Policy Analysis: State Laws Bring Practice Changes Clinicians, take note: Changes to laws and regulations on telepractice, licensure, hearing aids, early intervention, newborn screening, and other professional and practice issues may affect SLPs and audiologists. Policy Analysis
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Policy Analysis  |   January 01, 2014
Policy Analysis: State Laws Bring Practice Changes
Author Notes
  • Janet Deppe, MS, CCC-SLP, is ASHA director of state advocacy. ·jdeppe@asha.org
    Janet Deppe, MS, CCC-SLP, is ASHA director of state advocacy. ·jdeppe@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   January 01, 2014
Policy Analysis: State Laws Bring Practice Changes
The ASHA Leader, January 2014, Vol. 19, 24-27. doi:10.1044/leader.PA1.19012014.24
The ASHA Leader, January 2014, Vol. 19, 24-27. doi:10.1044/leader.PA1.19012014.24
State Laws Bring Practice Changes
Clinicians, take note: Changes to laws and regulations on telepractice, licensure, hearing aids, early intervention, newborn screening, and other professional and practice issues may affect SLPs and audiologists.
BY JANET DEPPE
Many issues that concern audiologists and speech-language pathologists are regulated by states—education policy, licensure, insurance mandates and Medicaid, to name a few—so ASHA keeps an eye on state legislation and regulations related to insurance, education and other issues. In 2013, economic uncertainty continued to plague state legislators: Concerns about the states’ ability to fund education, health care and other programs led to few legislative victories and more oversight and restrictions by regulatory agencies.
Of the 1,298 bills relevant to ASHA members that were introduced in state legislatures, only 99 passed. These dealt with licensure and scope of practice, support of military spouses and active duty service members, volunteer services, telepractice, and hearing aid dispensing. States also adopted 141 regulations related to licensure, hearing aid dispensing, newborn hearing screening, telepractice, autism coverage mandates, early intervention and Medicaid.
Licensure legislation
Colorado’s S.B. 39 and S.B. 238 authorized regulation of the professions of audiology and hearing aid dispensing, which had been allowed to expire, and established conditions for licensure and activity related to the sale and delivery of hearing aids by dispensing audiologists and hearing aid dispensers.
North Dakota revised eligibility requirements for licensure as
In 2013, economic uncertainty continued to plague state legislators: Concerns about the states’ ability to fund education, health care and other programs led to few legislative victories and more oversight and restrictions by regulatory agencies.
an audiologist or SLP and the composition of the licensing board.
Texas (H.B. 595) reaffirmed provisions for licensure for audiologists and SLPs.
Virginia’s H.B. 2031 creates a provisional license for clinical fellows, leaving only nine jurisdictions (Colorado, Connecticut, D.C., Hawaii, Massachusetts, Nevada, New York, North Dakota and Pennsylvania) without this provisional licensure. New Mexico added additional requirements for CFs, conformed state licensure to national standards and created a bilingual/multilingual licensing endorsement that requires an active New Mexico license, a bilingual endorsement from the department of education, at least five years of practice and demonstrated proficiency in the specific language.
Other states, including Arizona, Arkansas, Maine and Oregon, revised their licensing laws and rules. Arizona extended the renewal period for licensure and increased the continuing education requirements. Among changes to the Arkansas licensing law is the addition of provisions for the audiology doctorate. Maine set a uniform quorum requirement for all of its licensing boards and
established an electronic system for renewal and distribution.
Oregon consolidated provisions related to certificate permits, licenses and related fees, and now requires licensees have continuing education related to cultural competence.
Licensure regulations
Colorado and South Dakota adopted rules to implement their licensure acts and several other states—Michigan, New Hampshire, New Jersey, Rhode Island, Tennessee and Texas—made technical changes to their practice acts.
Regulations governing speech-language pathology assistants were adopted in several states. Alabama and New Hampshire developed new guidelines; Florida created rules for certification and supervision; Louisiana now allows SLPAs to place their license on inactive status; Montana rules address supervisor responsibility, clarify supervision requirements and the function of assistants, and establish grounds for unprofessional conduct.
Scope of practice
West Virginia’s H.B. 2531 includes several important provisions, including revised qualifications
for speech-language pathology practice, waivers for individuals with credentials from other states that have substantially equivalent standards, and registration of and supervision requirements for assistants in audiology and speech-language pathology.
Illinois added swallowing to the occupational therapist scope of practice.
Military exemptions
Five states enacted laws related to military spouses and active duty service personnel. In Missouri, higher education institutions must accept credits for courses taken in military training if the courses meet certain standards for academic credit. Members of the military with active licenses when entering active duty remain in good standing throughout their
service: The license will renew at no charge and continuing education will not be required under certain circumstances.
Mississippi will issue licenses to military-trained applicants and military spouses will also be allowed to practice as long as certain conditions are met.
Tennessee’s S.B. 493 and Louisiana’s LAC 46 expedite the licensing process and grant temporary extensions of licensure for military personnel.
Wyoming will issue licenses to past and present military personnel and will consider military education and training as meeting certain requirements.
