State of the States 2009 Gains Made in Legislation and Regulation, Challenges Remain Policy Analysis
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Policy Analysis  |   September 01, 2009
State of the States 2009
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.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   September 01, 2009
State of the States 2009
The ASHA Leader, September 2009, Vol. 14, 1-9. doi:10.1044/leader.PA2.14112009.1
The ASHA Leader, September 2009, Vol. 14, 1-9. doi:10.1044/leader.PA2.14112009.1
Despite uncertainty and tough economic conditions, states achieved a number of legislative and regulatory successes in 2009—and some defeats as well. Nine states remain in session, six through the end of the year.
Autism Coverage
Bills requiring health insurance to cover treatment for children with autism spectrum disorder (ASD) were introduced in 30 states. Of those 30, five states enacted laws requiring insurance coverage.
Legislation in Colorado, Connecticut, New Mexico, and Montana requires insurers to cover autism services including speech-language pathology. Montana’s S.B. 234 caps coverage at $50,000 per year for children 8 and under and at $20,000 for children 9–18. In Colorado, S.B. 244 provides coverage for assessment and treatment of ASD that is in addition to services provided under the Individuals With Disabilities Education Act (IDEA); treatment limits can be exceeded if medically necessary. New Mexico enacted legislation covering individuals with ASD through the age of 22 (annual maximum coverage of $36,000), including speech-language pathology services. On June 9, S.B. 301 was signed into law in Connecticut; it provides coverage for assessment and treatment of ASD, including services provided by a licensed speech-language pathologist.
Nevada’s A.B. 162 provides coverage for autism treatment—but requires that services provided by a certified SLP must be supervised by a licensed physician, psychologist, or behavioral analyst.
Salary Supplements
Two states obtained funding for state-wide salary supplements for school-based SLPs. Mississippi (the first state to provide salary supplements for school-based SLPs, in 1999), re-enacted legislation that awards a $6,000 annual salary supplement for SLPs, audiologists, and counselors in schools. Arkansas is also awarding $2,500 annual bonus for ASHA-certified SLPs in state public schools (H.B. 1149).
Speech-Language Pathology Assistants
Washington passed a comprehensive licensure bill (H.B. 1631) for speech-language pathology assistants. The legislation includes minimum qualifications, defines the amount and level of supervision required, and identifies the tasks and procedures an assistant is competent to perform.
Hearing Aid and Cochlear Implant Coverage
Three states—Indiana, Arkansas, and Wisconsin—passed legislation providing coverage of hearing aids. H.B. 1311 in Indiana provides a hearing aid assistance fund and authorizes the state’s health department to help eligible children pay for the devices (up to $1,500).
Arkansas legislation requires health plans to offer hearing aid coverage of not less than $1,400 per ear every three years.
Wisconsin passed landmark legislation (S.B. 27) requiring insurers to cover the cost of hearing aids and cochlear implants prescribed by a physician or audiologist for a child under 18 years of age. Coverage also includes services, procedures, surgery, and treatment related to the hearing aid or cochlear implant. This legislation—covering not only the cost of the device but associated services—is the first of its kind in the nation.
Oregon passed legislation providing hearing aid coverage for children and for young adult dependents enrolled in college.
Louisiana passed legislation (H.B. 257) that adds hearing aid dispensing to audiologists’ scope of practice; Delaware enacted S.B. 170, which updates the audiology practice definition to include hearing aid dispensing without having to meet licensure requirements for hearing aid dispensers. With those measures, 34 states now allow audiologists to dispense under their own licenses.
Telehealth/Telepractice
Maine, New Hampshire, Oklahoma, and Washington added measures to existing laws covering telepractice by SLPs, and Kentucky added telepractice provisions to their state regulations. Maine’s amended bill (L.D. 1073) stipulates that a health plan may not deny coverage for health care services provided through telepractice if those services would be covered by the carrier if they were provided in person, and further provides that coverage for telepractice must be consistent with coverage for health care services provided in person (see sidebar).
Under the “SoonerCare” Medicaid program in Oklahoma, beneficiaries and providers in rural and underserved areas may opt for delivery of services via telepractice. Oklahoma has identified schools as originating sites eligible to bill Medicaid for a facility fee.
New Hampshire’s Telemedicine Act requires insurance coverage for telepractice to be consistent with coverage provided for in-person services. Washington’s H.B. 1529 stipulates that home health services delivered through telepractice must meet the criteria of medical necessity and will be covered by the state’s Medicaid plan.
Early Intervention Services
Colorado’s H.B. 1237 provides for a comprehensive, coordinated system of payment among state and federal funds and private health insurance plans for early intervention services for children from birth through 3 years of age who have developmental disabilities or delays and are eligible for IDEA Part C benefits.
This bill:
  • Clarifies that mandatory coverage for early intervention services includes contracts for health insurance and renewed plans.

