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Posted 5/16/2016

Legislation Introduced to Restore Graduate Student Loans
The Protecting Our Students by Terminating Graduate Rates that Add to Debt Act (H.R. 4223), known as the POST GRAD Act, introduced by Representative Judy Chu (D-CA), would restore the eligibility of graduate student access to the Federal Direct Subsidized Loan Program. Urge your Representative to cosponsor this legislation.

Background
For many years, both undergraduate and graduate students were eligible for the Federal Direct Subsidized Loan Program with the goal of making all levels of post-secondary education accessible to students with financial need. In 2012, however, changes in the Budget Control Act (P.L. 112-25) eliminated eligibility for graduate students.

This change has significantly increased the cost of borrowing and put graduate study out of reach for many students with financial need, especially underrepresented groups. It has had a negative impact on students wishing to pursue a graduate degree in a variety of fields, including audiology and speech-language pathology.

According to the U.S. Bureau of Labor Statistics (BLS), the national employment rate of speech-language pathologists (SLPs) is expected to grow faster than average through the year 2022. An additional 26,000 SLPs will be needed to fill the demand between 2012 and 2022—a 19% increase in job openings. In occupational employment projections for 2012 to 2022, speech-language pathology ranked 13th out of the 20 large-growth occupations that typically require a master's, doctoral, or professional degree for entry.

Similarly, according to the BLS, the national employment rate of audiologists is expected to grow much faster than average through the year 2022. An additional 4,300 audiologists will be needed to fill the demand between 2012 and 2022—a 34% increase in job openings.

Now more than ever, the federal government should be investing in graduate education as a means of maintaining a globally competitive workforce that fosters innovation, discovery, and research.

Contact your Representative today and ask this to cosponsor the POST GRAD Act (H.R. 4223).

Resources
For more information on the H.R. 4223, the POST GRAD Act, please contact Neil Snyder, ASHA's Director of Federal Advocacy, by email at nsnyder@asha.org or by phone at 800-498-2071, ext. 5614.

 

Posted 8/11/2015

Medicare Clarifies Manual Medical Review for 2014 Therapy Claims

During a meeting with ASHA and other representatives from therapy professional organizations, the Centers for Medicare & Medicare Services (CMS) officials clarified the Recovery Audit Contractors (RACs) review process for 2014 therapy claims.

  • RACs now have the option to apply their own targeting algorithms to claims above the $3,700 threshold (speech-language pathology and physical therapy services combined) submitted for dates of service in the 2014 calendar year. The targeting methods are not required to be approved by CMS or published for public viewing.
  • RACs will review only those claims submitted by institutions (e.g., hospitals, skilled nearing facilities) in 2014. Claims submitted by private practice or group practices will be held for potential review by a new contractor, yet to be determined.
  • The following number of Additional Documentation Request (ADR) letters and claim limitations has been imposed on the RACs by CMS:

    o   1st ADR: can only request documentation for 1 claim
    o   2nd ADR: can request up to 10% of total eligible claims
    o   3rd ADR: up to 25% of remaining eligible claims
    o   4th ADR: up to 50% of remaining eligible claims
    o   5th ADR: up to 100% of remaining eligible claims

  • ADR letters must have a minimum of 45 days between mailing. No more than 5 separate ADR letters related to the therapy manual medical review may be sent to a provider.
  • Facilities have 45 days from the receipt of the notification to respond to the ADR request. No response results in a denied claim.
  • RACs have 30 days from the receipt of the documentation to inform the provider of their decision.
  • For claims that have been determined not medically necessary by RAC review, providers have a "discussion period" of 40 days prior to the implementation of the payment recovery to question the determination.
  • ADR letters will be addressed according to the provider's preferences. Providers should contact their RAC to update contact information.

Background
The manual medical review process for Medicare Part B therapy services that exceed the $3,700 threshold was mandated by the Middle Class Tax Relief and Job Creation Act of 2012. The mandate requires any therapy claims for combined speech-language pathology and physical therapy services that reach $3,700 to be reviewed for medical necessity. Earlier this year, CMS announced the resumption of the manual medical review processing for 2014 claims after a pause due to RAC contracting issues. The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) changed the requirements from every claim over $3,700 to a targeted review for claims over $3,700.

