New guidelines that detail the profession of speech-language pathology and the medical necessity of treatment are now available online.

Speech-Language Pathology Medical Review Guidelinesis designed for use by two different groups: members advocating for better health plan coverage and policy changes, and health plan officials reviewing claims and developing reimbursement policies.

The document is a comprehensive resource containinag information about provider qualifications, services, standard practices, documentation of services, and treatment efficacy. The medical review guidelines are intended for use by health plan medical directors, health plan claims reviewers, and representatives from state insurance commissioner offices, as well as individuals seeking information to justify the validity of claims for reimbursement. ASHA members can use the guidelines to advocate with health plans for improved coverage or policy changes related to speech-language pathology services.

Medical review guidelines are documents that describe specific disorders. Private and public health plans (such as state Medicaid agencies) use the information in medical review guidelines to make coverage and payment decisions for health care services, including those provided by speech-language pathologists.

The guidelines were created in accordance with a resolution adopted by the Board of Directors in 2008 to address inaccurate medical review guidelines related to speech-language pathology published by other organizations. The Board called for development of speech-language pathology medical review guidelines that include clear and correct information written by experts in the profession.

The resulting Ad Hoc Committee on Speech-Language Pathology Medical Review Guidelines, consisting of SLPs Becky Cornett (chair), Diane Ross, Lynne F. Harmon, Gretchen Bebb, and Pat Ford, developed the document in conjunction with Janet McCarty, private health plans advisor, and Neela Swanson, health care financing information coordinator. Thomas J. Hallahan, vice president for government relations and public policy, served as Board liaison and monitoring officer; Steven C. White, director of health care economics and advocacy, served as consultant.