States facing continued economic woes mirrored the U.S. Congress by passing fewer bills this session than in previous years, according to ASHA's annual analysis of state laws and regulations related to speech-language pathology and audiology professionals and services. Analysts believe that with tight budgets, state legislatures are reluctant to pass laws that cost money—or are perceived to cost money—to implement.
In their review of 1,528 pieces of 2012 legislation, ASHA staff found only 64 bills enacted that affect speech-language pathologists and audiologists, down from 85 bills of the 1,091 reviewed in 2011. In addition, staff analyzed 365 regulatory proposals, of which only 115 were adopted.
States enacted bills and regulations related to licensure and scope of practice, insurance coverage for autism services, Medicaid, essential health benefits, education, military exceptions, truth and transparency, hearing aids, student loan forgiveness, telepractice/telehealth, and music therapy licensure.
The two remaining states without SLP regulations achieved significant victories. South Dakota's bill (SB 72), signed into law in March, licenses SLPs and also speech-language pathology assistants. The universal bill requires a single license for practice across all settings. The law culminates a 30-year effort, led by the South Dakota Speech-Language-Hearing Association and its members, to attain licensure for SLPs.
The Colorado Speech-Language-Hearing Association conducted a similar campaign, attaining certification through the Division of Registration in the Department of Regulatory Agencies for SLPs practicing in all settings, except schools. HB 1303 concludes a multi-year effort to gain regulation of SLPs. All 50 states and the District of Columbia now regulate audiologists and SLPs through a state agency.
In Maine, a new regulation allows SLPs and audiologists with state licensure to work in state public schools without additional Department of Education credentials.
Scope of practice
Ten states made technical changes to their practice acts:
- Missouri places fewer restrictions on SLPA supervision in all settings.
- Kentucky updated licensing forms for interim practice.
- Florida and Iowa amended disciplinary guidelines, and Florida changed language related to the disposition of disciplinary cases.
- Maryland and Missouri amended continuing education requirements for licensure maintenance.
- Ohio and Maine established fee structures for biennial licensure.
- Oregon approved rules that reduced the initial licensure application, renewal and delinquent fees to 2011 levels.
- Several states, including Maryland and West Virginia, removed a specific numerical test score required to pass the Praxis exam for audiologists, replacing the number with "passing score."
Autism insurance mandates
Several states passed laws requiring insurers to cover services for children with autism.
- Arkansas passed a bill requiring insurance coverage for autism-related services with no limitations on benefits.
- Alabama's bill includes coverage for services for children 9 and younger.
- Louisiana's HB 721 increases the age of insurance coverage to 21 and eliminates the cap on benefits.
- In Utah, HB 144 prohibits insurers from denying coverage based on an autism diagnosis.
- Massachusetts established rates for specialty services (such as physical therapy, occupational therapy and speech-language treatment) for children diagnosed with autism.
- Delaware, Michigan, New Jersey, Vermont and West Virginia also enacted bills mandating various amounts of coverage for services related to autism.
Oregon, however, limited the maximum benefit for autism services at $36,000 per beneficiary per year.
Health and Medicaid services
States continue to grapple with the cost of providing Medicaid services. As in 2011, states curtailed costs by reducing services, eliminating optional services (including speech-language and hearing services for adults older than 21) and reducing reimbursement rates.
- Idaho adopted an amendment that modifies copayments for some services—including speech-language pathology—and that limits the amount of speech-language treatment and occupational and physical therapy per beneficiary per year, similar to Medicare restrictions.
- In Illinois, SB 2840 placed an annual limit of 20 visits per service on the three therapy services.
- Colorado set limits on case management and services provided to each client annually.
- Indiana rules (405 IAC 1-11.5-2 and 5-16-6) reduce rates to providers—including SLPs, audiologists, optometrists and other medical personnel—by five percent.
- Texas amended rule 354.1231 concerning the limitations and benefits of Medicaid-related hearing aid services.
- Finally, in a budget-balancing action, Washington adopted rules (WAC 388) eliminating optional medical services, including vision, dental and hearing services, for clients age 21 and older.
Essential health benefits
Utah and California both addressed essential health benefits in 2012. Utah's HB 144 authorizes the legislature to determine the benchmarks for the state's essential health benefits plan; in California, SB 951 requires small group and individual health insurance plans to cover essential health benefits.
Minnesota has adopted rules revising special education teacher licensing, including two new categories, the Academic and Behavioral Strategist. The Minnesota Speech-Language-Hearing Association worked closely with the Board of Teaching in Minnesota to ensure that these individuals were not being credentialed to provide speech and language therapy. In Virginia, new requirements for early intervention professionals and early intervention case managers specify the requirements for certification of early intervention professionals under the department of education and as certified Medicaid providers. Iowa's early access program has made substantive changes including timelines for referrals, evaluation, monitoring and general supervision.
Several states have adjusted licensure requirements for military families.
- In Wisconsin, SB 550 extends the expiration date from 90 to 180 days for service members' professional licenses that would otherwise expire when the military personnel are on active duty. The extension also applies to the service member's spouse if the spouse is not practicing while the service member is on active duty.
- In Delaware, HB 238 allows a military spouse to apply for licensure reinstatement within two years of the license expiration and provides a temporary license for up to six months while the application for licensure is being processed.
- Oregon's HB 4063 requires licensing boards to accept military training or experience as a substitute for education training and experience, if the military training and experience is substantially equivalent.
Truth and transparency
The American Medical Association's Scope of Practice Partnership is designed to identify and target—through state practice acts—those professions the AMA believes are operating outside of their scope of practice. The partnership has identified "truth and transparency" legislation as one of its major goals. These bills require professionals, particularly those with doctoral degrees, to identify themselves to the general public as doctors of their stated professions, such as "doctors of audiology." Nonphysician health care professionals believe that AMA-supported "truth and transparency" legislation is unnecessary, redundant and part of the AMA's effort to examine professional competence of other health professionals. A few states, including Massachusetts and Maryland, passed this type of legislation.
Hearing aid dispensing
A few states made changes to hearing aid dispensing.
- In Iowa, HB 2464 requires applicants for a hearing aid dispensing license to demonstrate knowledge in areas such as anatomy and physiology of hearing and function of hearing aids, rather than pass a written test.
- North Carolina no longer requires an examination prep course for hearing aid dispensers as a pre-requisite for taking the exam.
- In Virginia, SB 678 merges the boards for opticians and hearing aid dispensers.
Mississippi passed loan forgiveness legislation (HB 1082) that establishes a student loan forgiveness program for SLPs working in the state's schools.
Telepractice and telehealth
Three states passed telepractice bills in 2012. Maryland requires insurers to provide the same coverage for health care services delivered in person or via telehealth and prohibits insurers from denying coverage for services solely because they are delivered remotely. Michigan prohibits denying coverage for services delivered remotely. New York's AB 9834 provides for credentialing of health care providers providing services through telehealth.
Music therapy licensure
Music therapy licensure proposals were considered in several states in 2012. Due to the broad scope of practice included in those bills—including assessment and treatment of communication disorders—ASHA opposed these proposals. ASHA worked closely with the Georgia state association to limit the scope in a revised bill, SB 414, which passed and was signed into law in May.
Although fewer laws were enacted and regulations approved in 2012, slow and steady improvement in the economy and state budgets may allow for the restoration of programs and reimbursement rates and continued innovation in areas such as telepractice. ASHA will continue to monitor legislative and regulatory proposals in states and assist state associations and ASHA members to advocate for programs and services that will benefit members, consumers and the professions.