Medicaid regulations state that in order for Speech Services to be reimbursable, they must be provided by a licensed and/or ASHA (American Speech and Hearing Association) certified speech pathologist. At the same time, SED states that speech services must be provided by a teacher of the speech and hearing handicapped. Therefore, only those speech services provided by a professional who is dually certified as a teacher of the speech and hearing handicapped AND is a NYS licensed and/or ASHA certified speech pathologist are reimbursable through Medicaid. "Under the direction of" for speech services allows school districts to be reimbursed by Medicaid for those services provided to Medicaid eligible students by teachers of the speech and hearing handicapped.
"Under the Direction of" for Speech Services Options for Districts Three options are currently offered to school districts considering purchasing "Under the Direction of" for speech services program. These currently include:
	a.	Identify Medicaid Eligible Students Receiving Speech Services This option is delivered and billed on a ½ day per quarter per therapist caseload. If a district has four therapists, for example, they would contract for ½ day per quarter per therapist for a total of 8 days for the school year. Only those students identified by the district will be reviewed. The district runs some risk acquiring services delivered in this manner since Medicaid eligibility for speech caseloads frequently fluctuates, i.e., a student may be eligible for one quarter and not the next or a student may not be eligible for the first quarter but becomes eligible the next quarter but is not being reviewed by the speech pathologist since he/she was not identified to the speech pathologist by the district.  Therefore, Medicaid lists should be reviewed by the district on a regular basis to insure accuracy.
	b.	Review of Total Caseloads This option is delivered and billed on a full day per therapist caseload. For example, a district with three therapists choosing not to identify Medicaid eligible students would contract for a total of 12 days for the school year.
	c.	BOCES Caseloads If a district chooses, it may include their students enrolled in BOCES programs for review by the Speech Pathologist. If this is chosen, the BOCES caseload is generally considered as an additional therapist (even though in actuality many therapists may be involved). For example, a district with four district therapists, who also chooses to include their students enrolled in BOCES programs, would be considered as having five caseloads for review.
Request for Service To request this service, a letter must be sent to the Assistant Principal of Special Education, Kathleen Fonda, at the Special Education Center.