Hits, Misses in 2011 Practice Regulations In a legislative success unusual in the current economy, New York state expanded Medicaid services to people with traumatic brain injury by eliminating limits on the number of visits for speech-language and other treatment. This victory, achieved with legislative advocacy from the New York State Speech-Language-Hearing Association, was unique—other states ... Policy Analysis
Free
Policy Analysis  |   November 01, 2011
Hits, Misses in 2011 Practice Regulations
Author Notes
  • Janet Deppe, MS, CCC-SLP, director of state advocacy, can be reached at jdeppe@asha.org.
    Janet Deppe, MS, CCC-SLP, director of state advocacy, can be reached at jdeppe@asha.org.×
  • Susan Adams, JD, director of state and regulatory advocacy, also contributed to this article.
    Susan Adams, JD, director of state and regulatory advocacy, also contributed to this article.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2011
Hits, Misses in 2011 Practice Regulations
The ASHA Leader, November 2011, Vol. 16, 1-21. doi:10.1044/leader.PA1.16142011.1
The ASHA Leader, November 2011, Vol. 16, 1-21. doi:10.1044/leader.PA1.16142011.1
In a legislative success unusual in the current economy, New York state expanded Medicaid services to people with traumatic brain injury by eliminating limits on the number of visits for speech-language and other treatment. This victory, achieved with legislative advocacy from the New York State Speech-Language-Hearing Association, was unique—other states added treatment caps and reduced reimbursement rates for speech-language and audiology services, reflecting a national trend as states struggle to balance budgets.
Overall, much of the new state legislation passed and regulations implemented in 2011 have minimal impact on members’ day-to-day practice. ASHA staff reviewed 1,091 pieces of proposed legislation and 307 proposed regulations related to speech-language pathology and audiology practice. Of those, 85 legislative bills passed and 163 regulations were adopted as of mid-October of this year. A summary of some of the major changes follows.
Legislative Successes
Montana (S.B. 132) allows audiologists to dispense hearing aids without a separate hearing aid dispenser license. Thirty-eight states now allow audiologists to dispense under their own licenses.
North Dakota (S.B. 2115) amended the composition and compensation of the licensing board and requires a doctoral degree for audiology practice. Twenty-five states have amended their licensing requirements to include a doctoral degree for audiology.
Texas (S.B. 662) prevented the expiration of the State Board of Examiners for Speech-Language Pathology and Audiology under Chapter 325 Government Code. Texas Speech-Language-Hearing Association members worked closely with legislative staff and others to ensure that the state licensing board would continue operations.
Regulatory Success
The District of Columbia Department of Health adopted a rule to establish licensing requirements for audiology (17 DCMR, Chapter 78).
Missouri, Oklahoma, and Pennsylvania adopted licensing provisions for behavioral analysts and behavioral analyst assistants, who often provide behavioral therapy for children with autism spectrum disorders (ASDs). In the wake of mandated insurance coverage for autism services in more than half of the states, many have adopted rules governing behavioral analyst practice. State associations and state licensing boards remain concerned that rules governing the scope of practice of these providers may infringe on the scope of speech-language pathologists and audiologists providing needed communication treatment for individuals with ASDs.
A Maine (10-144 CMR Chapter 101, Chapter II, Section 109) rule clarifies that unlicensed speech and language clinicians (Certificate 293 holders) are not qualified to provide Medicaid services. This rule change was made to ensure compliance with federal Medicaid regulations.
Licensing Laws
California (S.B. 933) repealed its hearing aid dispensing law and includes its provisions in the renamed Speech-Language Pathologists and Audiologists and Hearing Aid Dispensers Act (formerly the Speech-Language Pathologists and Audiologists Licensure Act). The new act includes licensing, regulatory, and disciplinary provisions applicable to hearing aid dispensers.
Idaho (H.B. 47) added provisions to provide for licensure by endorsement, which allows individuals who hold licensure from other states to obtain licensure in Idaho by presenting their credentials, provided those credentials are substantially the same as the Idaho requirements. Licensure by endorsement helps eliminate barriers for SLPs and audiologists moving from one state to another.
Indiana’s H.B. 1273 allows speech-language pathology personnel who hold a life license from the Indiana state department of education to supervise speech-language pathology support personnel. This law removes the requirement for supervisors to hold the Certificate of Clinical Competence and eliminates the provision for supervisors to have a minimum of three years of clinical experience.
Tennessee’s S.B. 1262 prohibits audiology graduate students at public universities from evaluating, prescribing, or dispensing hearing aids.
Texas approved S.B. 613, which amends the Occupations Code to require an audiology license applicant to have at least a doctoral degree in audiology or a related hearing science from a program (accredited by a national accrediting organization approved by the state) in an institution recognized by the U.S. secretary of education as an accredited or approved college or university. It also specifies that the master’s degree required of an applicant for licensing as a speech-language pathologist must be from a program accredited by such an approved and recognized organization in an accredited or approved college or university.
Licensure/Scope of Practice
Reflecting a growing trend by state licensing boards, Delaware adopted rules to identify and establish a method for addressing fraud and abuse and for carrying out resultant disciplinary actions.
The Texas Board established procedures to evaluate the criminal history of audiology and speech-language pathology licensure applicants.
Illinois [Hearing Instrument Protection Code (77 Ill. Adm. Code 682)] and Iowa (645 IAC Chapter 121–124) amended hearing aid dispensing rules on supervision and continuing education requirements.
Maryland increased the number of continuing education requirements from 20 to 30 hours within two years for SLPs, audiologists, and hearing aid dispensers (COMAR 10.41.03, 10.41.08).
Ohio’s Board of Speech-Language Pathology and Audiology adopted rules addressing definitions and procedures for accessing confidential information.
Oregon’s Board of Examiners created rules clarifying the requirement that only licensed SLPs may supervise speech-language pathology assistants.
Wisconsin’s Hearing and Speech Examining Board issued a notice of intent to include an ethics continuing education requirement for audiologists, SLPs, and hearing aid dispensers.
Health Care and Insurance
States passed 37 pieces of legislation and adopted 104 regulations related to health care and insurance.
Arkansas (H.B. 1315), Rhode Island (H.B. 5275), Virginia (H.B. 2467), and West Virginia (H.B. 2693) passed legislation requiring insurers to provide coverage for ASDs. Illinois’ H.B. 1530 requires that insurers who provide coverage for ASDs must include those same provisions for other mental health services (mental health parity). Four states—Alaska, Delaware, South Dakota, and Wyoming—do not have specific insurance coverage mandates for ASDs and either have no mental health parity law or the mental health parity law does not include ASDs as a covered mental illness.
Georgia, North Carolina, and Tennessee passed legislation related to insurance coverage of hearing aids. Georgia’s H.B. 168 exempts sales of hearing aids from sales tax, North Carolina’s S.B. 323 made changes to the hearing aid law, and Tennessee mandated coverage of hearing aids for children (H.B. 761).
Missouri adopted rules related to insurance coverage of ASDs, including definitions of behavioral analysts, licensure, education and training requirements, and supervisory guidelines.
Many states reduced Medicaid expenditures to balance state budgets:
  • Montana lowered reimbursement rates by 2% for Early and Periodic Screening Detection and Intervention (EPSD) and other services to Medicaid providers, including SLPs.

