With the passage of the Speech-Language Pathology Practice Act in June, Colorado became the final state to regulate speech-language pathologists. All states also regulate the profession of audiology.
The push to pass the legislation was led by the Licensure Committee and other members of the Colorado Speech-Language-Hearing Association (CSHA). CSHA received several ASHA personnel grants to fund the lobbying effort. ASHA also helped conduct e-mail blasts to ASHA members in Colorado to keep them informed of the effort to regulate the professions and to encourage them to contact their legislators in support of the legislation.
Under the new Colorado law, SLPs—except for those in school settings—require certification under the Director of the Division of Registrations through the Department of Regulatory Agencies. The law protects consumers by regulating who may provide speech-language pathology services; sets educational standards and provides title protection for practitioners; and includes a reciprocity provision for SLPs licensed in other states who want to practice in Colorado.
Efforts to codify the professional requirements to practice speech-language pathology in Colorado began in the 1970s. The first recorded attempt in 1975 failed when one state chamber approved the measure, but the other failed to act before the session adjourned, effectively killing the bill. Other attempts in subsequent decades did not get as far, nor did they have unified, broad-based constituent support, demonstrated by the meager response to a CSHA survey in the early 1990s to measure member interest in pursuing licensure laws.
In late 2008, some state education leaders suggested reducing the standard for SLPs from a master's degree to a bachelor's degree to address SLP shortages in rural areas of the state. CSHA acted quickly to work with the Colorado Department of Education's Speech Language Advisory Council and representatives of state university training programs to inform these leaders about the pre-service level of preparation represented by the bachelor's degree. As a result, an SLP Shortage Coalition was formed, of which CSHA was a part, convened to identify areas of need, share information and resources, and identify strategies to address challenges.
Around the same time, the CSHA office began to receive an increasing number of consumer and member complaints—such as unqualified providers representing themselves as SLPs—in Colorado. Additionally, private-practice SLPs notified the CSHA Board of Directors of difficulties enrolling as providers in medical insurance plans and receiving reimbursement for their services for lack of state regulation. CSHA again surveyed its members; more than 500 responded, with overwhelming support—more than 85% expressed a strong desire to pursue licensure.
The survey results ignited a three-year effort that included an extensive search for a lobbyist, town-hall-style meetings with speech-language pathology constituents to exchange information and inform the licensure platform, and conversations with stakeholders, including school administrators, the Colorado Medical Society, and other professional organizations (occupational and physical therapy, psychology, etc.).
One of the first challenges was to determine the nature of the licensure to seek: either universal licensure that would cover all practice of speech-language pathology in the state of Colorado, or a dual-pronged system with the regulation of school-based SLPs left to the Colorado Department of Education.
After months of discussion and negotiations, it became clear that the dual system had the most support from all interested groups. School-based SLPs in Colorado are already required by the Department of Education to have a master's degree and pass the national exam in speech-language pathology to work in schools.
The CSHA lobbyist and ASHA staff helped draft a bill that achieved the goals of ensuring basic educational standards and competencies, title protection, and consumer recourse. In 2010, CSHA secured a legislative sponsor, Rep. Sue Schafer, and was hopeful that the bill would be introduced in the 2011 legislative session. However, time ran out before the group was able to draft a bill that would protect consumers and the profession without negatively affecting the ability of schools to bill Medicaid for speech-language services.
CSHA's Public Policy Committee used the time before the start of the 2012 session to work with school administration groups, Colorado Medicaid, and ASHA to revise the bill language and secure assurances from the Colorado Department of Health Care Policy and Financing that the law would not prevent school-based SLPs from participating in the Medicaid School Health Services Program.
On Feb. 15, Rep. Schafer introduced H.B. 1303; it was brought to the Senate by Sen. Nancy Spence on March 30, and signed into law by Gov. John Hickenlooper on June 6.
Certification vs. Licensure
The Colorado bill mandates state certification—not licensure—of SLPs (the regulatory department offers three levels of regulation of professions: registration, certification, and licensure). CSHA chose to pursue certification because the Colorado legislative climate makes licensure bills exceptionally difficult to pass; several failed this past session. The certification requirements, however, include key components of licensure—that is, the bill has the same protections of licensure bills in other states, including education and qualification standards (master's degree, clinical fellowship, national exam), title protection, and consumer recourse. In addition, registration and certification laws are less expensive to administer. It should be noted that many professions have started at these lower levels of regulation and later moved to licensure (e.g., audiologists were registered for 10 years and then moved to licensure).
CSHA has achieved much more than regulation of speech-language pathology in Colorado. In the process, CSHA also gained a positive reputation as a reasonable, collaborative group, and became a recognized presence at the State Capitol. During the three-year effort, CSHA became involved with two other bills; was invited to participate in the Colorado Medicaid Benefits Collaborative and a Conflict of Interest Task Force (with the Colorado Department of Health Services and the Division of Developmental Disabilities); and joined other professional groups advising on the implementation of an autism coverage mandate for health insurance companies.
Members of the CSHA Public Policy Committee are meeting with regulatory department representatives to draft rules, next steps, and implementation timelines. With the success of the regulation effort, CSHA intends to stay engaged at the state level and with other professional groups to continue to advocate for consumers and the professions on issues including Medicaid guidelines, autism mandates, and audiology licensure legislation set to expire.