ASHA’s 2024 Payer Summit Continues the Conversation About Provider Challenges

October 17, 2024

On September 26-28, 2024, ASHA held its annual Payer Summit to discuss the state of the professions, advocate on key issues, and gather information from insurers to improve our provider resources. Attendees included representatives from private insurance and utilization management companies, state Medicaid agencies, and Medicaid managed care organizations. ASHA staff discussed coverage, coding, and payment policy issues for audiology and speech-language pathology services with payer representatives. This year’s summit boasted the largest number of private insurance and utilization management company representative attendees to date.

Building the Agenda

Throughout the year, ASHA staff collects feedback and information from ASHA members in the field that informs the summit agenda. ASHA gathers information from member committees, state-based advocacy networks, and individuals through conversations, email, social media, meetings, and surveys. Over the summer, ASHA circulated a Payer Summit feedback form through social media and email, including ASHA headlines. The agenda is centered on the issues and questions members highlight. This year, the summit focused on problems with decreasing rates, rising paperwork burden, coverage limitations, third party administrators, and more.

Starting a Conversation With Insurers

While discussing the real-world challenges members are facing, ASHA engaged the attendees in robust discussions to identify ways to address these challenges. We discussed the imbalance of decreasing rates and increasing paperwork burden, which is unsustainable for in-network providers. It’s vital that payers consider the financial and logistical burden placed on providers to ensure beneficiary access to medically necessary services.

ASHA educated payers on the purpose and importance of covering the new caregiver training codes, the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid benefit, habilitation services across the age spectrum, audiological treatment services, telehealth, and other areas with limited coverage. The summit addressed challenging aspects of utilization management policies and documentation. We also discussed the challenges and potential of payment innovation through value-based care and artificial intelligence.

What’s Next

During discussions at the summit, ASHA identified different ways that it and payers can better support audiologists and speech-language pathologists. Payers identified areas that need more supportive research and guidelines to support the changes we hope to see. Together, we identified opportunities for ASHA and attendees to improve provider training, resources, and other supports that can help providers navigate the payment world, such as tips on documentation for insurance, responding to denials, and drafting appeals.

ASHA continues to develop resources based on these discussions and to urge attendees to make necessary changes to improve the provider and patient experience. We will also continue our work to engage with attendees to share guidance, research, and data to support our advocacy on member pain points, such as limited coverage, burdensome prior authorization, and reimbursement rates.

Background

The Payer Summit was created in 2019 to forge relationships between health insurance payers and ASHA staff to share information directly from ASHA members in the field. Building and continuing these connections provides ASHA staff with better contacts at payers for member questions and issues. For example:

Last year’s summit helped push forward a policy that expanded coverage of cochlear implants for younger patients and helped create an adult habilitative benefit for speech-language pathology services by a Medicaid program.
Last year’s summit also resulted in payers adopting coverage of the new caregiver training codes.
This year we encouraged more payers to add the codes to their fee schedules.
In the weeks since this year’s summit, ASHA has advised a utilization management company on its coverage policy for voice therapy, informed a rate assessment methodology for one Medicaid program, and advised another payer on coverage of swallowing services via telehealth.