Requirements: Schools must enroll as an Audiologist provider: Have a school provider agreement completed and on file with DMAS Provide DOE Medicaid Specialist (Amy Edwards) with copy of the audiologists license Audiologist may be either employed or contracted with the school

    6. Audiology Services and the IEP The individual must have a medical need for audiology services documented on the IEP. Assessments services as part of the IEP eligibility process must be documented in order to be covered by Medicaid

    7. Audiology IEP Team The IEP team must include a physician or other licensed practitioner of the healing arts acting within the scope of his license under State law. The IEP team may include a licensed audiologist.

    8. Audiology Covered Services A qualified audiologist may provide the following services: Identification of children with hearing loss; Determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the rehabilitation of hearing; (cont.)

    9. Audiology Covered Services Provision of habilitative activities, such as language habilitation, auditory training, speech reading (lip-reading), hearing evaluation, and speech conservation; Creation and administration of programs for prevention of hearing loss; (cont.)

    10. Audiology Covered Services Counseling and guidance of children, parents, and teachers regarding hearing loss; and Determination of children's needs for amplification, evaluating the effectiveness of amplification Hearing aid fitting and dispensation are not covered school health services

    11. Audiology and Medicaid Audiology and Hearing Aids are Medicaid covered services Schools divisions shall be required to refer children who are identified through health assessment screenings as having potential abnormalities to their primary care physician for further diagnostic and treatment services

    12. Audiological Assessment Includes testing and/or observation as appropriate for chronological or mental age for one or more of the following areas of functioning:

    13. Audiological Assessment Auditory acuity (including pure tone air and bone conduction), speech detection, and speech reception threshold Auditory discrimination in quiet and noise Impedance audiometry including tympanometry and acoustic reflex Hearing amplification evaluation Central auditory function

    14. Audiological Treatment Auditory training Speech reading Aural rehabilitation including cochlear implants

    15. Documentation Requirements Any assessments and/or evaluations; A plan of care specifically designed for the recipient who is receiving therapy services, which includes: any measurable goals (long and short-term); the anticipated level of functional improvement together with time frames for improvement and/or goal achievement; any therapeutic interventions to be addressed by the audiologist; and identification of a discharge plan.

    16. Documentation Requirements Any changes in the recipient's condition must be noted with subsequent revisions in the plan of care. All progress notes; A discharge summary signed and dated by the audiologist within 30 calendar days of discharge which includes: the reason for discharge; the recipients functional status at discharge compared to admission status; the status of any established goals; and any recommendations for follow-up care.

    17. Hear the Codes! The Audiology codes are listed in your handouts The billing procedures will follow the procedures outlined in the Medicaid Updates Presentation Hearing aid checks (CPT 92592 and 92593) will be a covered beginning January 1, 2008

    18. Use of Codes in Practice Please refer to handouts for discussion and rate information

    19. Thank You! Brian Campbell, EPSDT Coordinator DMAS Email Fredia Helbert, AuD DOE Email:

    20. School Health Audiology Contacts Ashley Barton, Maternal and Child Health Coordinator DMAS Email: Amy Edwards, Medicaid Specialist DOE Email: