Expanding screening and requiring coverage of certain speech therapy services under Medicaid and CHIP

(a)

Inclusion of screening for stuttering and speech fluency in core set of child health quality measures

Section 1139A(b)(5) of the Social Security Act (42 U.S.C. 1320b–9a(b)(5)) is amended—(1)by striking Beginning no later than and inserting the following:

(A)

In general

Beginning no later than

; and

(2)by adding at the end the following new subparagraph:

(B)

Screening for stuttering and speech fluency

(i)

In general

Not later than January 1, 2028, the Secretary shall publish changes to the core measures described in subsection (a) to include measures of screening for childhood-onset fluency disorders, including stuttering, for children who have attained the age of 2 (and have not attained the age of 6).(ii)

Publication

The Secretary shall publish the changes required by clause (i) at the same time and in the same manner as the relevant annual recommended changes required under subparagraph (A).

(b)

Required screening for stuttering and speech fluency in Medicaid well-Child visits

Section 1905(r)(1)(B) of the Social Security Act (42 U.S.C. 1396d(r)(1)(B)) is amended—(1)in clause (iv), by striking and at the end;(2)in clause (v), by striking the period at the end and inserting , and; and(3)by adding at the end the following new clause:

(vi)beginning January 1, 2029, for children who have attained the age of 2 (and have not attained the age of 6), screening for childhood-onset fluency disorders, including stuttering.

(c)

Required coverage of certain speech therapy services

(1)

Medicaid

Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—(A)in section 1902(a)—(i)in paragraph (10)(A), by striking and (30) and inserting (30), and (32);(ii)in paragraph (89), by striking and at the end;(iii)in paragraph (90)(C), by striking the period at the end and inserting ; and; and(iv)by inserting after paragraph (90) the following new paragraph:

(91)provide that the treatment limitations applicable to specified speech therapy services (as defined in section 1905(ll)) are no more restrictive than the treatment limitations applicable to any speech therapy services for the treatment of expressive language disorder, receptive language disorder, mixed expressive and receptive language disorder, or articulation, for which medical assistance is provided under the State plan (or waiver of such plan).

;

(B)in section 1905—(i)in subsection (a)—(I)in paragraph (31), by striking and at the end;(II)by redesignating paragraph (32) as paragraph (33); and(III)by inserting after paragraph (31) the following new paragraph:

(32)beginning on January 1, 2029, specified speech therapy services (as defined in subsection (ll)); and

; and

(ii)by adding at the end the following new subsection:

(ll)

Specified speech therapy services

For purposes of subsection (a)(32), the term specified speech therapy services—(1)means speech therapy services for the treatment of childhood-onset fluency disorders, including stuttering, provided to—(A)individuals who have not attained 21 years of age; and(B)individuals described in section 1902(a)(10)(A)(i)(IX); and(2)includes such services delivered through real-time, audio and video telecommunications technology.

;

(C)in section 1932(b), by adding at the end the following new paragraph:

(9)

Parity in coverage of speech therapy services

A medicaid managed care organization, prepaid inpatient health plan (as defined by the Secretary), prepaid ambulatory health plan (as defined by the Secretary), and, when appropriate, primary care case management entity (as defined by the Secretary) with a contract with a State that provides for coverage of specified speech therapy services (as such term is defined in section 1905(ll)) shall establish procedures to ensure compliance with the requirements of section 1902(a)(91).

; and

(D)in section 1937(b)—(i)in paragraph (1), in the matter preceding subparagraph (A), by striking paragraphs (5) and (6) and inserting the succeeding provisions of this subsection; and(ii)by adding at the end the following new paragraph:

(9)

Coverage of specified speech therapy services

Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless the individual has access, through such coverage or otherwise, to specified speech therapy services (as defined in section 1905(ll)) that are provided in accordance with the requirements of section 1902(a)(91).

(2)

CHIP

(A)

In general

Section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) is amended by adding at the end the following new paragraph:

(13)

Required coverage of certain speech therapy services

Beginning January 1, 2029, the child health assistance provided to a targeted low-income child and, in the case of a State that elects to provide pregnancy-related assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section) shall include coverage of specified speech therapy services (as such term is defined in section 1905(ll)).

(B)

Treatment parity

Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended—(i)by redesignating subparagraphs (I) through (W) as subparagraphs (J) through (X), respectively; and(ii)by inserting after subparagraph (H) the following new subparagraph:

(I)Section 1902(a)(91) (relating to parity in coverage of speech therapy services).