State of the States 2006 Legislatures Address Qualified Providers, Early Hearing Detection, and More Policy Analysis
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Policy Analysis  |   August 01, 2006
State of the States 2006
Author Notes
  • Charlie Diggs, was ASHA’s director of state and consumer advocacy.
    Charlie Diggs, was ASHA’s director of state and consumer advocacy.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   August 01, 2006
State of the States 2006
The ASHA Leader, August 2006, Vol. 11, 1-41. doi:10.1044/leader.PA.11102006.1
The ASHA Leader, August 2006, Vol. 11, 1-41. doi:10.1044/leader.PA.11102006.1
You have just entered a new state that has no laws, but where all drivers move at 65 mph on the interstate, slowing down to 55 mph in crowded metropolitan areas. All citizens contribute according to their means to fund health, education, welfare, safety, and transportation programs, even to the point where it hurts a little. Rights of others are always respected, and differences of opinion are always worked out by open and honest discussion.
Yes, you are in the state of Nirvana. It has no laws because residents fully embrace all values of this society on a voluntary basis. In any other state, however, laws are needed to reinforce societal values that have not been completely upheld by free will alone.
This year, state legislatures have spoken loudly about many values related to audiology and speech-language pathology in the laws they have passed. They listened attentively to persistent messages they heard from state speech-language-hearing associations and the state associations’ lobbyists. They also listened to individual professionals who are their constituents and made the time to express their opinions on needed changes. Then the legislatures acted on issues identified by ASHA members, and here is what state lawmakers had to say.
Qualified providers
Children and adults need qualified audiologists and speech-language pathologists to provide necessary services.
As a result of revisions to their licensure laws, Alabama (via S.B. 26) and Georgia (via H.B. 1112) join four other states in requiring a doctoral degree rather than a master’s to provide audiology services. Alabama will institute this requirement for new applicants whose degrees are earned and conferred after Jan. 1, 2007. Applicants with earlier degrees may qualify for licensure with a master’s degree, no matter when they apply, but applicants with degrees after this date must have a doctorate. New Mexico has similar language in its licensure law that was revised last year.
In Georgia as well as in Indiana and Oklahoma, a doctoral requirement applies to all new applicants for licensure after Jan. 1, 2007, irrespective of graduation date. Ohio has a similar requirement that took effect this year. ASHA’s mandate for a doctoral degree in audiology for its Certificate of Clinical Competence begins in 2012.
Scope of Practice
Current laws unnecessarily restrict the scope of practice of audiologists and SLPs and need to be changed to increase consumer access to services.
California currently views suctioning as outside the practice of speech-language pathology. Also, a flexible fiberoptic endoscope can be used only by an SLP under the direct authorization of a board-certified otolaryngologist and the supervision of a physician in an acute care hospital. S.B. 1285 would change these restrictions in the state to allow suctioning by an SLP after compliance with a medical facility’s training protocols and to permit an SLP’s use of an endoscope upon any physician’s request and the general supervision of a physician or a medical director. This bill would also expand settings in which an SLP may use an endoscope to medical facilities that have protocols for emergency medical backup. The California Senate has already passed this bill, but the House needs to concur and the governor needs to sign the bill before it becomes effective.
Speech-Language Pathology Assistants
Other personnel may assist SLPs, but assistants need to meet certain minimum requirements, perform only certain tasks, and practice only under the direction and supervision of an SLP.
Arizona and New Hampshire have joined the 33 states that already regulate the use of support personnel by audiologists, SLPs, or both. In both states, speech-language pathology assistants who meet certain requirements may perform certain tasks but only under the direction and supervision of an SLP.
The New Hampshire law, as presented in S.B. 252, requires the licensing board to develop minimum qualifications, direction, and supervision requirements, and scope of permissible tasks for speech-language pathology assistants. Qualifications must include a minimum of a two-year associate’s degree granted by an accredited speech-language pathology program approved by the board. The new law does not apply to speech-language pathology assistants in the schools.
The Arizona law (S.B. 1379) provides greater detail. After Sept. 1, 2007, applicants must have 60 semester credit hours with 20-40 of these hours in general education and 20-40 hours in speech-language pathology technical coursework. In addition, a minimum of 100 hours of supervised clinical interaction is needed. Ten specific activities are authorized for speech-language pathology assistants, including following written lesson plans developed by the supervising SLP, collecting data on progress without interpretation, and second language interpreting. Fourteen activities are specifically prohibited including swallowing assessment and intervention, formal or informal evaluations, referral for additional services, and performing any task without the express knowledge and approval of the supervising SLP. A minimum of 30% supervision (20% direct, 10% indirect) by the SLP is required during the speech-language pathology assistant’s first 90 days of employment. Thereafter, 20% supervision (10% direct and 10% indirect) is required.
Salary Supplements
ASHA-certified SLPs and audiologists must meet rigorous standards of quality. We reward master teachers in our schools with an annual salary supplement and should do the same for school audiologists and SLPs who hold the CCC. It is children who will benefit.
Thanks to successful legislation this year, ASHA-certified audiologists and SLPs who work in Oklahoma, Rhode Island, and West Virginia schools can look forward to higher salaries in the 2006–2007 school year. In Oklahoma, S.B. 3XX appropriated more than $1.7 million dollars into a revolving fund to provide a $5,000 annual salary supplement for school-based SLPs and audiologists with ASHA certification. The Oklahoma legislature approved the concept in 2004, but did not provide appropriations to implement the law until this year. The Rhode Island 2007 budget bill (H.B. 7120, Substitute A as amended) provides a $1,750 salary supplement for licensed SLPs employed in the schools who hold ASHA’s CCC. Because of H.B. 4077, school SLPs and audiologists with the CCC in West Virginia will receive a $2,500 annual salary supplement. The bill limits awards for the first year to no more than 100 audiologists, SLPs, and school guidance counselors, who were also included in the legislation. Eligible recipients will be prioritized according to length of time certification has been held, years of experience, and other factors to be determined by regulations.
