Diggs, C. (2005, Sept. 6). State of the states 2005: Legislatures act upon licensure, insurance, salary supplements. The ASHA Leader, pp. 1, 24-26.
by Charlie Diggs
Many dreams of seeing favorable speech, language, and hearing legislation at the state level came true in 2005. If you pinch yourself, you will now find that more states license audiologists and SLPs; more states will soon require a doctoral degree to be licensed as an audiologist; more newborn babies must have their hearing screened before they leave the hospital; and more health benefits plans must cover speech, language, and hearing services, including hearing aids. In addition, school audiologists and SLPs with ASHA's Certificate of Clinical Competence (CCC) will receive higher salaries in more states.
These changes have occurred in both red Republican and blue Democratic states and stretch from the West (New Mexico, Nevada and Idaho) through the Midwest (Indiana and Ohio) and South (Arkansas) to the East (Delaware and Rhode Island).
Professional Licensure
On April 5, Gov. Dirk Kempthorne signed landmark legislation (H.B. 247) making Idaho the 50th state to regulate the practice of audiology and the 47th state to license speech-language pathology. The legislation specifically includes vestibular functioning, intraoperative monitoring, and the dispensing of hearing aids and assistive devices within the audiologist's scope of practice; and swallowing, cognitive-communicative disorders, and augmentative and alternative communication for SLPs.
Qualifications for an audiologist's license include at least 75 hours of post-baccalaureate study that culminates in a doctoral or other recognized degree from a nationally accredited school, passage of a licensing board-approved examination, and appropriately supervised academic clinical practicum and postgraduate professional experience as determined by the board. These requirements are consistent with the 2007 Standards for the Certificate of Clinical Competence in Audiology (CCC-A).
Requirements for SLPs are similar, but academic degree requirements are a master's or doctoral degree. Speech-language pathology aides and assistants who have a bachelor's or associate's degree, respectively, and meet other requirements could also be licensed.
As part of this action, the existing licensing law for hearing aid dealers and fitters was repealed. Provisions for regulation of hearing aid dealers and fitters were incorporated into this new Speech and Hearing Practices Act with a single licensing board having jurisdiction over audiologists, SLPs, hearing aid dealers and fitters, and speech-language pathology aides and assistants. Licensure takes effect July 1, 2006.
The Idaho Speech-Language-Hearing Association (ISHA) lobbied for years for passage of this bill. They engaged a lobbyist and agreed to compromises along the way. ASHA's state policy unit provided assistance by reviewing multiple drafts of bills and offering recommendations based on how other states had addressed similar issues.
Doctoral Degree in Audiology
In anticipation of ASHA's mandatory requirement for a doctoral degree in audiology in 2012, other state legislatures got a running start by changing their licensure laws to require such a degree for audiologists even earlier. Ohio (H.B. 66) will require an AuD degree or equivalent for initial audiology licensure beginning Jan. 1, 2006. Indiana (H.B. 1098) and New Mexico (H.B. 308) will require new applicants to hold a doctoral degree for state licensure effective Jan. 1, 2007. In all these states, the nature of acceptable doctoral degrees still must be specified by licensing board regulations. Since Oklahoma passed similar legislation last year that becomes effective in 2007, four states will soon recognize only doctoral degrees in audiology for licensure purposes.
Several states took other licensure action related to ASHA's new standards. Montana (S.B. 451) revised its licensure law to allow the licensing board to determine the specific scopes of practice for audiology and for speech-language pathology and to determine the specific "academic, supervised practicum, and post-classroom employment requirements" for licensure as long as they are equal to or greater than the standard generally accepted as the national norm.
Subject to the governor's signature of S.B. 451, which was still pending at press time, Illinois will now accept a master's or doctoral degree in audiology and 1,500 clock hours of supervised experience for its license. Current law in Illinois specifically requires a master's and no other degree. But successful candidates for a clinical doctorate in audiology often move directly from a bachelor's degree to the doctorate without receiving a master's degree in between and would not have been eligible for licensure under the current law. Likewise, the 1,500 hours of supervised experience replaces "nine months of full-time, supervised professional experience" to make it clear that supervised hours need not come after the granting of a degree but can be incorporated into the doctoral training itself.
Connecticut also addressed in H.B. 6713 its postgraduate supervised employment requirements by waiving them for persons who can meet ASHA's 2007 CCC standards. Missouri S.B. 100, enacted this year, also exempts applicants with an audiology clinical doctorate from a post-degree supervised experience.
Licensure Changes
The new Indiana licensing law also made dramatic changes in licensure requirements for SLPs. Currently exempt from the licensure law, school SLPs and audiologists would now be required to obtain a license from the health professions bureau. Until July 1, 2007, individuals who hold a teaching license in "speech and hearing therapy," have a master's degree in speech-language pathology or a related discipline, and have been employed for at least nine months out of the past five years will be issued a license. So will holders of a life teaching license in speech-language pathology who have been employed for at least nine months out of the past five years or have taken at least 36 hours of approved continuing education during 2002 through 2006. After July 1, 2007, applicants must meet all requirements for the health professions bureau license.
The law also expands the scope of practice for both audiologists and SLPs. Vestibular function is included within the audiologist's scope, but testing of this function requires a physician's referral. Swallowing, elective modification of communication behaviors, and augmentative or alternative communication would be included in the SLP's scope. An SLP may perform endoscopy if authorized and supervised by a physician.
Categories for speech-language pathology support personnel would increase from one (aide) to three (aide, associate, assistant). The bill specifies academic degree (high school, associate degree, bachelor's degree, respectively) for each level, identifies specific supervisor qualifications, and requires the supervising speech-language pathologist to register all support personnel with the board. Other details will be defined through rulemaking of the licensing board.
