Update on State Laws In 2016, legislatures in just about every state tackled issues that could affect communication sciences and disorders professionals and clients. Here’s a look at some of the changes. Policy Analysis
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Policy Analysis  |   February 01, 2017
Update on State Laws
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×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   February 01, 2017
Update on State Laws
The ASHA Leader, February 2017, Vol. 22, 28-30. doi:10.1044/leader.PA2.22022017.28
The ASHA Leader, February 2017, Vol. 22, 28-30. doi:10.1044/leader.PA2.22022017.28
An increased emphasis on state authority means that state legislatures are dealing with a heavier load of bills and regulations, many of which affect audiologists, speech-language pathologists and the people they serve.
In 2016, ASHA tracked more than 1,450 state legislative bills and 550 state regulations with potential impact on communication sciences and disorders. Of those, only 88 legislative bills were enacted and 182 regulations approved. In 2015, states grappled with 350 fewer bills, yet more were enacted.
Licensing issues
Professional licensure. Four states (Hawaii, Nebraska, Tennessee, Utah) passed laws and 13 states (Alabama, Colorado, Florida, Indiana, Maryland, Nevada, New Mexico, North Carolina, North Dakota, Oklahoma, Texas, Wisconsin, Wyoming) approved regulations that updated and corrected technical information in state licensure requirements. For example, Hawaii amended requirements for board members, Tennessee revised reinstatement rules and examination guidelines, and Florida changed provisional licensure requirements. Louisiana and West Virginia added criminal background check requirements. Alaska, Missouri and Washington amended application and license fees. New Hampshire updated ethical standards to correlate with national standards.
Licensing board oversight. Under a 2015 U.S. Supreme Court ruling (North Carolina Board of Dental Examiners v. Federal Trade Commission), if a “controlling number” (usually interpreted as a majority) of decision-makers on a state licensure board are active participants in the occupation the board regulates, the board is immune from antitrust laws only if the board is supervised by a state oversight board or agency. As a result, four states—Alabama, Georgia, Louisiana and Massachusetts—moved to provide executive oversight of their licensure boards.
Audiology assistants. West Virginia adopted new rules for audiology assistants and described tasks outside of the assistants’ scope of practice.
Speech-language pathology assistants. New Hampshire clarified that the title of “speech assistant” may be used only if the person holds a license issued by the board, and also clarified requirements for assistants working in public schools. Virginia now allows assistants to perform duties under the supervision of a licensed SLP; Tennessee added supervisory guidelines for assistants; and Florida updated certification rules.
Clinical fellowships. Virginia instituted provisions for clinical fellows and New Hampshire updated clinical fellow eligibility requirements. Only Nevada, North Dakota and Missouri have no provisional licenses for clinical fellows.
Military personnel and spouses. Four states made it easier for members of the military and their spouses to maintain certification and licensure. Colorado now requires state licensure boards to evaluate and provide credit toward licensure for military experience. Florida allows temporary certification for active-duty military clinicians if they hold an active license in another state and meet other requirements. Georgia requires the licensure board to implement processes to grant temporary and expedited licenses. Oklahoma allows some service members to petition for hardship relief from continuing education requirements.
Telepractice/telehealth. Oklahoma is the only state that amended and updated practice language in its telehealth licensing rules. However, 11 states updated definitions and Medicaid coverage requirements. Connecticut included SLPs as telehealth providers for insurance-coverage purposes, and Maryland and Rhode Island added provisions for telehealth insurance coverage. Florida created a telehealth advisory council, and Washington created an advisory collaborative to determine appropriate use of telehealth services. Tennessee eliminated the requirement for in-person contact for reimbursement of telehealth services.
Hearing aid dispensers. Many states changed requirements for dispensing hearing aids. Alabama now requires apprentices to be under the supervision of a licensed dispenser. Tennessee no longer allows the licensing board to waive the written examination requirements, and specifies that the International Hearing Instrument Examination is no longer accepted for licensure. California made substantive changes to its act, increasing required professional development hours from nine to 12 per year, adding requirements related to acceptable course content and criteria for course approval, and specifying that courses must be within the defined scope of practice. Wisconsin now requires the International Licensing Examination as the written test of knowledge for dispensers.
Music therapists. Connecticut and Oklahoma passed legislation requiring licensure of music therapists.

Three states—Nevada, North Dakota and Missouri—do not require a clinical fellowship for state licensure and, therefore, do not issue provisional licenses for clinical fellows. However, other jurisdictions—Connecticut, District of Columbia, Hawaii, Massachusetts, New York and Pennsylvania—offer no provisional licensure for clinical fellows despite requiring a clinical fellowship for state licensure.

