Keeping Pace: State Legislative and Regulatory Updates for Audiology and Speech-Language Pathology

May 2, 2024

State legislation and regulations have an enormous impact on audiologists, speech-language pathologists (SLPs), and assistants – how much they’re paid, what services and supports are available to the people they serve, and what they’re able to do. ASHA’s state affairs team reviews thousands of bills and regulations every year to determine their impact on the professions and coordinate efforts to advocate for SLPs, audiologists, and the people they serve.

Many states have short legislative sessions, so most legislative action happens early in the year, while regulatory action takes place year-round. Let's delve into the major state updates that have happened so far in 2024 through the lens of ASHA’s Public Policy Agenda (PPA). The PPA defines ASHA’s top advocacy priorities for the year and consists of three focus areas: workforce, payment and coverage, and service delivery and access.

Do you know when your state legislature is in session? See the 2024 State Legislative Session Calendar to find out.

Workforce Priorities

ASHA’s ongoing advocacy efforts focus on...

Ensuring that licensing and certification requirements are maintained in states across the U.S.
Supporting the ability to practice to the fullest extent of one’s education and training.
Preserving the critical role of audiologists and SLPs across work settings as well as productivity standards that support clinical excellence, ethical practice, and high-quality service delivery.

Licensing

ASHA has tracked numerous bills related to occupational licensure. ASHA opposed Alaska’s SB 157 [PDF], which creates a Sunrise Review Board to review any proposed changes to licensure unless the proposal has been the subject of a review within the preceding four years. ASHA also opposed Rhode Island’s H 7388 [PDF], which would require state agencies to conduct a comprehensive review of all entry regulations and allow any person to petition to modify or repeal entry regulations. These bills have not passed, but their respective legislatures are still in session.

ASHA submitted comments on Maryland’s SB 714 [PDF], which determines who will submit licensing board candidates to the governor’s office. ASHA launched a Take Action campaign for this bill, but despite our efforts, this bill passed the legislature without our suggested changes.

Advocacy win: ASHA worked closely with the Maryland Speech-Language-Hearing Association (MSHA) to support HB 464/SB 795 [PDF], which modernizes the practice standards for audiology in the state practice act. These bills have been enacted.

Salary Supplement

ASHA worked with MSHA to support HB 789 [PDF], which includes audiologists and SLPs who possess the ASHA Certificate of Clinical Competence (CCC) under the alternative high-quality educator credential, making them eligible for a minimum salary and salary increase. ASHA also worked with the Utah Speech-Language Hearing Association to support HB 103 [PDF], which would add audiologists and SLPs who meet set higher education standards to the teacher salary supplement program. Unfortunately, both bills failed to pass before each state’s legislative sessions ended for 2024.

We also worked with the Oklahoma Speech-Language-Hearing Association to support HB 1037 [PDF], which would provide a $5,000 salary bonus to public school-based audiologists and SLPs who have their CCCs. ASHA launched a Take Action campaign for this bill and will continue working toward passage.

ASHA teamed up with the Oregon Speech-Language & Hearing Association (OSHA) to support proposed regulations [PDF] that will provide stipends to SLPs and speech-language pathology assistants (SLPAs) working in school districts for a minimum of two years. ASHA will continue to work with OSHA and the Oregon Department of Education to promote the regulations after they are finalized.

Music Therapy

ASHA and the Indiana Speech-Language-Hearing Association are exploring how to best address a grant awarded to Optimal ACCESS by the Indiana Family and Social Services Administration, which poses scope of practice concerns for the professions. The grant allows music therapists to develop a virtual training model to ensure “family caregivers, authorized providers, and case managers are informed and equipped to understand and support the sensory, motor, and communication needs of autistic individuals.”

Expansion of Hearing Aid Dispenser Scope of Practice

ASHA and the Nebraska Speech-Language-Hearing Association continue to oppose a regulatory proposal that would expand the scope of practice of hearing instrument specialists in a manner that harms consumers and infringes upon the audiology scope of practice.

ASHA opposed South Dakota’s HB 1029 [PDF], which also expands hearing aid specialists’ scope of practice. Unfortunately, the bill was enacted.

LEAD-K

ASHA submitted comments of concern regarding New Jersey’s S 1073 [PDF], which proposed a duplicative Deaf mentor match program and an incomplete language team for children who are Deaf or hard of hearing. We also voiced concern with lack of parent choice. The bill is still active in the New Jersey legislature.

ASHA launched a Take Action campaign in Illinois to get Illinois Speech-Language-Hearing Association members’ feedback on various state bills.

A Take Action Campaign is launched when there is an active bill or regulation (state or federal) that we want to support or oppose. ASHA members are called on to “Take Action” by sending a prewritten message (you can personalize) to your elected officials. It’s a quick and easy way to engage in advocacy. The more elected officials hear from their constituents, the more likely change will happen.

Payment and Coverage Priorities

ASHA continuously engages with regulators and key decision makers—including public (Medicare and Medicaid) and private payers—on payment and coverage policies that reflect the value and full scope of audiology and speech-language pathology services, as well as the training and expertise of our members.

Hearing Health

Advocacy win: ASHA collaborated with the Arizona Speech-Language-Hearing Association to support HB 2112 [PDF] to expand coverage for hearing aids for children. The bill passed the House but has not passed the Senate.

