A three-year advocacy effort by speech-language pathologists in Illinois has achieved success—a new state law enacted in August amends SLPs' scope of practice to include the independent use of endoscopic procedures.
The need for the law, which states specifically that licensed, qualified SLPs in an appropriate setting may use rigid and flexible endoscopes, stems from reimbursement denials for SLPs who provided laryngeal stroboscopy. In addition, some medical facilities did not allow SLPs to perform stroboscopy or flexible fiberoptic endoscopic evaluation of swallowing (FEES) because of legal questions about scope of practice.
The Illinois Speech-Language-Hearing Association (ISHA) Board voted to sponsor legislation more than three years ago, but the research and networking required to prepare for the legislative effort took several years. ISHA received guidance from ASHA, including the appropriate knowledge and skills statements, training guidelines, contact information for colleagues who had worked on similar legislation in other states, and language from similar state statutes and regulations.
Members of the ISHA Division of Legislative and Regulatory Affairs contacted SLPs and other interested parties from across the state to encourage them to contact their legislators; called and initiated e-mail trees to SLPs in private practice and health care settings across the state; informed physicians about the need for the law and the possibility that SLPs might no longer be able to provide endoscope procedures if the bill was defeated; arranged for letters of support from SLPs and the physicians on their teams; and contacted legislators.
ISHA's long-time lobbyist James Morphew chose sponsors for the bill, educated legislators and their staff members, advised ISHA on protocol, arranged meetings, and, with input from ISHA members, wrote many drafts. Professionally knowledgeable and politically connected SLPs participated in phone conferences and trips to the state capitol. Susan Langmore, creator of FEES, provided compelling, expert testimony during a phone conference. On ISHA's annual lobbying day members met with legislators to urge the lawmakers to support the bill.
A critical part of the advocacy effort involved communication with the Illinois State Medical Society and the American Academy of Otolaryngology to develop language acceptable to all parties.
The law outlines the provisions necessary for SLPs to become competent to engage in independent practice and specifies the requirements needed for medical backup and supervision. Provisions to allow the use of a rigid or flexible laryngoscope for the purpose of training or research are also included.
SLPs working in hospitals or hospital affiliates are exempt from requirements of the new law, but they must meet requirements set by their individual facilities. SLPs working in other settings must take an ASHA-approved course, observe a number of rigid and/or flexible laryngoscope procedures, and perform a number of laryngoscope procedures under the direct supervision of a qualified physician. The supervising physician must have hospital privileges to perform such procedures but need not be an otolaryngologist.
The law stipulates three sets of requirements for observation and performance: for SLPs qualifying for rigid laryngoscopy only, for flexible laryngoscopy only, and for both. The supervising physician may delegate supervision of performed procedures to an SLP qualified under the terms of the law. Other requirements include a signed statement from the physician, written referral and direct authorization from the appropriate physician to perform a laryngoscope procedure for each patient, and some restrictions on practice setting.
At the end of this complex process we have great satisfaction in knowing that voice and swallowing patients will receive the best care, providers will be reimbursed appropriately, and facilities need not fear litigation.