State of the States: 2010 Economic Downturn Shapes Legislation and Regulations Policy Analysis
Policy Analysis  |   November 01, 2010
State of the States: 2010
Author Notes
  • Janet Deppe, MS, CCC-SLP, director of state advocacy, can be reached at
    Janet Deppe, MS, CCC-SLP, director of state advocacy, can be reached at×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2010
State of the States: 2010
The ASHA Leader, November 2010, Vol. 15, 1-9. doi:10.1044/leader.PA1.15142010.1
The ASHA Leader, November 2010, Vol. 15, 1-9. doi:10.1044/leader.PA1.15142010.1
In the current economic upheaval, state governments continue to seek ways to reduce deficits and cut the costs of providing essential services, a situation that has influenced the legislative and regulatory outcomes in many areas that affect ASHA members.
States adopted very few legislative or regulatory changes that were associated with costly price tags; those designed to reduce program costs and services fared much better. State legislatures enacted a variety of laws and regulations related to licensure, salary supplements, health insurance coverage, education, early intervention, and other issues. The following legislative and regulatory changes represent only a handful of the several hundred changes enacted in 2010. The majority of legislative sessions have been completed, but a few key states, including Michigan, Massachusetts, Ohio, and New York, remain in session until year’s end.
Seven states changed their practice acts through legislation, including California, Delaware, Illinois, Kansas, Ohio, Utah, and Wisconsin.
  • California’s SB 294 extends the practice act through 2013.

  • In Illinois, SB 3289, recently signed into law, requires that all licensing fees and related funds collected under the act be deposited in the Illinois General Professions Dedicated Fund rather than go to the Board of Speech-Language Pathology and Audiology.

  • In Delaware, SB 232 ensures that revocation or suspension of a license by a professional licensing board occurs immediately and that a written notice must occur within 30 days.

  • In Ohio, HB 215 allows a speech-language pathologist to petition the licensing board to classify his or her license as inactive if, for whatever reason, the SLP anticipates withdrawing from the workforce for an extended period of time.

  • In Kansas, SB 62 requires SLPs and audiologists with doctoral degrees who use the term Doctor or Dr. to identify themselves further with the appropriate words or letters (AuD, PhD, or ScD).

  • Utah’s HB 396 modifies licensing requirements to allow temporary licenses for individuals who have completed all licensure requirements but have not completed a clinical fellowship.

  • Wisconsin created new disciplinary provisions for hearing aid specialists, SLPs, and audiologists.

Additional amendments to licensing regulations have been approved in Alabama, California, Colorado, Florida, Iowa, Kansas, New Mexico, Ohio, Tennessee, Texas, and West Virginia. These include technical changes such as renewal cycles (California), increases in the required number of practicum hours (Kansas), clarification of educational requirements (Ohio), temporary license provisions (Iowa), and definitions and supervisory requirements (Tennessee).
Salary Supplements
Mississippi failed to renew its salary supplement for SLPs in education settings, but Kentucky passed HB 376, which provides an annual supplement for school-based SLPs and audiologists equivalent to the stipend paid to teachers who have attained National Board of Professional Teaching Standards certification.
Speech-Language Pathology Assistants
Two states passed laws regarding the use and regulation of speech-language pathology assistants (SLPAs). Colorado created a credentialing system for SLPAs (HB 1034); in Illinois, HB 5190 addresses minimum educational requirements.
  • New Hampshire and Washington both changed their previously adopted SLPA regulatory provisions. In New Hampshire, revisions included definitions for SLPAs, eligibility requirements, and application procedures. Washington included requirements and fees for state licensure.

  • Iowa adopted regulations allowing paraprofessionals wishing to assist SLPs to obtain a voluntary “area of concentration.”

Hearing Aid Dispensing
California’s SB 1489 allows audiologists to dispense hearing aids without a dispensing license.
Two bills were enacted in Louisiana with potential impact on SLPs in educational settings. HB 468 provides for sabbatical leave eligibility for SLPs and audiologists in schools; HB 509 prohibits returning teachers—including SLPs and audiologists—from receiving retirement benefits during reemployment unless they are employed as teachers in hard-to-staff schools. Idaho’s Department of Education adopted an interim endorsement for individuals with a bachelor’s degree in communication sciences and disorders (CSD) who are pursuing a master’s degree; the interim certificate is non-renewable and valid for three years.
Early Intervention Services
Three states adopted changes to the state early intervention (EI) programs. Idaho established a process to charge fees for EI services (including a sliding fee scale for services not covered under private insurance). Maine revised provisions establishing provider qualifications and covered services. New York changed the standards for the provision of services under the state EI program.
Telepractice/Telehealth Coverage
Colorado and Virginia now require coverage of health services provided via telepractice. In Colorado, HB 1005 requires the state’s medical assistance program to reimburse for health-related telepractice services. Virginia’s SB 675 requires health insurers and health maintenance organizations to provide coverage of health care services provided through telepractice.
Hearing Aids and Cochlear Implants
Six states have new provisions regarding hearing aid coverage.
  • New Hampshire’s comprehensive bill (HB 561) requires insurers to cover hearing evaluations and hearing aids as well as related services necessary to assess, select, and fit the aid.

  • North Carolina’s provisions include one hearing aid per ear, up to $2,500 per aid, every 36 months through age 21.

  • South Dakota’s HB 1275 extends the age limit for coverage of cochlear implants through age 21.

  • The Maine Department of Health has placed additional requirements on hearing aid purchasers and dispensers, including a current audiometric test, written confirmation from the hearing aid dispenser or audiologist that the device meets the individual’s need, and a mandatory 30-day trial period.

  • Michigan adopted rules to amend Medicaid reimbursement for audiologic services and hearing aids.

  • New Jersey will offer $100 annually to offset the cost of a hearing aid to individuals who are senior citizens or have disabilities.

Autism Coverage
A variety of autism mandates were enacted this year with mixed results for members and consumers. Ten states—Louisiana, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Missouri, New Hampshire, Oklahoma, and Vermont—passed legislation this session requiring insurers to cover services for autism spectrum disorders.
Coverage provisions vary, as do age limits for beneficiaries. Massachusetts and some other states, for example, have no limits on the number of visits but exclude some insurers from the mandate. Other states, including Minnesota, limit the number of sessions and have reduced the provider reimbursement rate for some autism services.
Several states took steps to reduce their Medicaid expenditures, with six adopting provisions affecting providers and consumers of Medicaid services. ASHA worked with several state associations, sending letters of opposition and helping state associations mobilize members to oppose cuts to reimbursement levels and benefits for children and adults.
States such as Arkansas approved measures to limit benefits to children younger than 21; others such as Iowa and Maine adopted provisions to reduce reimbursement rates by as much as 10% for certain services.
Nebraska, however, authorized services for autism under Medicaid; Texas amended rules concerning Medicaid benefits and service limitations.
As the economy stabilizes and moves toward recovery, state associations, members, and consumers hope to see restoration of programs and services for children, adults, and families—including those with disabilities—and increased reimbursement rates for the professionals who serve them. ASHA, in collaboration with state associations, will continue to advocate aggressively for programs, services, and reimbursement rates that allow individuals of all ages access to needed services.
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November 2010
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