Question
I am a school-based SLP. If I receive a doctor's order for therapy for a student, do I have to provide it?
Answer
No, you do not. The provision of speech-language services in schools is an educational decision, not a medical decision. The physician has not done the assessment that you have done as a speech-language pathologist. That physician does not have the ability to observe in the classroom and relate the speech-language impairment back to the educational environment. By federal law, the decision can only be made by the eligibility team and cannot be made by a single individual, including the child's physician. However, the physician can serve as an invited member of the team. Wouldn’t it be great, as we are entering the era of interprofessional practice, if physicians, nurse practitioners, and physician assistants had the time to come and participate in meetings, or even participate by phone? Certainly, the medical report should be considered by the team, but there is no mandate that it should be followed. This can be challenging in some areas, because doctors’ orders do apply in another venue (i.e. insurance). Whether private insurance or public insurance, like Medicaid, the doctor's order is critical. If you are billing Medicaid for children that you serve in schools, your state Medicaid office is most likely going to require the physician’s order; but that physician’s order does not make the child eligible. It is just a requirement to meet the Medicaid eligibility requirements.
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