  • Indiana adopted emergency rules that modify the Medicaid reimbursement formula to place limits on covered occupational therapy, physical therapy, and speech-language services and to reduce rates paid to providers (405 IAC 1-11.5-2 and 405 IAC 5-16-6).

  • Nebraska emergency rules stipulate a reduction of 2.5% to Medicaid providers.

  • Washington adopted rules that place limits on occupational therapy, physical therapy, and speech-language services, eliminate optional services for adults, and eliminate the hearing aid benefits for adults.

  • In Vermont, an emergency rule limits covered visits to 30 per year per approved service.

  • South Carolina adopted rules that reduce reimbursement rates by 3% and limit combined speech-language, occupational therapy, and physical therapy services to 75 hours per individual per year.

  • The Louisiana Department of Health and Hospitals issued emergency rules to reduce reimbursement rates paid for certain EPSD health services.

  • Oklahoma revised billing, service delivery, and coding of service rules to clarify “team therapy” guidelines for Medicare recipients.

  • The Texas Health and Human Services Committee (HHSC) proposed rules concerning school-based Medicaid, early childhood intervention services, and service limitations for speech-language services.

  • Kentucky (907-KAR1:715) now requires SLPs to hold both a current Board of Examiners license and the Certificate of Clinical Competence (CCC) from ASHA to be eligible as approved service providers for Medicaid-eligible children.

Education
States adopted 19 pieces of legislation and 14 regulations related to education.
Arkansas (H.B. 1819) specifies the date that the state department of education must pay the salary supplement to school-based SLPs.
Florida (H.B. 1255) requires that students whose Individualized Education Program includes assistive technology must receive devices within 60 days.
Maine (L.D. 129) requires the state department of education to accept Board of Examiner-licensed SLPs as meeting the requirements for education practice.
Although 2011 was a busy year for state legislators and regulators, few positive changes were seen. State legislatures and regulators focused on reducing program costs through a variety of measures. State associations, members, and consumers hope to see restoration of programs, services, and reimbursement rates. ASHA will continue to monitor state legislative and regulatory issues and advocate for programs, services, and reimbursement rates that benefit clinicians and their clients.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
November 2011
Volume 16, Issue 14