South Carolina Continues Medicaid Coverage of Speech-Language Pathology Telehealth Services
And Medicare Plays a Major Role
October 25, 2024
Advocacy win! After telehealth resource sharing and meaningful conversations with the South Carolina Speech Language Hearing Association (SCSHA) and ASHA—and after considering Medicare telehealth policy—South Carolina has decided to continue Medicaid coverage of speech, occupational, and physical therapies delivered via telehealth.
The decision comes after the South Carolina Department of Health and Human Services (SCDHHS) completed a comprehensive evaluation of telehealth service coverage over the summer. As part of that report, SCSHA and ASHA staff contributed many resources to show the benefits of telehealth for both patients and providers, including...
- A comparison of telehealth coverage for speech-language pathology services in Medicaid programs in surrounding states
- A telehealth data fact sheet on audiology and speech-language pathology services
- An Office of Inspector General report that references the extremely low incidence of claims at high risk for fraud in Medicare data
- A compilation of clinical vignettes and video examples of swallowing services performed via telehealth.
The department’s final report cut across multiple services delivered via telehealth.
Medicare’s Strong Influence on Medicaid
SCDHHS’ decision was strongly influenced by the House Energy and Commerce Committee’s vote to approve an extension of Medicare’s telehealth authority. This is more evidence that Medicare payment policy drives other payers’ coverage policies.
Sometimes Medicare has a direct influence—like when Medicaid reimbursement rates in certain states are developed as a percentage of Medicare payment rates. Other times Medicare has an indirect influence—like when Medicaid agencies and private insurance companies look to Medicare payment policy to determine their own coverage of services.
So even ASHA members who do not serve Medicare beneficiaries should pay attention to Medicare payment and coverage policies. It could impact you too!
Though coverage of speech-language pathology services via telehealth by South Carolina Medicaid will be up for consideration again in two years, SCSHA and ASHA are celebrating a continuation of coverage of these incredibly valuable services for patients and providers alike.
