State of the States 2015 States—mirroring the federal trend—passed fewer bills and regulations than in previous years that affect audiologists and speech-language pathologists in 2015. However, the 1,100 bills and 530 regulations relevant to the professions tracked by ASHA last year demonstrate that states continue to grapple with issues related to licensure, scope of practice, ... Policy Analysis
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Policy Analysis  |   March 01, 2016
State of the States 2015
Author Notes
  • Janet Deppe, MS, CCC-SLP, is director of ASHA state advocacy. jdeppe@asha.org
    Janet Deppe, MS, CCC-SLP, is director of ASHA state advocacy. jdeppe@asha.org×
  • Susan Adams, JD, is director of ASHA state and regulatory advocacy. sadams@asha.org
    Susan Adams, JD, is director of ASHA state and regulatory advocacy. sadams@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   March 01, 2016
State of the States 2015
The ASHA Leader, March 2016, Vol. 21, 22-24. doi:10.1044/leader.PA.21032016.22
The ASHA Leader, March 2016, Vol. 21, 22-24. doi:10.1044/leader.PA.21032016.22
States—mirroring the federal trend—passed fewer bills and regulations than in previous years that affect audiologists and speech-language pathologists in 2015. However, the 1,100 bills and 530 regulations relevant to the professions tracked by ASHA last year demonstrate that states continue to grapple with issues related to licensure, scope of practice, health care and education. Of those, 98 pieces of legislation passed and 183 rules were adopted.
Licensure
Universal licensure. Oregon passed legislation that requires SLPs to hold a state license to practice in education settings. Twenty-one states now require universal licensure.
Audiology and speech-language pathology. A number of states made changes to licensure and scope of practice rules, including Alabama, Arkansas, Missouri, New Hampshire, New Mexico, Oklahoma, Virginia and Vermont. Missouri and New Mexico made changes to their practice acts: Missouri eliminated the provisional license requirement for clinical fellows and New Mexico changed definitions and clarifying terms. Idaho, Maryland, New Hampshire, New Jersey, Nevada and Oklahoma changed licensure board operations. In Idaho, for example, the board changed the quorum requirements so that only one member of a relevant profession must be present when taking action that affects that profession’s licensees. In New Jersey, those renewing their licenses for the first time do not have to meet the continuing education requirements for existing licensees. Iowa and Virginia lowered licensure fees. Oklahoma added a three-hour course in ethics as a requirement for renewal.
Speech-language pathology assistants. Maryland and New Hampshire made changes to speech-language pathology assistant (SLPA) requirements. Maryland rules create penalties for failing to complete required continuing education and allows cease-and-desist orders for SLPs practicing on expired licenses. New Hampshire created initial and reinstatement provisions for SLPA certification.
Clinical fellows. Colorado passed legislation and Virginia issued rules to create a provisional license/certificate for clinical fellows; 43 states and the District of Columbia now have this provisional licensure requirement. Nevada, North Dakota and Missouri do not require a clinical fellowship for licensure, New York does not have licensure for clinical fellows, Pennsylvania has yet to establish rules for licensure, and Tennessee and Alabama require registration, not licensure. Oregon updated clinical practicum requirements for clinical fellows.
Audiology and speech-language pathology licensure boards. Ohio re-established its state licensure board following its expiration. Nevada, New Hampshire, Oklahoma, Idaho and Maryland updated requirements for licensure.
Military personnel and spouses. Nevada, New Mexico and Ohio added provisions to amend and expedite licensure for active-duty military and military spouses.
Hearing aid dispensers boards. Twelve states (Arkansas, Georgia, Illinois, Iowa, Montana, North Carolina, Oklahoma, Tennessee, Texas, Utah, Washington and Wyoming) changed laws and rules related to hearing aid dispensing (HAD). A few states amended board composition, increased the number of hours of required continuing education, and changed the name of the board from HAD to hearing aid specialists (Iowa, Washington). Illinois now requires dispensers to pass the International Hearing Society’s licensure exam to obtain a license, and Montana and Oklahoma, along with a few others, changed fee schedules and pass/fail exam criteria. Montana no longer requires a licensed audiologist to serve on the HAD board. The North Carolina and Virginia boards set parameters for cerumen management by hearing aid dispensers and audiologists, respectively. Washington created a nine-month alternative certification for licensure of hearing aid dispensers. Utah now requires hearing aid dispensers—including audiologists—to provide information to consumers about hearing aid–compatible assistive technology.

Oregon requires each school district to employ a dyslexia specialist to provide support and resources, and requires districts to develop plans to screen for dyslexia, develop guidance for parental notification, and provide teacher training.

