State of the States 2003: A Special Report With states facing dire deficits and continued economic uncertainty, state associations and their members continue to press for licensure, salary supplements for school-based clinicians, hearing health, and other advances for the professions of speech-language pathology and audiology. Grassroots advocacy led state legislatures to consider these issues during their 2003 sessions. ... ASHA News
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ASHA News  |   July 01, 2003
State of the States 2003: A Special Report
Author Notes
  • Charlie Diggs, is ASHA’s director of state and consumer advocacy.
    Charlie Diggs, is ASHA’s director of state and consumer advocacy.×
Article Information
Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / School-Based Settings / Professional Issues & Training / Regulatory, Legislative & Advocacy / ASHA News
ASHA News   |   July 01, 2003
State of the States 2003: A Special Report
The ASHA Leader, July 2003, Vol. 8, 6-7. doi:10.1044/leader.AN2.08132003.6
The ASHA Leader, July 2003, Vol. 8, 6-7. doi:10.1044/leader.AN2.08132003.6
With states facing dire deficits and continued economic uncertainty, state associations and their members continue to press for licensure, salary supplements for school-based clinicians, hearing health, and other advances for the professions of speech-language pathology and audiology. Grassroots advocacy led state legislatures to consider these issues during their 2003 sessions.
Some states realized full legislative victories this year—Minnesota enacted a licensure law, and Louisiana passed separate bills supporting school salary supplements and providing hearing aid benefits for children—and others achieved more incremental successes, paving the way for future changes in state public policies.
Licensure
Effective July 1, Minnesota upgraded the regulation of audiology and speech-language pathology from registration to licensure after a more than 35-year effort. Licensure provides more protection to consumers than registration, requiring that anyone who practices audiology or speech-language pathology obtain a state license. Registration only requires that persons who use specified titles register with the state.
The new Minnesota law (S.F. 333) is modeled after the state’s former registration law. Specific coursework requirements have been deleted and replaced with the requirement that graduate coursework and clinical practicum be completed at an institution with a program accredited by ASHA’s Council of Academic Accreditation in Audiology and Speech-Language Pathology, or its equivalent. Professionals with an ASHA Certificate of Clinical Competence (CCC) may apply for a Minnesota license by equivalency.
With Minnesota, 47 states now license audiologists and 46 states license SLPs. South Dakota licenses audiologists only, Colorado regulates only audiologists through registration, and the District of Columbia, Idaho, and Michigan do not regulate either profession.
These numbers may rise more by the end of the year. Last month, the Michigan Senate passed a bill (S.B. 206) to license audiologists that was then forwarded to the House Committee on Health Policy. The bill would require audiologists to hold a master’s degree, pass a national examination, and complete at least nine months of clinical experience, or to hold a doctoral degree and pass a national examination. If the House passes the bill, a second bill will be considered to allow audiologists to dispense hearing aids without needing a separate hearing aid dealer license. A third bill to license SLPs is in the works.
Several other states have enacted additional licensure-related legislation. Arizona passed a bill (S.B. 1309) removing the maximum allowable fee, currently $50, for an original license and for license renewal, thus giving the Department of Health Services the freedom to set fees as necessary. South Dakota repealed the requirement for registration of audiology aides. Tennessee will now accept an AuD degree and passing of a national examination for licensure (S.B. 509). Utah formed a committee to study the possible elimination or combination of licensure boards in the state, including the speech-language pathology and audiology board (S.B. 67).
Although not yet final, persons engaging in their supervised professional experience as an SLP in Illinois may soon have to obtain a temporary license. S.B. 684 also includes authorization for up to 90 days of practice by an SLP or audiologist while a state license application is being considered, or if the individual holds the ASHA CCC and a valid license from another state.
Salary Supplements
Seven state associations supported legislation this year to provide additional salary to school-based audiologists and SLPs who hold the ASHA CCC. Delaware, Georgia, Louisiana, Nevada, Oklahoma, Rhode Island, and West Virginia are all trying to emulate Mississippi’s 1999 success, which obtained an extra $6,000 per year for the state’s qualified school-based clinicians. Members in these states testified before committees, visited legislators, and wrote repeatedly to their legislators and key committee members.
In 32 states, teachers certified by the National Board for Professional Teaching Standards (NBPTS) receive an annual salary supplement or have received a one-time incentive. State associations are seeking similar supplements for school-based practitioners who hold the ASHA CCC, which is based on standards that meet or exceed those of the NBPTS. A successful salary supplement initiative will need to convince education committees in both chambers of a state’s legislature of the CCC’s value, the benefit of a salary supplement in recruiting and retaining qualified clinicians, and the difference that these qualified providers make in the education of the state’s school children. In addition, the current state budget deficits increase the difficulty of convincing a state legislature to fund such supplements.