Volunteer services
Three states allow professionals to provide volunteer services. In Missouri, S.B. 129 allows
licensed health care professionals to provide volunteer health care services for a sponsoring organization, establishing an application process and limiting the liability of the health care provider. Nevada authorizes health care providers to offer voluntary services as appropriate; Oregon sets requirements for a volunteer health care provider registration system and authorizes the regulation of volunteer providers in an emergency.
Telepractice licensure
Ten states—Arkansas, Arizona, Indiana, Maryland, Missouri, Montana, Nebraska, Oregon, Vermont and West Virginia— passed telepractice legislation. Arkansas revised its practice act to include definitions for telepractice and the delivery of telepractice services. Mississippi requires health
insurance plans to provide coverage for telemedicine services. Montana’s S.B. 230 defines telepractice services and outlines telepractice scope and requirements. Oregon adopted uniform credentialing and privileging standards for telemedicine service providers. West Virginia requires a state license to provide telepractice services.
Telepractice regulations
Arizona, Indiana and Ohio adopted telepractice rules. The Ohio rules establish telepractice guidelines for speech-language pathology and audiology service delivery.
Truth and transparency Of nine states that considered “truth and transparency” legislation, only Nevada passed it. Supported by the American Medical Association, this type of legislation requires professionals—particularly those with doctoral degrees—to identify themselves to the public as doctors of their stated professions, such as doctor of audiology. Nonphysician health care professionals believe that “truth and transparency” legislation is unnecessary, redundant and designed to examine professional competence of other health professionals. The Nevada bill requires a health care professional to communicate certain information to current and prospective patients; prescribes the format for certain advertisements and disclosures; requires a health care professional to wear a name tag indicating his or her licensure or certification under certain circumstances; and subjects health care professionals to disciplinary action under certain circumstances.
Maine approved regulations prohibiting deceptive or misleading advertisements or misrepresentation of health care services and requires a health care provider to identify and display his/her level of licensure.
Hearing health provisions
Colorado amended its consumer protection act to include penalties related to deceptive trade practices; South Dakota established a 30-day trial period for hearing aids. Utah’s H.B. 46 removed the prerequisite hours of practice for obtaining a license as a hearing instrument specialist.
Illinois changed the definitions of hearing instrument and hearing aids, and authorized Internet hearing aid sales.
Hearing aid dispensing rules changed in several states. Iowa amended the examination requirements for hearing aid dispensers, Maryland requires hearing aid dispensing license applicants to complete a two-year post-secondary program (audiologists are exempted).
Missouri set a limit on the time hearing aid dispensers can complete the application process for licensure, and North Carolina abolished exam preparation course requirements.
Ohio, Pennsylvania and Wisconsin changed their newborn hearing screening regulations. Ohio and Pennsylvania made extensive changes to the guidelines for newborn hearing screening programs, and Wisconsin will create a fee system for newborn screening.
Music therapy
North Dakota adopted rules related to 2012 legislation to license naturopathic physicians and music therapists. No other music therapy licensing provisions were adopted.
Autism services coverage
California, Connecticut, Delaware, Texas and Washington adopted regulations for coverage of autism-related services. California’s S.B. 126 requires coverage of autism services and Connecticut retained its coverage of the services. Delaware created rules certifying autism service providers.
Early intervention
Arkansas, Colorado, Louisiana, New Hampshire, New York and Virginia added or changed early intervention regulations. Arkansas clarified the referral process; Colorado’s revised EI rules describe implementation of the full range of activities under federal law; New Hampshire added rules for complaint resolution; New York added language to evaluate Medicaid rates for preschool and school support services; and Virginia added certification requirements for early intervention case managers.
Medicaid
Florida updated Medicaid coverage limitations, Indiana adopted emergency regulations reducing the reimbursement rate by 5 percent, and Minnesota revised eligibility rules for service providers and requires documentation. Montana approved several changes to provider fee schedules and waiver programs. New Hampshire placed limitation on covered services, and Utah clarified that children ages 2–6 could receive Medicaid services under an autism waiver.
Arkansas’s S.B. 277 requires insurers to pay comparable reimbursement rates to physical therapists, occupational therapists, SLPs and physicians.
Other notable health care provisions include updates to the District of Columbia and Vermont health care exchanges/marketplace. Washington established scope and limitations to its essential health benefits packages.
Impaired practitioners
Although only Florida enacted legislation related to impaired practitioners, a growing number of states have begun to consider revising or adding additional language to their practice acts. FLSB 248 requires a person licensed or applying for licensure to comply with provisions governing treatment programs for impaired practitioners as outlined by the Division of Medical Quality Assurance. While economic growth continues at a slow, steady pace, state legislators remain wary of legislative initiatives that affect the state budget. Observers hope to see restoration of programs and reimbursement rates soon. ASHA will continue to monitor legislative and regulatory proposals in states and assist state associations and ASHA members to advocate for programs and services that will benefit members, consumers and the professions.Image Not Available
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January 2014
Volume 19, Issue 1