BCBS Drops Cognitive Rehabilitation Report

Abstract

You have accessThe ASHA LeaderOn the Pulse1 Nov 2011BCBS Drops Cognitive Rehabilitation Report Janet McCartyMEd, CCC-SLP Janet McCarty Google Scholar More articles by this author , MEd, CCC-SLP https://doi.org/10.1044/leader.OTP.16142011.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/111122/BCBS-Drops-Cognitive-Rehabilitation-Report.htm A 2008 report that deemed cognitive rehabilitation treatment as “investigational” has been removed from the Blue Cross and Blue Shield Association (BCBSA) public website. The removal, coupled with the lack of a replacement, may signal a change in the policy on coverage of cognitive rehabilitation services for BCBSA, whose companies provide health care coverage to 98 million people (one in three) in America. “Cognitive Rehabilitation for Traumatic Brain Injury in Adults,” an assessment report issued by the BCBSA Technology Evaluation Center, indicated that data were insufficient to determine whether cognitive rehabilitation results in beneficial health outcomes. ASHA disputed that position, providing supportive evidence for the treatment, including data from ASHA’s National Outcomes Measurement System. These data demonstrate that a large percentage of patients with traumatic brain injury (TBI) who received speech-language treatment made significant gains on four functional communication measures in key cognitive-communication skill areas: attention, memory, pragmatics, and problem-solving. BCBSA posts assessment reports on its public website for three years, and recently removed the cognitive rehabilitation report. BCBSA policies are made available to the 39 independently owned and operated BlueCross BlueShield plans, which may choose whether or not to adhere to them when creating or updating their individual medical policies. Speech-language pathologists can view BCBSA’s removal of its policy on cognitive rehabilitation for treatment of TBI as a signal to advocate for coverage with local and regional BlueCross BlueShield plans. In requesting coverage of these services, SLPs are encouraged to use information assembled by ASHA, including the rationale for coverage and published reports and research supporting treatment (e-mail [email protected] to receive this information). Each regional BlueCross BlueShield plan operates independently and coverage contracts differ among the plans. Lack of coverage may be due to a contractual requirement (e.g., the contract specifies that cognitive rehabilitation is not covered) rather than a medical necessity decision. Nevertheless, the removal of the BCBSA assessment report on cognitive rehabilitation from its public website may provide an opportunity for SLPs and consumers to advocate for improved coverage of medically necessary cognitive rehabilitation for TBI patients. Author Notes private health plans advisor, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 14November 2011 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2011 Metrics Current downloads: 73 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...