Behavioral analysts. Seven states—Hawaii, Mississippi, New York, Oregon, Rhode Island, Utah and Washington—implemented a licensing requirement for applied behavior analysts. Most created boards and credentialing requirements for behavior analysts, assistant behavior analysts and, in some cases, behavior technicians.
Music therapy. Licensing boards in Oregon, Rhode Island and Utah created rules governing the licensure/certification of music therapists. Illinois created an advisory board to determine the necessity of credentialing music therapists.
Telepractice/telehealth. Arkansas and Tennessee updated and added telepractice-related rules, and other states—Arkansas, Colorado, Idaho, Nebraska, Nevada, New Hampshire, New York, North Dakota, Texas, Virginia and Washington—enacted legislation to pave the way for the delivery and reimbursement of telehealth services: Idaho and Nevada established telehealth access acts, Nebraska requires insurers to provide descriptions related to telehealth service delivery, and Washington recognizes telehealth as a service that does not require in-person contact. Texas established provisions for reimbursement of telehealth services in school settings.
Truth and transparency. American Medical Association (AMA)–supported truth and transparency legislation requires nonphysicians to identify themselves as doctors of their stated professions, suggests requirements for advertising, and allows the AMA to influence the practice of nonmedical professions. There have been several attempts in recent years to pass this type of legislation; this year, only Georgia passed legislation establishing certain parameters related to advertising and signage.
Health care
Hearing issues. Mississippi exempted hearing aids from state sales tax, Utah amended the criteria for the coverage of children’s hearing aids, and Missouri added a prior authorization requirement for hearing aid coverage. Texas passed legislation related to hearing aid benefit plans for designated individuals. Texas also incorporated rules reflecting change in definitions and roles of providers, tracking documentation, intervention requirements, and reporting rules by health care providers in early hearing detection and intervention (EHDI). Kentucky established standards, eligibility criteria, reporting requirements, appeal rights and approved methods for hearing screening. Maryland requires the EHDI program to reflect new guidance from the Joint Committee on Infant Hearing Screening and requires audiologists to report results of hearing screening and diagnostic evaluations to the Program for Hearing Impaired Infants.
Autism spectrum disorder (ASD). Eleven states addressed coverage of services for people with ASD: Georgia, Hawaii, Kansas, Louisiana, Maine, New Jersey, North Carolina, South Dakota, Texas, Virginia and Washington. Hawaii requires insurers and health maintenance organizations to provide coverage for ASD services; Virginia requires the Board of Medicine to post information on its website about appropriate treatment and the role of health care providers in identifying and treating individuals with ASD. New Jersey allows for physical, occupational and speech therapy to people with ASD beyond the 30-visit limit and allows treatment to continue beyond the age of 21 if necessary. Colorado increased the age limit from 6 to 8 years for children receiving services under the state’s autism waiver program and includes ASD in the state’s mental health parity law.

Oregon passed legislation that requires SLPs to hold a state license to practice in education settings. Twenty-one states now require universal licensure.

Health plan/essential health benefits. Three states—California, Maryland and Washington—included definitions of habilitation in their essential health benefits. A number of states and District of Columbia adopted emergency rules to cover community-based waiver programs (Louisiana, Maine, Maryland and Mississippi).
Rhode Island prohibits a health plan or insurer from discriminating with respect to participation against any health care provider acting within the scope of practice of that provider’s license or certification. Montana amended legislation to include audiologists and SLPs under the freedom of choice for practitioners act.
Medicaid. Arkansas, Illinois, Minnesota and Wyoming addressed coverage and reimbursement of Medicaid services. Other states, including Colorado, Delaware and Florida, have revised provider qualifications. Colorado, Louisiana, Montana and Ohio have instituted increases in coverage rates for Medicaid services.
Education
Early intervention. California, Connecticut, Illinois, Louisiana, Ohio, Nebraska, Tennessee, Texas, Virginia and Washington added new provisions for early-intervention services. Connecticut requires annual hearing screenings of all children enrolled in birth-to-3 programs; Illinois, Tennessee and Washington incorporated definitions of qualified staff; Nebraska added guidelines for early-intervention services and provider qualifications. Virginia updated its entire early-intervention system to align with Part C of the Individuals With Disabilities Education Act.
Dyslexia. Many states are dealing with guidance on the treatment of students with dyslexia. Several states required mandatory screening for dyslexia, including Alabama, Arizona, Arkansas, California, Mississippi and Oregon. Oregon requires each school district to employ a dyslexia specialist to provide support and resources, and requires districts to develop plans to screen for dyslexia, develop guidance for parental notification, and provide teacher training.
Emergency teaching waiver. Kentucky allows the Educational Professional Standards board to grant emergency certificates to out-of-field teachers if qualified professionals are not available, and establishes the definition of out-of-field teaching.
Teacher certification. Alabama, Arkansas, Illinois, Nebraska, New Jersey, Ohio and Tennessee changed teacher certification requirements. Arkansas issued emergency rules to update educator licensing guidelines, including definitions of an accredited graduate speech-language pathology program. Nebraska required school-based SLPs to pass the Praxis II exam. Illinois clarified rules for supervision and licensure requirements for SLPAs.
Loan forgiveness. Mississippi established rules to implement the SLP Forgivable Loan program.
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March 2016
Volume 21, Issue 3