Update on State Laws Affecting Hearing, Speech-Language Treatment In 2017, states 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  |   April 01, 2018
Update on State Laws Affecting Hearing, Speech-Language Treatment
Author Notes
  • Janet Deppe, MS, CCC-SLP, is director of ASHA state affairs. jdeppe@asha.org
    Janet Deppe, MS, CCC-SLP, is director of ASHA state affairs. jdeppe@asha.org×
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   April 01, 2018
Update on State Laws Affecting Hearing, Speech-Language Treatment
The ASHA Leader, April 2018, Vol. 23, 28-31. doi:10.1044/leader.PA.23042018.28
The ASHA Leader, April 2018, Vol. 23, 28-31. doi:10.1044/leader.PA.23042018.28
With uncertainty at the federal level and polarizing positions on key issues, state legislatures passed fewer bills and adopted fewer regulations related to speech-language and hearing in 2017—despite an overall increase in state-level legislation of interest to ASHA members.
In 2017, ASHA tracked 1,684 bills and 721 sets of regulations—as compared to 1,450 bills and 550 regulations in 2017—related to licensure, scope of practice, hearing aids, health insurance, early hearing identification and detection programs, and other issues.
Licensure and scope of practice
Provisional licenses. In states with no temporary or provisional licenses for clinical fellows, these new speech-language pathologists often have a hard time finding and keeping health care jobs because their services are not reimbursable by Medicare or other insurers. ASHA worked with several states on this issue: New York, Alabama, Pennsylvania, Montana and West Virginia created or revised requirements for clinical fellow licensure, and the District of Columbia created registration requirements.
Support personnel. North Dakota added licensure of speech-language pathology assistants to its practice act. The District of Columbia established registration for audiology and speech-language pathology assistants. An Idaho rule now defines audiology assistants. Virginia and Wyoming established rules for speech-language pathology assistants that address qualifications, scope of practice, and supervisory responsibilities.
Practice acts. Illinois, Colorado and Tennessee successfully dealt with sunset provisions of their practice acts by extending the repeal dates by several years. Ohio consolidated the audiology and speech-language pathology licensing board with the hearing aid dispensers board.
Hearing aid dispensers. Arkansas, California, Iowa, Kansas, New Jersey, New Hampshire and Virginia—all of which require audiologists to have a dispensing license—made changes to hearing aid dispensers’ requirements. California revised continuing education requirements as a condition for licensure renewal, and amended eligibility and application requirements of continuing education courses and providers. Kansas revised its fee schedule, examination scoring and application process and New Jersey changed its rules to allow only 10 of the 20 required continuing education hours to be completed online.
Occupational licensing. ASHA expects more legislation requiring review of occupational licensing in 2018. These bills are designed to create additional oversight of state licensing boards. ASHA supports occupational licensure with independent boards—consisting of professionals and public members—to ensure public safety and maintain uniform and appropriate standards for practicing professionals, including audiologists and speech-language pathologists. State and federal efforts to eliminate or provide greater oversight are concerning, because licensure requires a minimum level of competence (doctoral degree for audiologists and master’s degree for SLPs, for example), protects the professions by allowing boards to investigate complaints, and informs the public about the requirements to provide audiology and speech-language services. State licensing requirements also prevent employers from hiring underqualified individuals to work independently.
Despite opposition from licensed professionals and professional organizations, including ASHA, a few of these bills passed in 2017, although many more were introduced.
Tennessee passed legislation that authorizes the commissioner of administrative departments to evaluate actions by regulatory boards to determine whether actions by the board constitute an unreasonable restraint of trade. In Idaho, a sweeping executive order requires licensing divisions to review license requirements, timelines for approving or denying a license, renewal requirements that could be eliminated to reduce barriers, the mechanism of disciplinary actions—including the statutory authority for revocation of a license—and the cost and fees associated with issuing licenses. New Jersey requires boards to suspend the license of professionals when the board is notified that the licensee has defaulted on state or federal educational loans.
These disturbing trends continue to undermine professional licensure. ASHA continues to oppose efforts to weaken state licensure standards to ensure that only qualified professionals be permitted to provide audiology and speech-language services.

New York, Alabama, Pennsylvania, Montana and West Virginia created or revised requirements for clinical fellow licensure, and the District of Columbia created registration requirements.