Medicare has not completed development of the manual medical review process for private practice and group practice claims from 2014, or for any 2015 claims. ASHA continues to engage in discussions with CMS officials and will update members through ASHA Headlines and the Manual Medical Review Process for Therapy Claims webpage.

Resources
CMS Recovery Audit Program
ASHA's Medicare Audits and Program Integrity

For additional information or questions, please contact reimbursement@asha.org

 

Posted 7/20/2015

ED Issues Guidance to Ensure Access to Speech-Language Pathology Services for Children with Autism

The United States Department of Education (ED) has issued guidance in the form of a "Dear Colleague" letter [PDF] regarding services delivered to children with autism spectrum disorder (ASD). In its letter, the Office of Special Education Programs (OSEP) recognizes the importance of speech-language pathology services that may be appropriate for students with ASD, and that school systems must ensure that speech-language pathologists and other appropriate professionals are part of the evaluation process and IEP/IFSP teams for students with ASD. ED stated that "ABA therapy is just one methodology used to address the needs of children with ASD, and reminded States and local programs to ensure that decisions regarding services are made based on the unique needs of each individual child with a disability (and the child's family in the case of Part C of IDEA)."

 

Posted 7/20/2015

Steve Gleason Act Passes the House of Representatives—Bill Set for President's Signature
Today, the United States House of Representatives passed the Steve Gleason Act of 2015 that allows for the immediate purchase and transfer of ownership for speech-generating devices (SGDs) to the Medicare beneficiary and removes SGDs from Medicare capped-rental requirements. Introduced by Representative Cathy McMorris Rodgers (R-WA), the bill ensures coverage of eye-tracking technology that allows individuals with extremely limited voluntary muscle control to effectively use SGDs to communicate their personal and health care needs.

The legislation, which was spearheaded by Senator David Vitter (R-LA), passed the Senate in April and is now heading to the President's desk for his approval.

The legislation is set to sunset in three years. ASHA is committed to working with Congress and other stakeholders to develop a more permanent solution.

Background
SGDs fall under the Centers for Medicare & Medicaid Service (CMS) capped-rental requirements, an arrangement that adversely impacts patients who use them during extended hospital stays or in skilled nursing facilities. CMS maintains that the capped-rental issue must be addressed through legislation. Speech-generating devices are highly customized electronic augmentative and alternative communication devices that are used to supplement or replace speech. The Steve Gleason Act will ensure that Medicare beneficiaries—who utilize these devices to communicate—can retain their customized devices when requiring inpatient care.

ASHA Resources
For legislative activities, contact Ingrida Lusis, ASHA's director of federal and political advocacy, at ilusis@asha.org. For CMS implementation, contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at lsatterfield@asha.org.

 

Posted 7/10/2015

Senate Warren Offers Literacy Amendment to ESEA Bill
Senator Elizabeth Warren (D-MA) will offer an amendment to S. 1177, the Every Child Achieves Act, which could result in an increased role for audiologists and speech-language pathologists in delivering literacy services in schools. The United States Senate began debating S. 1177 on Tuesday, July 7, 2015, and will continue to debate the bill for approximately two weeks. Your help is needed today to ensure that the Warren amendment is adopted as part of the debate on S. 1177.
 
Background    
ASHA has advocated for specialized instructional support personnel (including audiologists and speech-language pathologists), as appropriate, to be inserted in several locations in the literacy section of S. 1177. If enacted as amended, these changes would explicitly allow audiologists and speech-language pathologists to have an expanded role in support of the reading curriculum in schools. This could include access to professional development and more opportunities to collaborate with other school personnel on the delivery of literacy instruction.
 
If the Senate passes S. 1177, it would enter into negotiations with the House of Representatives to resolved differences with H.R. 5, the Student Success Act, its version of a No Child Left Behind (NCLB)/ Elementary and Secondary Education Act (ESEA) re-write. A successfully conferenced bill would then go to President Obama for his signature into law and the formal replacement of NCLB.
 
ASHA Resources
For additional information related to legislative action, please contact Ingrid Lusis, ASHA's director of federal and political advocacy at ilusus@asha.org.

 

Posted 6/15/2015

PSHA's Response to the Essential Health Benefits Benchmark Plan

Posted June 6, 2015

Governor Wolf Announces
Fee Waivers for Volunteers Seeking Background Checks


Governor Tom Wolf announced today that fees for child abuse clearances and criminal background checks required by the Child Protective Services Law will be waived for volunteers working with children. Additionally, the Department of Human Services (DHS) and the Pennsylvania State Police (PSP) will be reducing the cost of both the child abuse and criminal history record checks from $10 to $8 for all other applicants. These changes will take effect July 25, 2015.
 
