Welcome to the MSHA Reimbursement Blog! My name is Barbara Wilson Arboleda, MS CCC-SLP and I am the new State Advocate for Medicare Policy (StAMP). This is a joint MSHA/ASHA position which purpose is to help keep the clinicians in our state informed as to Medicare policies and regulations.
The first topic I have been asked to address is in regard to the pending legislation H.3879 “An Act Providing for Provisional Licensure for Speech-Language Pathologists”. There remains a great deal of confusion regarding the status of Clinical Fellows in our state and the reasons why we need to have this legislation passed.
Many years ago, it was acceptable for speech-language pathology practices and clinics to hire Clinical Fellows and bill for their services under the license number of the supervising speech-language pathologist. Over time, however, payers have become more restrictive in terms of who they will allow to see their patients and bill for speech-language pathology services. At this point most payers, including Medicare, will not accept a non-licensed clinician providing skilled services to their members.
The key to understanding this issue is remembering that the Clinical Fellow is an ASHA designation for a person who is in the process of earning ASHA’s CCC, but the matter of licensure is a separate matter. The Clinical Fellowship program is overseen by ASHA. Licenses are issued by the State. In states where no license is provided to Clinical Fellows, Medicare (and many other payers) considers that fellow to be a student for the purposes of seeing patients and billing. In regard to Medicare Part B, that means in-the-room supervision with the licensed clinician directing the session and not involved in seeing another patient or in other tasks.
To clarify this difference further, it is not illegal to be a Clinical Fellow in the state of Massachusetts. The licensure law clearly makes provisions for the activities of a Clinical Fellow who is properly supervised. What the licensure law does not do is say that anyone has to pay you for those services provided by a Clinical Fellow. Therefore, Clinical Fellows are in a somewhat untenable situation.
Massachusetts is actually late to the game in recognizing this problem. We are only one of eight states left in the country that does not grant licensure during the Clinical Fellowship period. There is a great deal at stake in terms of ensuring passage of H.3879, including the fact that there are certainly clinics out there who continue to hire based on the old rules, unaware that anything has changed. The risk that these clinics are open to is enormous. In addition, we continue to lose some of our best and brightest students to other states where there is more varied opportunity open to them – particularly those who are interested in working in the healthcare sector.
At this time, H.3879 resides with the “Joint Committee on Healthcare Finance”. From there it will hopefully be recommended forward for a vote in the legislature. Those of us who have been involved in the development of this legislation are working hard to ensure that it will be passed in time to benefit the current graduating class of students.
We can’t afford to wait any longer to join the rest of the country in giving Clinical Fellows a license to practice during their fellowship. A letter to your local Representative or state Senator stating your support for this bill will help resolve this conflict, keep our Clinical Fellows in the state and bring many clinics into compliance with current Medicare regulations. I hope you will join us in urging its passage.