[DYSPHAGIA] FEES and physician supervision

[jbrown@Asha.org (Janet Brown)]

Your question points up the difficulty of knowing whether new "laws" are really laws, interpretations of regulations, policies of specific entities, or unfounded rumors. I forwarded your message to Mark Kander in ASHA's Medicare reimbursement section because he has been following the FEES supervision issue very closely.  Here is his response:  

The Medicare intermediary serving Kentucky is AdminaStar Federal (based in Indianapolis).  Its Local Medical Review Policy (LMRP) for dysphagia services, effective September 2000, does require "direct supervision of a physician in order for Medicare reimbursement [of the FEES or FEESST] to be made."

Most LMRPs that specifically address FEES have this same supervision requirement.  ASHA is working to get this requirement waived at the national level when the FEES or FEESST is performed by a "specially trained" SLP in an institutional setting: hospital, skilled nursing facility, or rehabilitation agency.

Incidentally, the Medicare definition of "direct physician supervision" has been interpreted as the presence of a physician within 50 or 60 feet.

Some states have laws that define endoscopy as a medical procedure that can only be conducted by or under the supervision of a physician.  Such laws are separate from Medicare requirements.  When we are successful at loosening the Medicare requirement, we will also have to assist in lobbying some state legislatures that currently have laws that would supersede Medicare.  

Attached are results of a survey of state licensure boards conducted by ASHA's Government Relations and Public Policy cluster about six months ago.  Boards from 26 states responded (we queried THREE times).  Kentucky's board responded that it has no official position on the performance of endoscopy by SLPs.  That answer does not guarantee that a state law does not exist that limits endoscopy to physician control.  For instance, while the California board states no official position on endoscopy, there is a California law that classifies it as a medical procedure.   

Mark Kander
Director
Health Care Regulatory Analysis
American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD  20852
301/897-0139    fax  301/897-7356
800/498-2071 x4139
Mkander@asha.org 


Janet Brown, MA CCC-SLP
Director
Health Care Services in Speech-Language Pathology
American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD  20852
301-897-0136
800-498-2071 x 4136
jbrown@asha.org

>>> "Weaver, Lorraine (WBH)" <Lweaver@bhsi.com> 12/13/01 02:27PM >>>
Hey everyone,

I have been told by one of the staff speech pathologists that we can no
longer do FEES without a physician present.  This is due to a new "law".  I
am from the state of KY and although I try to to keep up with all new
procedures, trends in the field and laws affecting my role as a SLP this
one, if  true,  got past me.  Can anyone confirm or deny this statement?
The therapist telling me this did not know if it was a federal or state law,
just that another agency was not doing FEES anymore because of this new
"law".  Please let me know if this is true for anyone else.  I am contacting
my state organization also to get confirmation on the accuracy of this
statement but was wondering if anyone or any other state had this limitation
on the performance of the FEES procedures for their patients.


LW in KY

 
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