While the road to a salary supplement can be long and arduous, persistence pays off. On July 1, Louisiana Gov. Mike Foster signed H.B. 1317 into law. The bill endorses a $5,000 annual salary supplement for school-based SLPs and audiologists who hold a State Department of Education credential, state license, and ASHA CCC. The full supplement would be implemented over a three-year period. The legislature still needs to appropriate the needed funds during its next session.
Rhode Island convinced its legislature to pay ASHA CCC application fees, but the bill (S.B. 217) still needs the governor’s signature. Other state associations achieved salary supplement victories in only one legislative chamber, but will continue to push forward in the next session. The Nevada Assembly passed a bill (A.B. 268) to allow local school districts to pay an additional 5% salary to SLPs who hold the ASHA CCC and a state license, but the bill was still in Senate committee when the legislature ended its regular session for the year. Bills in Georgia, Oklahoma, and West Virginia were introduced, but the political climate was such that they moved no further. The latter two states, as well as Rhode Island, continue to work with ASHA’s State Education Action Team to continue their salary supplement advocacy efforts. (Watch The ASHA Leader for an update on the activities of the State Education Action Team and partner states.)
Recently, recognizing the severity of states’ budget problems, Congress provided states with a one-time, $20-billion relief as part of the tax cuts signed into law by President Bush. However, half of these funds are earmarked for Medicaid, and states are expected to use the rest of the money to delay further cuts in services, not to fund new initiatives.
So, where will the money for future salary supplements come from? The Delaware and Nevada associations—with assistance from ASHA’s state policy unit, which documented annual federal IDEA contributions to their states—have pointed to federal contributions to IDEA that more than doubled from 1998 through 2002. Additional IDEA increases are predicted for the future as Congress strives to fulfill its promise of fully funding this key special education program. The argument is that the money is there—it’s just a question of priorities.
Hearing Health
For the fourth year in a row, a dozen or more states introduced legislation to require health insurers to pay for hearing aids. These bills were fairly evenly divided between required coverage for children and coverage for both children and adults. As in previous years, few of these bills made it through the legislature. Others have been stopped by insurance industry opposition to mandated health benefits or state budget concerns arising from increased insurance premiums for programs like state employee health plans.
Again, Louisiana can claim the biggest victory. Gov. Foster also signed into law S.B. 408, requiring any new health insurance policy after Jan. 1, 2004—and any existing policy on or before its renewal date but no later than Jan. 1, 2005—to cover hearing aids for children under 18 years of age if the aids are fitted and dispensed by a licensed audiologist or hearing aid specialist. Benefits may be limited to $1,400 per ear with hearing loss every 36 months. An insuree may purchase a more expensive hearing aid and pay the difference to the hearing aid provider. Louisiana joins Connecticut, Kentucky, Maryland, Missouri, and Oklahoma as the sixth state with a hearing aid benefit for children.
Illinois passed into law a more limited bill (H.B. 1031) that allows the coverage of hearing evaluations, hearing aids, and the dispensing and fitting of hearing aids as part of the State Employees Group Insurance Act only. Additional bills on hearing aid coverage could be passed later this year in states like California, Massachusetts, New Jersey, and New York, where legislatures are still meeting.
Early hearing detection and intervention (EHDI) legislation also succeeded in two states, Iowa and Oregon. With the passage of H.B. 454, Iowa became the 38th state to require—as of Jan. 1, 2004—birthing hospitals to screen all newborns and infants for hearing loss prior to discharge. Improving its 1999 EHDI law through S.B. 401, Oregon created a newborn hearing screening test registry, a tracking and recall system, and an advisory committee to foster follow-up audiologic evaluation and placement in early intervention.
Other Issues
Other states passed legislation this year in response to particular state needs. As a result of H.B. 761, it is now a criminal offense in Florida for a hearing aid seller not to refund designated costs in a timely manner when a hearing aid is returned during its trial period. Maryland H.B. 1042 established a task force to study the availability of audiology and speech-language pathology services. Mississippi H.B. 742 allows public school audiologists and SLPs to count prior experience in clinical settings toward years of teaching experience for salary determinations. As a result of Tennessee S.B. 47, an SLP in a solo private practice will no longer need to be licensed as a home care organization to provide services in the home when they are incidental to services provided in the office.
Status of state legislation is current as of July 7.
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July 2003
Volume 8, Issue 13