  • Requires private plans to increase the rate paid for early intervention services if the base rate for state-funded early intervention services increases by more than the cost-of-living adjustment.

  • Creates an exception to the cap on the annual limit for early intervention services for post-surgical rehabilitation or therapeutic services.

  • Directs that private plans pay for services prior to the use of state or federal funds.

  • Bans insurers from terminating coverage, refusing to deliver services, or failing to renew coverage because a child accesses the benefits to receive services.

  • Requires all private plans to make benefits payments to the state’s early intervention services trust fund and sets deadlines for payments.

Salary Increases for School-Based SLPs
Texas bill 461, a sweeping budget bill, included an $80 monthly salary increase (or an amount equal to the product of $60 multiplied by the number of students in weighted average daily attendance) for each classroom teacher and full-time SLP, librarian, counselor, and school nurse.
Voluntary Immunity from Liability
Texas, Utah, and Oklahoma passed bills giving SLPs and audiologists immunity from civil liability for any act or omission resulting in harm to a patient if the clinician was acting in good faith and within the scope of his or her duties; carried out the act or omission in the course of conducting an assessment or screening; and was providing services within the profession’s scope of practice.
Dyslexia/Academic Language Therapist Licensure
Despite opposition from ASHA and ASHA members in Texas, H.B. 461 was signed into law by Governor Perry on June 19. This legislation, which provides for the regulation and licensure of dyslexia and academic language therapists, specifically states that school districts are not required to employ a person licensed as a dyslexia therapist and may not authorize a person to practice audiology or speech-language pathology unless licensed as an SLP or audiologist.
Licensure Updates
Both the District of Columbia and Michigan are developing regulations for new licensing requirements for SLPs. Updated information about the establishment of the licensing board, promulgation of the rules, and application procedures for Michigan can be found on the Michigan Speech Hearing Language Association’s Web site and for D.C. on the DC Speech-Language-Hearing Association’s Web site.
The Pennsylvania Speech-Language-Hearing Association introduced a bill (H.B. 1653) to update licensure laws for SLPs and audiologists. The bill revises and adds definitions; provides new language for creation, appointment, terms, officers, and duties of the Board; requires all persons newly employed by a school to hold a valid license issued by the Board; provides a workload formula for schools; requires audiology applicants to possess a doctoral degree beginning Jan. 1, 2012; and provides for waivers and provisional licensure. With passage of the bill, Pennsylvania would become the 16th state to have comprehensive licensure and the first to include workload language in licensing provisions.
Regulatory Trends
In their efforts to reduce budget shortfalls, a number of states—including California, Georgia, Minnesota, Michigan, and Massachusetts—have regulatory proposals pending to reduce or eliminate certain services under state insurance plans, including Medicaid. These proposals include reduction or elimination of speech-language and audiology services. ASHA has sent letters of opposition to these proposals and helped states activate grassroots advocacy opposition through ASHA’s e-advocacy network.
The California Teaching Commission has proposed a new credential, the Communication Development Credential (CDS), requiring a bachelor’s degree plus one year in an educationally relevant field. This credential was created in response to the shortage of certified school-based SLPs. CDS-credentialed individuals would be eligible to provide assessment and intervention for all non-medical services (defined by the commission as language-related, including autism), but not for articulation, fluency, or voice disorders (defined as medical services and therefore under the purview of an SLP). Both the California state association and ASHA strongly oppose the creation of the CDS credential and continue to work together to offer alternatives. For more detailed information, including how to provide comments, go to the California Speech-Language-Hearing Association’s Web site and click on the California Teaching Commission.
Despite the tough economic climate, states have had some regulatory and legislative success in 2009, but more challenges related to reduction in benefits, reimbursement, threats to professional standards, and potential job loss are expected. ASHA continues to work with state associations to advocate for high standards and quality services for all consumers.
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September 2009
Volume 14, Issue 11