In Minnesota, as the result of S.B. 1204, licensed audiologists may dispense hearing aids without a dispensing certificate. However, all applicants for licensure after Aug. 1 now must pass the practical portion of the hearing aid dispensers' examination. Also, as a result of this bill, the trial hearing aid period was extended from 30 to 45 days. The enabling legislation for these changes was part of an extensive multidisciplinary health occupations bill.
EHDI / Hearing Aids
More is new in state laws, however, than just licensure requirements.
Because of H.B. 205, all newborn babies in Delaware must now have their hearing screened prior to hospital discharge or 3 months of age, whichever occurs first.
Hospitals must report the proportion of newborns screened, referral rate, and follow-up rate and establish criteria (
The Alaska House passed its own Early Hearing Detection and Intervention (EHDI) bill (H.B. 109) this year, but the state senate took no action on the bill before the legislature adjourned.
Delaware became the 39th state with EHDI legislation. Five additional states (Alabama, Arizona, Idaho, Michigan, and Vermont) screen 95% or more of their newborns without having passed legislation.
While no additional states have passed legislation to require health benefits plans to pay for a portion of the cost of hearing aids, Rhode Island (H.B. 5742) expanded its requirements to include coverage for both adults and children. No other state has a requirement for coverage of such a broad age range.
Rhode Island's previous law required every individual or group health insurance contract and hospital or medical expense insurance policy to provide $1,000 coverage per hearing aid per ear every three years for children under 18 years of age.
Each contract or policy must also provide, as an optional rider, additional coverage for hearing aids. The new law has reduced coverage to $400 per hearing aid under the same terms, but requires coverage for all ages.
Besides Rhode Island, seven other states (Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri, and Oklahoma) already had laws requiring some form of hearing aid coverage for children. Requirements for ages covered, the amount of coverage, the benefit period, provider qualifications, and type of hearing loss covered vary from state to state.
Mandated Benefits
Arkansas specifically excludes hearing instruments and devices from required coverage in health benefits plans, but Gov. Mike Huckabee's signing of S.B. 998 on April 11 mandates other "coverage for the necessary care and treatment of loss or impairment of speech or hearing, subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as other covered services..." This requirement applies to every accident and health insurer, hospital or medical service corporation, or health maintenance organization transacting accident and health insurance or providing health coverage in the state. Coverage must include all communication disorders within the state's scope of practice for SLPs or audiologists, whether the disorder is developmental or acquired. This new Arkansas law is believed to require the broadest coverage of speech, language, and hearing services by health insurers in the United States.
Both Colorado and Maryland already have more limited mandates. Colorado requires that all individual and group health benefit plans "provide medically necessary physical, occupational, and speech therapy for the care and treatment of congenital defects and birth abnormalities for covered children up to five years of age." Maryland requires coverage of speech-language pathology services for the treatment of children under 19 years of age with a congenital or genetic birth defect.
Then, there is a group of states (Connecticut, Illinois, Missouri, New Jersey, Tennessee, and Texas) that requires insurers to offer a speech, language, and hearing benefit in all of their policies. However, any employer may choose not to include this benefit in the actual health insurance plan or plans it offers to its employees. Until passage of its recent law, Arkansas had been included in this group.
Salary Supplements
Advocacy efforts for increased salaries for SLPs and audiologists in the schools have also been quite successful this year. Nevada concluded a more than five year initiative with enactment of A.B. 580 that provides a 5% salary increase to school SLPs who are also licensed by the state's Board of Examiners for Audiology and Speech Pathology and who hold ASHA's Certificate of Clinical Competence. The Nevada Speech-Language-Hearing Association, with assistance from ASHA's state policy unit and its State Advocacy Guide for the Salary Supplement Initiative, has been tireless in answering questions from legislators such as state graduation rates in speech-language pathology, employment choices of graduates, school district by school district need for qualified SLPs, and sources of funding for the proposed increase. Their perseverance has literally paid off for school SLPs in the state.
Indiana had a different, and quite clever, approach. The successful amendment of the licensure law (H.B. 1098, as described above) included language that would provide a salary supplement to school audiologists and SLPs who have held the ASHA CCC for at least three consecutive years and have at least three years of professional experience in the schools. Successful passage of the licensing amendments then also provided the salary supplement.
In Arkansas, an incentive bonus of $5,000 was approved for school SLPs who hold the CCC. However, these awards are to be paid from state funds available for SLP bonuses, and these funds have yet to be appropriated by the legislature. In all three of the above states, the supplements are comparable to what master teachers with certification from the National Board for Professional Teaching Standards receive.
Delaware, Mississippi, and Missouri already provide salary supplements for school audiologists and/or SLPs with the CCC. Like Arkansas, Louisiana and Oklahoma have approved a salary supplement in principle but still need to appropriate funds. Rhode Island will pay for CCC application fees only.
Charlie Diggs is director of ASHA's State and Consumer Advocacy unit. Susan Pilch, director, state legislative and regulatory advocacy, contributed to this article through her tracking and analysis of proposed legislation. Eileen Crowe, director of state association relations, contributed her running inventory of salary supplement legislation. Janet Deppe and Susan Karr worked with some of the successful salary supplement states as part of ASHA's Schools Focused Initiative. Contact Diggs at cdiggs@asha.org
Contact a state policy staff member if you need further information:
Susan Pilch, spilch@asha.org, licensing, teacher certification, status of state bills, state mandated health benefits
Eileen Crowe, ecrowe@asha.org, state association relations, salary supplement
Janet Deppe, jdeppe@asha.org, personnel issues in the schools, early intervention
Charlie Diggs, cdiggs@asha.org, early hearing detection and intervention, hearing aid insurance mandates, and other issues
State of the States 2005: Legislatures Act Upon Licensure, Insurance, Salary Supplements
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