In 2014, 23 pieces of legislation were enacted including Act 153 of 2014, changing how Pennsylvania responds to child abuse. These changes significantly impacted the reporting, investigation, assessment, prosecution and judicial handling of child abuse and neglect cases. 
 
“My action today could not have been accomplished without the hard work of the General Assembly, who has participated in an ongoing bipartisan working group with the Administration in an effort to develop needed clarifications to the Child Protective Services Law,” said Gov. Wolf. “Through that process, the General Assembly expressed concerns of many members about the cost of background clearances, particularly for volunteers. I share those concerns, and that is why I am excited to announce these actions today.”
 
Beginning July 1, 2015, volunteers are required to obtain background checks, including the Child Abuse History Clearance, issued by the DHS, and the Criminal History Record Check, issued by the PSP. 
 
Persons seeking employment for work with children and others required under the law will still be assessed fees for the clearances, but at a reduced cost of $8 each.  FBI clearances are also required for all employees and for volunteers who have not been a continuous resident of the commonwealth for the last 10 years, but because these are administered by the federal government current costs will continue to apply.
 
“The work from DHS and PSP sets a strong example of interagency collaboration,” Gov. Wolf continued.  “Partnerships like these create the foundation for a government that works.”
 
A comprehensive list of persons required to get clearances is as follows:

  • Child care service employees;
  • Foster parents and adult household members;
  • Prospective adoptive parents and adult household members;
  • Individuals 14 year of age or older applying for a paid position as an employee responsible for the welfare of a child or having direct contact with children;
  • Any individual seeking or provide child-care services under contract with a child-care facility or program;
  • School employees governed by public school code and those not governed by the public school code (colleges and universities).
From Jan 1, 2015 to April 30, 2015, there were 61,019 clearance applications received for volunteers. The projected total number of volunteer clearances for FY 2015-2016 is 296,836
 
For DHS, the total number of clearances received was 512,583 since the electronic system went live in late December 2014 through May 31, 2015.  The PSP processed 828,579 Criminal History Record Checks from January through May of 2015.
 
More information about clearances required under the Child Protective Services Law can be found at www.keepkidssafe.pa.gov.  Individuals seeking clearances can go directly to www.compass.state.pa.us/cwis to create an individual account and apply for their child abuse clearance electronically.

 

Posted April 1, 2015

House Passes Permanent "Doc-Fix"—Fails To Address Permanent Fix for Therapy Caps

By an overwhelming majority (393-37 with 4 not voting), the House of Representatives passed H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015, legislation that will permanently repeal the flawed SGR payment formula for Medicare Part B providers. The bill moves Medicare Part B reimbursement to a system based on quality and patient outcomes. ASHA is pleased that Congress has passed legislation that provides more predictability in provider payments under Medicare.

Unfortunately, ASHA is disappointed that H.R.2 did not permanently repeal and replace the Medicare Part B therapy cap, but rather provided for a 2-year patch. ASHA worked tirelessly with other stakeholders to develop a permanent solution that was part of a bicameral and bipartisan deal reached last year. Issues related to how to pay for a permanent therapy cap repeal led the House to forgo permanent repeal and provide for a 2-year patch.

Decoupling the therapy cap from the larger SGR issue is of great concern to ASHA. There is no guarantee that Congress will have the interest to do anything in two years and, absent a larger Medicare bill, there is no guarantee that the therapy community will not be forced to find more than $8 billion dollars in pay-fors from its own benefit in order to permanently resolve the therapy cap issue.

The Senate has not yet announced when it will take up consideration of H.R.2. In order to pass in the Senate without debate all 100 Senators must agree to pass the measure. There have been reports that both Republican and Democrat Senators have concerns with the bill and the process by which it was created.

Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, ASHA Fellow
Chief Staff Officer, Speech-Language Pathology
American Speech-Language-Hearing Association
2200 Research Boulevard, #229
Rockville, MD 20850-3289
+1 301-296-5705 telephone
301-296-8577 fax
lmcneilly@asha.org

 

Posted January 8, 2015

Education Specialist Certification for Speech-Language Pathologists in the Schools

Framework for School Speech and Language Pathologist Educational Specialist Program Guidelines

CSPG No. 086 Educational Specialist  Certification for Speech Language Pathologist was established by the Pa Department of Education (PDE) this summer and has the potential to change the landscape of SLPs in the schools. The finalization of this certificate was spearheaded by Rep. Julie Harhart as part of the final negotiations for the passage of Senate Bill 137 which became Act 103 of 2014, our new licensure law.

The creation of the new Educational Specialist Certificate will increase the number of qualified candidates who are able to provide school-based speech therapy services without reducing the quality of services provided by making the certificate appealing to already state licensed speech and language professionals. The benefits of creating a Speech and Language Pathologist Educational Specialist Certificate Program include:

  • Candidates for the Educational Specialist Certificate will be required to take only the Praxis II content area test in Speech-Language Pathology (the ASHA national exam) versus the five Praxis exams currently required for a Speech and Language Impaired Instructional I certificate.
  • Removing such testing requirements removes road-blocks and provides an incentive for professionals to seek out service in public schools in lieu of hospital settings.
  • The Educational Specialist Certificate would properly align the types of service being provided by many speech and language professionals.
  • A pathway is provided to certification for licensed speech pathologists to perform services in a public school that may significantly reduce the number of emergency permits issued.

The requirements for the certification have been established by PDE. There are essentially two pathways to the certificate. New master’s degree graduates from schools in PA can get the Ed. Specialist certification rather than the instructional I certificate, once a graduate program is approved to recommend candidates for the new certificate. Since the Educational Specialist certification is not a teacher certification and does not allow a therapist to act as a teacher, it moves therapists in the schools in the right direction as they cannot be assigned a duty as a teacher, nor can they be evaluated as a teacher. They would be evaluated much like a school psychologist or a school nurse. As SLPs in the schools re-invent themselves they have a robust opportunity to increase not only their value but also their respect as a highly educated professional who is different from a teacher

The second pathway is for those who come to PA from other states or those who do not have the Instructional I certificate in PA and wish work in the public schools. These cases would be handled by PDE on an individual basis. Once the individual obtains a PA license and their educational program obtains approval from PDE they will be granted the Educational Specialist Certification.

 

Posted August 21, 2014

Action Alert: Help Protect SGD Access for Medicare Patients

Speech-language pathologists are needed to garner support for a letter opposing Medicare’s SGD regulations! Please contact your members of Congress TODAY and ask them to sign on to this important letter.

Over the past 5 months, access to speech-generating devices (SGDs) and SGD accessories has been significantly limited by Medicare to the patients that need them the most. Even after multiple meetings with the Centers for Medicare and Medicaid Services (CMS) and contractor staff as well as nearly 200 comments opposing the new regulations, there have been no changes in policy. Therefore, Congresswoman Cathy McMorris Rodgers is preparing a bicameral sign on letter to CMS asking for their rationale on these issues. 

This is a time sensitive issue. Your members of Congress must request to sign on to the letter before this coming Monday, August 25. On September 1, if the devices and accessories continue to have non-speech capabilities, they will no longer be approved for use by Medicare beneficiaries. Don’t let CMS deny much needed patient access to these devices!

Background
In February, the Medicare contractors that administer Durable Medical Equipment (DME) claims issued a “coverage reminder” that prohibits SGDs from having any non-speech capabilities (e.g., e-mail, internet, environmental control) or the ability to upgrade in the future at the patient’s own expense.  Related to the coverage reminder prohibitions, Medicare’s contractors are routinely denying coverage for eye-gaze, a technology that is needed by patients with limited or absent mobility in the arms and hands. Contractors indicate the denials are due to the ability of the eye-tracking to be used for other purposes or plugged into devices that are not SGDs.

Then in April, CMS changed the manner in which it pays for SGDs, requiring patients to rent them over a 13-month period before owning the device. “Capped Rental” adversely affects patients in an extended hospital stay or in skilled nursing facility because while the patient is in the rental period, Medicare will not cover the rental fees. Instead, the device is returned to the manufacturer while the patient would have to obtain a new one from the hospital or hospice or pay the entire monthly rental fee out-of-pocket. The regulation has left many patients with no way to communicate at a time when they need it most.

