ASHA Expresses Concern Over Anthem Connecticut Payment Structure Changes

July 17, 2024

Update: October 2, 2024

Over the summer, ASHA Advocacy met with Anthem Blue Cross Blue Shield Connecticut (Anthem CT) representatives to discuss how shifting to a capped payment structure with an “up to $80 daily per diem” would hurt providers and beneficiaries. In collaboration with the Connecticut Speech-Language-Hearing Association (CSHA), we messaged speech-language pathologists in Connecticut with guidance on the issue and encouraged them to respond to Anthem CT individually.

Advocacy win! Due to the wave of responses from providers, ASHA, and CSHA, Anthem CT reconsidered its decision. On October 1, 2024, Anthem CT announced that it will not move forward with the $80 daily per diem for speech-language pathology services. Instead, Anthem CT will maintain the fee-for-service (FFS) model and listed the codes that will continue to be under the FFS model. Anthem CT did not clarify the fee schedule for these codes in its announcement, so we encourage providers to reach out to provider representatives at Anthem CT to ensure rates will meet practice needs.

Alone we can do so little; together we can do so much. – Helen Keller

On July 1, 2024, Anthem CT announced a significant change in payment structure for physical therapy (PT), occupational therapy (OT), and speech therapy (ST). According to the announcement, Anthem CT is planning to shift from a fee-for-service payment structure to a flat-rate payment system that provides “up to an $80 daily per diem” for PT, OT, and ST. They have stated that this change in payment structure does not alter how claims are submitted to Anthem CT. Providers will still be expected to submit all the same claim information and documentation as required under the current fee-for-service system. The new structure will apply to services on or after October 1, 2024.

What ASHA Is Doing

ASHA is deeply concerned by this announcement; the payment structure change could result in a significant reduction in payment while providers are continuing to experience high inflation costs and increasing practice expenses.

ASHA and the Connecticut Speech-Language-Hearing Association (CSHA) have met with stakeholders to analyze the potential impact of the change and identify member questions and concerns. ASHA has sent a letter to Anthem CT [PDF] expressing concern over this new payment structure, seeking answers to member questions, and requesting a meeting with Anthem CT staff to discuss these issues. We are also identifying opportunities to work with other stakeholders in CT to encourage Anthem CT to change this policy before it goes into effect.

For Anthem CT Providers

Providers should carefully review their contract with Anthem CT and determine how this will affect their practice. It’s important for providers to respond individually to their provider representatives at Anthem CT to express their concerns and how this policy will impact their practice. ASHA and CSHA have developed a template letter [DOCX] for providers to edit and send to their Anthem CT representatives. This template offers a blueprint, but providers should add a personal touch to strengthen the message.

Resources

Questions?

If you have questions or similar issues with Anthem or another payer in your state, please contact ASHA’s health care and education policy team at reimbursement@asha.org.