These three states were targeted for special assistance from ASHA in their salary supplement efforts as part of the 2001–2004 ASHA Focused Initiative on Schools. State speech-language-hearing associations in these states received concentrated technical assistance and some financial support from ASHA, increased their skills in political advocacy, and continued to move their agendas forward after this Focused Initiative was complete. It is estimated that these laws will ultimately increase school salaries for CCC holders in these three states by a total of $4.8 million dollars per year. When similarly successful salary supplement legislation in Delaware, Indiana (specified school districts only), Mississippi, Missouri (specified school districts only), and Nevada is added to the calculations, the sum rises to more than $12 million per year. Like Oklahoma, Louisiana in 2003 and Arkansas in 2005 have already approved the concept of a salary supplement but still have not found funds for implementation.
Beginning July 1, licensed audiologists and SLPs in Maryland who provide services on a third-party billing basis in the schools will receive reimbursement from their county school system for their initial licensing fee or for their renewal fee. The Maryland state Board of Audiologists, Hearing-Aid Dispensers, and Speech-Language Pathologists will adopt regulations to implement and administer the program.
Hearing Loss in Children
Hearing loss is a serious problem, especially for children, and should be diagnosed and treated early.
This year Alaska became the 40th state (plus the District of Columbia) to enact a law requiring that newborn babies be screened for hearing loss. Five other states have no infant screening laws but still screen 95% or more of newborns through voluntary programs. Only Michigan, Minnesota, South Dakota, Vermont, and Washington do not have a law and do not meet the 95% voluntary compliance criterion.
The new Alaska law also requires follow-up evaluation for those who fail screening, reporting individual results to the health department and intervention services. A community outreach and awareness campaign must be conducted, and health care insurers that cover pregnancy and childbirth services must also cover both the screening and follow-up evaluation.
Recognizing the important role that early amplification can play for many children with hearing loss, multiple states in the last several years introduced or carried over bills that would require health insurance coverage for children’s hearing aids. These states include California, Illinois, Maine, Massachusetts, New Jersey, New York, South Carolina, and Tennessee. Although details vary by state, the bills typically require payment for hearing aids up to $1,000–$1,400 for each impaired ear, define children as younger than between 15 and 21 years, usually restrict payment to once in a three-year period, and allow insurees to purchase more expensive hearing aids and pay the difference in cost without penalty to the insuree or to the provider.
Such legislation faces strong opposition from insurance companies who argue that insurance mandates drive up the cost of health insurance and, no matter how small the increase, result in even more Americans becoming medically uninsured. Of all the bills being considered for new mandates, the California bill has moved the farthest. It has passed through the Senate and is now in the Health Committee of the Assembly.
Rhode Island has expanded its existing mandate for hearing aid coverage (S.B. 2382). As the only state that requires insurers to cover hearing aids for both children and adults, Rhode Island previously required $400 coverage per hearing aid per ear every three years. Effective immediately for new and renewed health plans, coverage must be expanded to $1,500 for persons under 19 years of age and to $700 for everyone else. Some form of insurance mandates for children’s hearing aids already exist in Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri, and Oklahoma.
New York is considering a different change in hearing aid reimbursement policy. Currently, New York Medicaid does not pay for digital hearing aids, denying Medicaid recipients access to the range of digital features such as gain processing, feedback and noise reduction, and speech enhancement that can provide significant benefit. H.B. 10994 and S.B. 7422 would change this policy by requiring Medicaid to pay for digital hearing aids. To date, both bills have only been introduced and referred to committee as the initial step in the long legislative process of transforming a bill into a law.
Reimbursement
There should be health insurance mandates for designated speech-language pathology services.
Illinois H.B. 4125 now requires that group health benefit plans after Jan. 1, 2007, provide an additional 20 outpatient visits specifically for speech-language pathology treatment for pervasive developmental disorders. These visits are in addition to any authorized visits under the policy’s general outpatient therapy benefit.
If you live in any state other than Nirvana, you may need to make sure that you have laws that reflect these and other values related to audiology and speech-language pathology.
Louisiana Issues Disaster Preparedness Rule for Clinicians, Assistants

In response to legislation signed by Gov. Kathleen Blanco, the Louisiana Board of Examiners for Speech-Language Pathology and Audiology (LBESPA) promulgated an emergency rule to implement temporary registration for audiologists, speech-language pathologists, and speech-language pathology assistants during a public health emergency. The rule allows out-of-state audiologists, SLPs, and speech-language pathology assistants who hold appropriate unrestricted licensure in another state to provide gratuitous services in Louisiana. The time period is not to exceed 60 days, with the potential extension of up to two additional periods not to exceed 60 days each. Initially promulgated as an emergency rule, it will remain in effect for 120 days. LBESPA plans to promulgate it as a final rule.

As part of the governor’s legislation, a system also must be in place to safeguard the current database of licensees with a hard copy of current Louisiana licensees to be taken offsite should the regular office site be affected.

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August 2006
Volume 11, Issue 10