ASHA Resource
For more information on SGD issues please contact Lisa Satterfield, ASHA’s director of health care regulatory advocacy, at lsatterfield@asha.org or Ingrida Lusis, ASHA’s director of federal and political advocacy, at ilusis@asha.org.

 


Posted July 15, 2014

A Pennsylvania Bill Becomes Our New Licensure Law!!!

On June 26, 2014, the House of Representatives passed the final version of our new licensure act, Senate Bill 137. It went to the Senate on June 30, 2014, and passed unanimously.  The bill was then sent to the Governor on June 30, 2014, which was subsequently approved and signed on July 2, 2014. Our bill is now Act 106 of 2014!
               
After much negotiation and compromise for both speech-language pathology and audiology, Senate Bill 137, as amended in the House of Representatives included updates for both speech-language pathology and audiology practice.

This law has been a long time in the making. Our original law was SLP License Law 1253, No. 238 and was passed on December 21, 1984. That Practice Act, or “Title Act” was almost 30 years old. For the last eight years the PSHA board has worked diligently to reword a new bill which was inclusive of the current practices in our fields.  Both speech-language pathology and audiology had to make compromises along the way. They were not easy compromises to make and were only agreed upon after exhausting alternative solutions by both PAA and PSHA. Our old “Practice Act” gave us the right to exclusively call ourselves speech-language pathologists and audiologists but never defined our scope of practice. The current act clearly defines our scope of practice with updates to reflect current training included.

The new law continues to give an exemption from licensure to speech-language pathologists and audiologists who work in the public school system. However, separate from the bill, Representative Julie Harhart, the chair of the House Licensure Committee, was instrumental in getting all of the stakeholders, including PDE, together in order to finally establish the Educational Specialists Certification in Speech-Language Pathology for those who wish to work in the public schools. More information on that certificate will be available as soon as regulations are established.

What does the Speech-Language Pathology and Audiology Licensure Law include?

Speech-Language Pathology
Defines the scope of practice to include:

  • Evaluation and treatment of disorders of speech, language, voice, swallowing, cognitive and social aspects of communication
  • Augmentative and Alternative Communication
  • Fitting and establishment of effective use of prosthetic and adaptive devices for speaking and swallowing
  • Auditory training, speech reading and speech and language intervention secondary to hearing loss
  • Using Instrumental Technology for disorders of communication, voice and swallowing

Audiology
Establishes the clinical doctorate as the entry level into the profession.
Defines the scope of practice to include:

  • Assessment and treatment of hearing and vestibular disorders
  • Assessment of candidacy for cochlear implants, fitting and mapping of cochlear implant devices
  • Selection, fitting, evaluation and dispensing of hearing aids and other amplification systems including fitting of middle ear implantable hearing aids, fully implantable hearing aids and bone anchored hearing aids.
  • Conducting otoscopic examinations.
  • Use of neurophysiologic intraoperative monitoring as long as it is upon the delegation from and under the overall direction of a physician

The act also

  • Establishes provisional licensure for new graduates of each profession
  • Removes teachers of the hearing impaired

Act 106 is set to take effect in 60 days. For more information, click here. Click on the top tab titled “Text”, and then click on the printers number “1603” to read the details of the law.

Many, many individuals including present and past board members of PSHA as well as our lobbyist Mr. David Tive, were instrumental in the long awaited passage of this updated licensure bill and we thank each and every one of them for the vital roles they played.

Ralph Belsterling
Craig Coleman
Amy Goldman
Kathleen Helfrich-Miller
Char Molrine
Caterina Staltari
David Stein
Karen Stein

 

Posted July 2, 2014

New Licensure Act For Speech-Language Pathology and Audiology

On June 30, 2014, the Senate passed the final version of our new licensure act, Senate Bill
137. After much negotiation and compromise for both speech-language pathology and audiology,
Senate Bill 137, as amended in the House included updates for both speech-language pathology and audiology practice.

It was a long, laborious process to get to this point, and I won’t elaborate except to let you know both speech-language pathology and audiology had to make compromises along the way. They were not easy compromises to make and were only agreed to after all efforts at working out alternative solutions were exhausted by both Pennsylvania Audiology Association (PAA) and PSHA.