Health care issues
Hearing aids and newborn hearing screening. Louisiana passed legislation to exempt hearing aids from state sales tax. Illinois amended its newborn screening act to require a registry of cases, define the intervention provided, and require bilateral hearing screening for each infant prior to discharge. Iowa clarified and defined roles of qualified providers and the Early Hearing Detection and Intervention (EHDI) Advisory Committee, and allows the state’s EHDI program to monitor and make recommendations to improve the quality of care provided by early intervention practitioners.
Insurance coverage for ASD-related services. Six states passed legislation or created rules that apply to insurance coverage for services related to autism spectrum disorder (ASD). California expanded eligibility for ASD-related service providers to include those with bachelor’s degrees who meet other requirements and paraprofessionals with high school diplomas or equivalent. Kentucky and Oklahoma now require insurers to cover services for people with ASD. Delaware now provides Medicaid coverage of ASD-related services, and Iowa clarified eligibility requirements for its Autism Support Program. Maryland amended Medicaid regulations for its community-based waiver program (which allows beneficiaries to receive services at home or in the community rather than in facilities) for people with ASD.
Health plans. New Jersey clarified the provision of individual and small-employer health benefits programs and created standard health plan benefits offered in the individual health coverage market. Its Small Employee Health Benefits Program Board of Directors amended requirements for carriers providing standard plans.
Colorado, Maryland and Washington updated rules regarding essential health benefits in accordance with the Affordable Care Act. Several states (Iowa, Kentucky, Louisiana, Maine, New Mexico) and the District of Columbia adopted emergency rules to cover home- and community-based waiver programs. Massachusetts and Missouri revised rules regarding prior authorization for services.
Medicaid. Arkansas and Florida updated Medicaid requirements for providers including SLPs; Delaware updated coverage and reimbursement language to comply with federal laws and regulations. Indiana, Kentucky and Montana made changes to coverage requirements, and Mississippi made changes to supervision and reimbursement requirements. New York changed provisions for coverage of preventive services, and North Dakota updated rules to comply with federal regulations. Ohio and Virginia revised reimbursement rates for home and hospital services, and Texas updated its fee schedule for speech-language pathology and early-intervention services. Wyoming adopted emergency rules to establish scope of services covered under Medicaid.

California expanded eligibility for ASD-related service providers to include those with bachelor’s degrees who meet other requirements and paraprofessionals with high school diplomas or equivalent.

Education issues
Early intervention. Only New York and Virginia addressed early intervention (EI) issues. New York adopted rules to conform to state and federal laws and regulations. Virginia rules address the referral process, service delivery, funding and payment options, alternatives to resolve disputes and the establishment of a certification program for certain EI providers.
Dyslexia screening and treatment. Illinois amended the school code to include a definition of dyslexia, Maryland altered the date by which the Dyslexia Task Force must submit findings, and Mississippi created a scholarship for students with dyslexia. Missouri and Tennessee now require schools to screen for dyslexia. Virginia legislation requires applicants for teaching licensure to complete professional development related to dyslexia. Arizona amended speech-language pathology guidelines related to services for students with dyslexia, and Texas created additional rules for licensed dyslexia therapists.
IDEA/IEP changes. Several states made changes to the IEP process. California and Idaho created additional procedural safeguards for parents, Delaware and Illinois added notification requirements, and Florida amended eligibility requirements for students and qualifications for SLPs.
School-based Medicaid. Idaho and New Hampshire revised school-based Medicaid rules. Idaho changed Medicaid provisions to ensure that federal and state reporting rules do not place unnecessary burdens on school-based providers. New Hampshire clarified what services are not covered under school-based Medicaid and indicated that school districts’ participation in Medicare is not mandatory.
Teacher certification. Arizona, Alabama and Kentucky amended standards and requirements for teacher certification. Louisiana adopted an Educational Leader in Special Education Certificate that allows educators without a standard teacher certificate to obtain a leadership certificate specific to special education. Minnesota adopted rules regarding requirements for teacher preparation programs. Mississippi established criteria for a nonrenewable license for teacher candidates completing alternate-route teacher education programs.
Continuing education. Michigan revised continuing professional development guidelines requiring SLPs to create a Continuing Professional Development (CPD) portfolio as a condition for license renewal. The rule also clarifies that licensees who have let their licenses lapse for less than three years meet the CPD requirements for reinstatement for the previous cycle.
More to come …
The new administration and Congress have indicated plans to cede more decision-making authority for education and health care services to the states, a strategy that may lead to more state initiatives, legislation and rules in 2017. Members and state leaders need to be vigilant and prepared to act, and ASHA will provide resources and tools to ensure that audiologists and SLPs can advocate in an uncertain future. These resources may be helpful:
  • ASHA members can use State Hot Topics to advocate with stakeholders and decision-makers. Each page includes a summary of a specific issue, talking points, an issue briefing to leave with the decision-maker, sample letters and sample legislation related to the issue.

  • Later this year, the ASHA state advocacy webpage will include license requirements for telepractice in each state. In addition to licensure requirements, the information will include state regulations on telepractice reimbursement and telesupervision requirements for students, clinical fellows and speech-language pathology assistants.

  • Later this year, state-by-state requirements for early intervention practice will also be added to the website.

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February 2017
Volume 22, Issue 2