Clarifications for the inclusion of speech pathologists in GESS

Clarifications for the most recent additions of specialties to the list of GESS and specifically for the inclusion of speech pathologists that took place at the beginning of March 2021, in the context of the completion of the XNUMXnd phase of the System, is given by the Health Insurance Organization (OAY).

It is specifically mentioned that speech therapists, upon joining the GESS, offer services to both children and adults, with their list of activities including four different activities.

It is added that in the first phase of the procedure, the possibility to issue referrals for the speech pathologists of GESS have doctors belonging to the specialties of gastroenterology, geriatrics, medical genetics, neurology, pathology, pediatrics, child psychiatry, pulmonology, pathology, pathology medicine and rehabilitation, psychiatry and otolaryngology, as well as doctors specializing in intensive care, pediatric neurology and neonatal intensive care.

The referrals issued by the specialists refer to 3 or 6 sessions with the right of renewal, depending on the maximum number of defined sessions to which the beneficiary is entitled, based on his needs within the GESS, it is specified in the announcement.

It is also mentioned that for beneficiaries over 12 years old, the maximum number of sessions they are entitled to through GESS is set at 9, for each symptom, while for children up to 12 years old, up to 18 sessions per symptom are provided.

According to the announcement, the Health Insurance Organization has compiled a list of situations (symptoms) which may receive speech therapy services from a specialist. These include dysarthria, stuttering, hoarseness, eating disorders in infancy and childhood, etc.

The announcement clarifies that a speech therapist, contracted with GESS, has the ability to provide services outside the System, as long as they are not included in those reimbursed by the Organization, however he must inform the beneficiary that these services are out of scope and are not reimbursed. the same applies in cases where the beneficiary has exhausted the maximum number of visits to which he is entitled, as defined by the Agency.

Also, a speech therapist has the opportunity, if he chooses, to provide services during the weekend, however the Organization emphasizes that it is important that the treatments have a reasonable total duration, within the same day, in order to ensure the provision of quality health care services to the beneficiaries, is added in the relevant announcement.

Finally, OAY clarifies that with regard to home visits, the provision of home care services is not included in the agreed service package but however if the beneficiary's situation is such that there is no other option, the provider has the option to and be reimbursed by the Agency on the basis of the activities included in the existing package of services.