Our prior licensure act was a “Title Act.” This means it gave us the right to exclusively call ourselves speech-language pathologists and audiologists but never defined our scope of practice. The current act clearly defines our scope of practice. The major elements (not an exclusive list) for each profession include:

Speech Language Pathology

Defines the scope of practice to include

  • Evaluation and treatment of disorders of speech, language, voice, swallowing, cognitive and social aspects of communication
  • Augmentative and Alternative Communication
  • Fitting and establishment of effective use of prosthetic and adaptive devices for speaking and swallowing
  •  Auditory training, speech reading and speech and language intervention secondary to hearing loss
  • Using Instrumental Technology for disorders of communication, voice and swallowing

Audiology

Establishes the clinical doctorate as the entry level into the profession.

Defines the scope of practice to include:

  • Assessment and treatment of hearing and vestibular disorders
  • Assessment of candidacy for cochlear implants, fitting and mapping of cochlear implant devices
  • Selection, fitting, evaluation and dispensing of hearing aids and other amplification systems including fitting of middle ear implantable hearing aids, fully implantable hearing aids and bone anchored hearing aids.
  • Conducting otoscopic examinations.
  • Use of neurophysiologic intraoperative monitoring as long as it is upon the delegation from and under the overall direction of a physician

The act also

  • Establishes provisional licensure for new graduates of each profession
  • Removes teachers of the hearing impaired

The new law continues to give an exemption from licensure to speech-language pathologists and audiologists who work in the public school system. However, Rep. Julie Harhart, the chair of the house licensure committee was instrumental in getting all of the stakeholders together in order to finally establish the Educational Specialists Certification in Speech Language Pathology for those who wish to work in the public schools.

More information on that certificate will be available as soon as regulations are established. Many, many individuals including present and past board members of PSHA as well as our lobbyist David Tive, were instrumental in the long awaited passage of this updated licensure bill and we thank each and every one of them for the vital roles they played.

Kathleen Helfrich-Miller
Kathleen Helfrich-Miller, PhD, CCC-SLP, PSHA Past President

 

Posted November 22, 2013

I wanted to give you an update on House Bill 1561 which has now become Senate Bill 137.

In the past few weeks there has been a lot of action on our licensure bill, sometimes so much action that it was hard to quickly be on top of things! There were many individuals involved at the grassroots level from Ellen Cohn and Janice Tucker on telepractice to Karen and David Stein, Julie Stroup, Catie Stalteri and I meeting with key representatives on licensure of school based SLPs. There were multiple emails that were circulated among our lobbyist David Tive, Craig Coleman, Amy Goldman, Cati Stalteri and myself. SLPs in Julie Harhart’s district wrote personal letters to her and they received personal letters in response. There was a record response to PSHA’s survey concerning universal licensure.

This is what transpired (any errors are mine alone!)

Recall that there were two bills, an audiology bill (Senate Bill 137) and speech language pathology bill (House Bill 1561). Our hope was that at some point they would be put back together as one bill because we have one State Board that oversees both professions. However, key representatives in the Senate wanted two bills.

Senate Bill 137 passed the Senate and was referred to the House Professional Licensure Committee.

In the meantime, House Bill 1561 was introduced by Rep. Donna Oberlander and was also referred to the House Professional Licensure Committee.

On Wednesday Nov. 20, 2013, Rep. Julie Harhart introduced an amendment to Senate Bill 137 which was approved by unanimous vote. Then, Senate Bill 137 was reported out of the House Professional License Committee by a unanimous vote.

This is what the amendment accomplished:

  • Put the speech language pathology bill into the audiology bill so we once again have one bill which covers both professions (Senate Bill 137)
  • Deleted telepractice from the bill (at our request)
  • Deleted school based speech license from the bill (with our disappointment).
  • Updated our scope of practice including instrumental technology!
  • Required neurology oversight for all interoperative monitoring by audiologists (with audiology disappointment)

It now goes to Appropriations Committee and then out to the full House for a final vote. At this point, no one anticipates a problem getting the bill passed by the House of Representatives.

It then goes back to the Senate Rules Committee (where it can also be amended) and the bill will then be sent to the floor of the Senate for a vote.

The telepractice language was taken out of the bill at PSHA’s request because there was a push for extremely restrictive language to be put into the law. After consultation with Ellen Cohn and other stakeholders in Telehealth, it was determined that regulations will be put into place for all health professions and there was not a need for it to be part of our licensure bill. The deletion of telepractice from our bill will have no effect on our ability to continue to use telepractice as a treatment modality.