We also monitored legislation in Wisconsin, which specifies that a license is not required to sell or fit over-the-counter hearing aids; legislation in Washington that expands screening and support for cytomegalovirus; and legislation in Wyoming that creates an adult hearing aid program. All of these bills were enacted.

Coverage of Services

Advocacy win: ASHA worked closely with the Kentucky Speech-Language-Hearing Association to support SB 111 [PDF], which requires insurance coverage for habilitative and rehabilitative speech therapy as a treatment for stuttering. The bill was enacted.

Advocacy win: ASHA worked closely with the Delaware Speech-Language-Hearing Association to support HB 273 [PDF], which would require insurance coverage for speech-language disorders. The bill has passed the House and awaits action in the Senate.

Advocacy win: ASHA and the Florida Association of Speech-Language Pathologists & Audiologists (FLASHA) supported HB 7016 [PDF], which includes appropriations to increase the Medicaid reimbursement rate for occupational, physical, and speech therapies.

We also launched four Take Action campaigns addressing payments and coverage.

North Carolina pushed for increased Medicaid rates.
Georgia pushed for a rate increase in the Georgia Department of Community Health’s Children’s Intervention Services program and the Department of Public Health’s Babies Can’t Wait program.
Kentucky pushed to require insurance plans to cover habilitative and rehabilitative speech therapy as a treatment for stuttering.
Washington state pushed to provide an annual increase in reimbursement for audiology and speech-language pathology private practices by requiring a cost-of-living adjustment in contracts between providers and insurers.

ASHA often collaborates with state speech-language-hearing associations on public policies in the states. Learn more about the benefits of joining your state association.

Service Delivery and Access Priorities

ASHA monitors and responds to legislative and regulatory changes that could impact licensing and certification requirements and/or the scope of practice for audiologists and SLPs as well as for audiology assistants and SLPAs. We also work to advance policies that create an environment that’s conducive to efficient and effective service delivery and that broadens access to critical audiology and speech-language pathology services.

Telepractice

ASHA monitored the following enacted telepractice legislation to ensure it had no adverse effects on the professions:

South Carolina’s H 4159: The Telehealth and Telemedicine Modernization Act updated telepractice rules in the state and created a new process for out-of-state providers to serve clients in the state without a South Carolina license.
Washington’s S 5481: Allows for out-of-state telehealth providers to serve patients in the state without a Washington state license.

Audiology & Speech-Language Pathology Interstate Compact

Advocacy win: While ASHA worked closely with FLASHA to support SB 7016 [PDF] for Medicaid reimbursement rate increases, the two associations also supported the bill for its adoption of the Audiology & Speech-Language Pathology Interstate Compact (ASLP-IC). The bill passed, making Florida the 31st state to join the compact. A companion bill to the compact, SB 322—which implements the compact open meetings requirements—was also enacted.

ASHA is working closely with the Alaska Speech-Language-Hearing Association to support HB 138/SB 75. As part of that effort, ASHA launched a Take Action campaign to support the adoption of the ASLP-IC in Alaska. ASHA is also working with the Minnesota Speech-Language-Hearing Association (MNSHA) to support SF 2394/SF 2656/HF 2738 [PDF] to adopt the ASLP-IC.

Special Education

ASHA launched a Take Action campaign to encourage ASHA members in Iowa to share their concerns about House Study Bill 542, which would severely undercut Iowa Area Education Agencies. Although this bill failed, it was revived in HF 2612. ASHA worked with the Iowa Speech-Language-Hearing Association to oppose HF 2612, which allows schools to contract with outside companies for special education services. Unfortunately, the legislation was enacted. ASHA is monitoring questions about how the bill will be implemented.

Assistants

ASHA collaborated with the Oklahoma Speech-Language-Hearing Association to support SLPA regulations [PDF] providing clarifications surrounding supervision, clinical experience, and transcripts.

ASHA worked with the Illinois Speech-Language-Hearing Association to support HB 5532 [PDF], which clarifies language for SLPA supervisors and SLPAs. ASHA also worked in conjunction with MNSHA to support SF 2982 [PDF], which provides additional delineations and protections for the practice of SLPAs. Both of these bills are still active in their respective legislature.

Advocacy win: In 2023, ASHA supported proposed California regulations [PDF] addressing SLPA supervision and telepractice. Some of ASHA’s recommendations will go into effect this July 2024.

Diversity, Equity, Inclusion

Advocacy win: Legislation was introduced in Kentucky and West Virginia that would ban certain diversity, equity, and inclusion (DEI) requirements for certification. West Virginia’s HB 4387/SB 870 would have banned DEI requirements for health care-related professional licensing boards and organizations that issue health care-related professional licenses and certifications. In Kentucky, HB 9/SB 6 would have banned higher education programs from requiring DEI training for graduation. ASHA and the two state associations opposed the bills, which failed.

Challenges and Opportunities Ahead

Advocacy is challenging work that often takes time to achieve results. ASHA and other advocates are fighting to address workforce shortages, equitable reimbursement, and culturally competent care—all while navigating complex regulations. However, each challenge presents an opportunity for collaboration, innovation, and advocacy to drive positive change. By monitoring these developments and actively engaging in advocacy efforts, ASHA and its members can contribute to the advancement of audiology and speech-language pathology and ensure that all individuals have access to the services they need for optimal communication and hearing health.