Pennsylvania Achieves New Licensure Law, Regulations After 11 years, audiologists and SLPs clarified their scopes of practice and secured provisional licensure for clinical fellows. State of Success
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State of Success  |   June 01, 2018
Pennsylvania Achieves New Licensure Law, Regulations
Author Notes
  • Caterina Staltari, MA, CCC-SLP, is director of clinical education in Duquesne University’s Department of Speech-Language Pathology and president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; 10, Issues in Higher Education; and 11, Administration and Supervision. staltari@duq.edu
    Caterina Staltari, MA, CCC-SLP, is director of clinical education in Duquesne University’s Department of Speech-Language Pathology and president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; 10, Issues in Higher Education; and 11, Administration and Supervision. staltari@duq.edu×
Article Information
State of Success
State of Success   |   June 01, 2018
Pennsylvania Achieves New Licensure Law, Regulations
The ASHA Leader, June 2018, Vol. 23, 40-41. doi:10.1044/leader.SOS.23062018.40
The ASHA Leader, June 2018, Vol. 23, 40-41. doi:10.1044/leader.SOS.23062018.40
After 11 years of advocacy and compromise, audiologists and speech-language pathologists in Pennsylvania have a licensure act and associated regulations, some of which are game-changing for school-based clinicians and for speech-language pathology clinical fellows.
Under regulations adopted in 2017 to implement a law enacted in 2014:
  • Speech-language pathology clinical fellows (CFs) may apply for a provisional license. Under Medicare and other insurance plans, unlicensed providers may not bill for service. Implementing a provisional licensure program allows CFs to bill for the services they provide.

  • To qualify to work in schools, SLPs may apply for a new educational specialist certification in speech and language pathology. The new certificate aligns with SLPs’ role in the schools as specialists in communication and swallowing. SLPs can also choose to pursue the previous requirement—teacher certification—to work in Pennsylvania schools.

The need to update
The Pennsylvania Speech-Language-Hearing Association (PSHA) and the Pennsylvania Academy of Audiology began pushing for a new licensure bill in 2009. The original 1984 state practice act needed an overhaul:
  • It contained a very limited definition of the professions’ scopes of practice. The speech-language pathology scope of practice did not include evaluation and treatment of speech, language, voice, swallowing, cognitive and social communication disorders; augmentative and alternative communication; using instrumental technology for communication, voice and swallowing disorders; and other common interventions. The audiology scope of practice did not include assessment and treatment of hearing and vestibular disorders; assessment of candidacy for, fitting or mapping cochlear implants; hearing aid selection, fitting, evaluation and dispensing; conducting otoscopic examinations; and other procedures.

  • It required clinicians in health care settings to have state licensure, but had no provisional or temporary license for clinical fellows. Because Medicare and other insurers will not pay for services of unlicensed professionals, most health care facilities did not hire clinical fellows.

  • It had no professional licensure specifically for school-based SLPs, and the regular SLP license was not accepted by the Department of Education. Instead, audiologists and SLPs who wanted to work in schools needed teacher certification, which required applicants to pass the teaching PRAXIS and content tests in subjects unrelated to audiology or speech-language pathology.

[Under the outdated practice act] audiologists and SLPs who wanted to work in schools needed teacher certification, which required applicants to pass the teaching PRAXIS and content tests in subjects unrelated to audiology or speech-language pathology.

The proposal
Not everyone agreed with all of the licensure and other provisions in the original proposal. Some school-based audiologists and SLPs opposed mandated universal licensure—they felt their instructional certification was sufficient and saw no need to maintain a license.
One university program also opposed universal licensure, anticipating the need to modify its speech-language curriculum to prepare students. In the health care arena, the proposed bill allowed SLPs to perform stroboscopy and fiberoptic endoscopic evaluation of swallowing (FEES), and allowed audiologists to perform auditory brainstem responses during surgeries. Physicians opposed both provisions.
The bill as passed
PSHA and the Pennsylvania Academy of Audiology worked together to hammer out compromises. After much effort, the final bill:
  • Clearly defines the scopes of practice and includes updates for both speech-language pathology (including stroboscopy and FEES) and audiology practice.

  • Creates a provisional license, allowing speech-pathology graduates to secure health care positions for their clinical fellowships.

  • Continues to give licensure exemption to school-based audiologists and SLPs if they choose to obtain teaching certification, but establishes another route to working in schools—the Educational Specialist Certification in Speech and Language Pathology for SLPs who have a state license or ASHA certification, or who have completed an in-state educational specialist speech-language pathology program.

  • Allows the State Board of Examiners (BOE) to adopt changes to the scope of practice by regulation, based on changes adopted by ASHA or the American Academy of Audiology.

  • Updates statutory language regarding professionals whose practice is adversely affected by addiction, substance abuse or other health-related conditions.

  • Requires new audiologists to have a doctoral degree to apply for a license.

  • Allows audiologists to perform intraoperative monitoring (IOM) only if they have separate IOM certification and only under physician supervision.

The bill was finally signed into law in 2014, 30 years after the initial practice act was passed.

[The final bill] creates a provisional license, allowing speech-pathology graduates to secure health care positions for their clinical fellowships.

Implementation
Before the law could be fully implemented, regulations had to be drafted and approved, and PSHA frequently appealed to the Board of Examiners to encourage a speedy regulatory process. We had hoped to have regulations in place in time for spring 2015 graduates—the next round of clinical fellows—who wanted jobs in health care. Despite PSHA’s urging, the approval process and legal review took more than a year and a half.
PSHA was represented at every meeting by the association’s lobbyist—often joined by PSHA officers. After three years of work, the State Board of Examiners in Speech-Language Pathology and Audiology approved the regulations in 2017.
Advocacy
To get the bill passed, PSHA board members met with a variety of stakeholders, including the prime sponsor of our bill and his staff; the chairs, members and staff of the Senate and House Professional Licensure Committees; BOE members and staff of the Department of State, which oversees all licensing boards in Pennsylvania; Pennsylvania Department of Education; and lobbyists and members of the Pennsylvania Academy of Otolaryngology.
PSHA members also met with state senators and representatives in their home district offices. PSHA also initiated several large and successful email and phone campaigns to generate grassroots support when potential problems arose and when key votes were pending.
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June 2018
Volume 23, Issue 6