Health care and insurance issues
Telehealth. Several states dealt with bills related to telepractice authorization, coverage of services and reimbursement. New Jersey and Oregon approved bills to ensure that health care providers, including audiologists and SLPs, are authorized to provide telehealth services. Kentucky adopted a number of rules regarding authorization and coverage of telehealth services in community and mental health programs. Several states—including Colorado, Nebraska, North Dakota, Texas, Utah, Vermont and Washington—now require coverage of services provided through telehealth. Colorado clarified that a health plan cannot restrict coverage based on the communication technology used to deliver the telehealth service. Nebraska, Texas, Utah, Vermont and Washington now require insurers to cover telehealth services that meet certain requirements. Oklahoma updated the definition of consent and added other services that could be delivered via telehealth.
Medicaid. Maine, recognizing that state Medicaid providers were subject to a service-provider tax that they may not have been able to pay, adopted rules to increase certain reimbursements by 1 percent. The District of Columbia and Maryland added eligibility rules for Medicaid recipients and participation conditions for providers. Florida adopted regulations regarding provider codes and reimbursement schedules, Montana updated its fee schedule, and Indiana adopted rules regarding which service providers are able to provide for consent under Medicaid. New York Medicaid authorized telehealth services in education settings and childcare facilities within the state.
Arkansas set limits on the number of occupational therapy, physical therapy and speech-language services that can be provided to Medicaid beneficiaries each week without prior authorization. Texas Medicaid adopted several rules concerning the reimbursement of durable medical equipment; occupational therapy, physical therapy and speech-language treatment; and Early Periodic Screening Diagnosis and Treatment Services (EPSDT).
Affordable Care Act (ACA). Hawaii now ensures that benefits of the ACA—including the individual mandate, essential health benefits (EHB) coverage and prohibition on preexisting conditions exclusions—are retained in state law. California requires individual and small-group health plans and insurers—in and outside of the state exchange—to provide coverage of the ACA essential health benefits. Montana now requires coverage of habilitation services. New York mandates individual and small group plans that provide hospital, surgical and medical expense coverage and student accident and health policies to cover all 10 categories of essential health benefits. New York also reaffirmed that insurers are prohibited from discriminating against individuals because of race, national origin, sex, age marital status, disability or preexisting conditions.
Illinois and Montana updated provisions to ensure that there are enough providers in the state to care for Medicaid beneficiaries.
Other insurance issues. Alabama, California, Iowa and Nevada mandated coverage of services for people with autism spectrum disorder. Two states passed legislation requiring coverage of hearing aids: Georgia requires health plans to cover hearing aids and replacement aids for certain people and to provide coverage of supplies and options for higher-priced hearing aids; Texas authorizes health plans to cover hearing aids and cochlear implants for certain beneficiaries; Montana revised its insurance law to provide mental health parity.
Early hearing detection and intervention. Arizona adopted amendments to newborn screening guidelines to establish a central database for information about newborns tested and the test results, develop a parent educational program, and provide specified follow-up services. The state also created a newborn screening program committee. Louisiana now requires Medicaid to cover newborn hearing screenings provided in an acute-care hospital.

ASHA continues to oppose efforts to weaken state licensure standards to ensure that only qualified professionals be permitted to provide audiology and speech-language services.

Education legislation and regulations
Dyslexia. Providing language and early literacy services for children with dyslexia is in SLPs’ scope of practice, and they are adequately trained to work with children with this disorder. However, some states require teachers and other providers—including SLPs—to take additional coursework or training to do so.
Arkansas and Oregon added provisions concerning screening and intervention services for public school children with dyslexia. Connecticut requires special education teachers to complete a program of study in evidence-based literacy intervention that includes supervised practicum hours, instruction in the identification of dyslexia, and structured literacy intervention for students with dyslexia. Mississippi extends the dyslexia scholarship program for students in grades 1–12 and North Carolina and Nebraska added the definition of dyslexia to special education. Texas requires educational services centers to employ dyslexia specialists and list training opportunities for teachers.
Teacher evaluation. SLPs in public schools are often considered teachers and are subject to teacher evaluation provisions. Kentucky and Nevada passed legislation to update teacher performance evaluation systems. Kentucky also prohibits individual teacher evaluation results from being used in school-wide accountability systems. New Jersey added provisions to require teachers to have instruction and experience in special education, including hours related to autism spectrum disorder.
LEAD-K (Language Equality & Acquisition for Deaf Kids). The Oregon legislature established a task force to report on the educational needs of children who are deaf or hard of hearing. Utah amended provisions for educational services for people with hearing loss, requiring hearing test results to be reported to the Utah School for the Deaf and requiring that school to provide certain educational services.
SLP standards and preparation programs. New Hampshire updated rules for SLPs’ certification and educator preparation program requirements. New Jersey authorized SLPs who do not meet Medicaid qualifications for service delivery to work under the supervision of certified SLPs to comply with the state Medicaid plan.
Other education issues. Nebraska updated teacher certification guidelines for teachers (including school-based SLPs) and endorsed the speech-language pathology Praxis examination as an acceptable content test. The Maine Department of Education updated education personnel guidelines and requires SLPs providing telepractice services to be licensed in the state.
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April 2018
Volume 23, Issue 4