UnitedHealthcare Must Cover Speech-Language Treatment in
UnitedHealthcare must provide coverage in California for
medically necessary speech-language services and reimburse members who paid
out-of-pocket for these services after they were inappropriately denied,
according to an agreement between UHC and the California Department of Managed
According to information from CDMHC [PDF],
the insurer also must revise all current health plan documents to ensure they
comply with California law, which requires health plans to arrange for and
cover medically necessary speech-language treatment.
A CDMHC review of consumer complaints identified a pattern
of UHC denials for speech-language services because the beneficiaries'
communication difficulties were not due to a medical condition.
The settlement took effect Aug. 23 and requires UHC to
notify all affected members of the change within 60 days and to notify all of
its members of the agreement in its November newsletter. The notice will
include information on how to request reimbursement for past out-of-pocket
speech-language treatment expenses. UHC members have until July 30, 2014, to
file for reimbursements.
In February 2012, CDMHC reached a similar settlement with
Kaiser Permanente Foundation Health Plan. The department had received
complaints from more than 100 Kaiser policyholders, dating back to 2009, who
were denied coverage for occupational therapy, physical therapy and
speech-language services because the policyholders lacked a physical or mental
In the Kaiser case, the department cited people who stutter
or have a lisp—and were denied speech-language pathology services under the
insurer's policy—as an example of the difficulties stemming from Kaiser's
coverage policies. Kaiser claimed that its policies were mischaracterized as
limited only to patients with physical conditions. It is significant to note
that some observers view the Kaiser settlement as an order to cover treatment
for "developmental conditions," which often are excluded from coverage by many
In a statement, UHC said that its original policy was
"appropriate," but that the agreement was reached "to resolve this old issue."
Janet McCarty, MEd, CCC-SLP, is ASHA private health plans
Tip Sheet for Medicare Providers on Avoiding Penalties
A new document can help Medicare Part B providers who are
confused about how to avoid future penalties for failure to participate in the
2013 Physician Quality Report System. The Centers for Medicare and Medicaid
Services has an online tip sheet [PDF] that includes
guidelines on eligibility and step-by-step how-tos.
PQRS applies to all private- and group-practice audiologists
and speech-language pathologists who submit claims for Medicare Part B
beneficiaries. To avoid the 1.5% payment penalty on all 2015 claims, providers
must report at least one valid measure through claims or a registry in calendar
year 2013. Providers can meet this requirement by submitting codes on Medicare
Part B claims specifically for PQRS. The functional outcomes reporting
requirements for all Medicare Part B therapy services do not satisfy the PQRS
reporting requirements. All 2013 PQRS submissions must apply to service dates
in 2013 on payable claims processed by Feb. 28, 2014.
Feds Grant $1.9 Million for Assistive Technology
The U.S. Department of Education has awarded $1.9 million to
organizations in California, Missouri and Washington to help people with
disabilities purchase assistive technology, including hearing aids.
The grants, given through the Assistive Technology
Alternative Financing Program, will help people with disabilities get private
financing to buy services and devices, including hearing aids, computers,
vehicle modifications, vision aids and other devices. The organizations will
use the funds for their own programs:
- The California Foundation for Independent Living Center will
establish the FreedomTech Low-Interest Loan Program, offering low-interest
loans and a loan guarantee option for some applicants.
- The Missouri Assistive Technology Council will offer Show-Me
Loans, which have distributed more than $1.2 million in support to individuals
with disabilities since 1998.
- The Washington Access Fund will provide low-interest loans
and matched savings accounts for assistive technology, as well as business
equipment needed for employment or self-employment grants.
The Assistive Technology Alternative Financing Program is
administered by the Education Department's Rehabilitation Services
Administration of the Office of Special Education and Rehabilitative Services.
Model Privacy Practice Notices Available
Providers who want help developing privacy practice notices
required under the Health Insurance Portability and Accountability Act can
download customizable templates in a variety of formats from a federal government website.
HIPAA regulations that took effect in September require
providers to explain how they will handle patients' protected health
The Office of the National Coordinator for Health
Information Technology and the Health and Human Services Office for Civil
Rights developed the forms with input from consumers and key stakeholders.
Providers may enter their own information (name and contact information, for
example) into a format and print the notice for distribution and/or post the
electronic version on their websites.
AHRQ Report Compares Tinnitus Treatments
The U.S. Department of Health and Human Services' Agency for
Healthcare Research and Quality recently released "Evaluation and Treatment of Tinnitus: Comparative Effectiveness" [PDF]. The authors
evaluated the peer-reviewed literature on three areas of tinnitus management:
measures used to assess patients for management needs, the effectiveness of
various treatments, and identification of prognostic factors.
The report, which is based on research conducted by the
McMaster University Evidence-based Practice Center in Ontario, Canada, is
intended to help health care decision makers—patients and clinicians, health
system leaders, and policymakers, among others—make well-informed decisions
and, therefore, improve the quality of health care services.