We are very disappointed that licensure of school based SLPs was deleted from the bill. Chairwoman Harhart firmly believes the ultimate resolution of this issue needs to come from PDE. PDE determines the qualifications it requires for school based employees. She believes that PDE, rather than the licensure act, is where this decision should be made. We made a valiant effort to convince her otherwise but were unsuccessful. However, she does agree that SLPs working in the schools should be licensed. Working with the lobbyist for PDE, our lobbyist is attempting to set up appropriate meetings to make this a reality.

Audiologists are extremely disappointed that oversight by a neurologist for interoperative monitoring is now written into the bill. PAA will be handling this issue in the Senate.

It’s been a long road to this point. We’ve never had a full bill even make it out of a committee before.

There is still much to be done but this is a great Thanksgiving blessing for us all!!!

Kathleen R. Helfrich-Miller, Ph.D. CCC
President, PSHA

 

Posted September 4, 2013

Good News! We are closer than ever to reaching our goal for SLP Licensure. On August 28, 2013, The House Professional Licensure Committee, chaired by Representative Julie Harhart, conducted public hearings which included our House Bill 1561. As you know this bill proposes updates to the Speech-Language and Hearing Act relative to licensure requirements and scope of practice for speech pathology. PSHA President, Dr. Kathy Miller and dysphagia expert, Dr. Susan Langmore presented testimony at the hearing. In addition to verbal testimony, PSHA obtained written testimony by Ear Nose and Throat Physicians in support of the bill which were presented at the hearing. Specifically, letters describing the use of instrumentation by SLPs for speech and swallowing assessment and treatment were presented. 

Following the hearing, Representative Harhart said “These are professions and an area of consumer care that we clearly need to address as it pertains to licensing requirements.” Rep. Harhart said that she found the “…testimony by professionals practicing in the industries and those teaching coursework in the fields, to be helpful in highlighting the pros and cons of the proposals and their impact on speech pathologists and audiologists as well as their patients. This is an issue that will require further examination and discussion by the committee as we move forward.”

So, it is time to continue our efforts while we have such great momentum. Please contact your local representatives, as well as the members of the licensure committee and ask them to urge Rep. Harhart to report the House Bill 1561 out of the Professional Licensure Committee as soon as possible. Members  of the committee are: Harhart, Julie, Chair; Hickernell, David S., Vice Chair; Brooks, Michele; Christiana, Jim; Cox, Jim; Cutler, Bryan; Gillespie, Keith; Gillespie, Keith; Maher, John; Mustio, Mark; O'Neill, Bernie; Quinn, Marguerite; Scavello, Mario M;  Sonney, Curtis G; Toepel, Marcy; Readshaw, Harry, Democratic Chair; Kortz, William C., II, Democratic Vice Chair; Gibbons, Jaret; Briggs, Tim; Galloway, John T.; Gergely, Marc J.; Harris, Jordan A.; McNeill, Daniel T.; Parker, Cherelle L.; Sims, Brian.  You can find all the contact information for each member of the Committee by clicking on the links provided above. 

You can find your local representative by clicking here.

Below you can see the testimonies of Dr. Miller and Dr. Langmore. If you have any questions feel free to contact me at staltari@duq.edu.

Kind Regards,
Caterina Staltari
VP Governmental Relations

Kathy Miller, PSHA President -----Testimony

Honorable Chairwoman Harhart, Chairman Reedshaw and esteemed Representatives
As President of the Pennsylvania Speech Language and Hearing Association (PSHA), I am pleased to have this opportunity to bring to your attention a number of speech-language issues that impact the services delivered in Pennsylvania by speech-language pathologists and to stress the need to update the 1984 Speech-Language and Hearing Licensure act that governs our practice and ethical conduct in a variety of service delivery settings.

As it has been almost three decades since the Act was passed much has changed in the delivery of health care services, including speech-language pathology, in that time. The overall goal of House Bill 1561 is to provide better treatment for individuals suffering from communication and swallowing disorders, resulting in improved consumer protection in Pennsylvania. This is accomplished in this bill by ensuring that all persons performing the functions of a speech language pathologist are properly licensed by the Commonwealth regardless of the setting in which they practice. In addition, the bill updates our scope of practice to better reflect our education and training, aligning our roles and responsibilities to be consistent with the American Speech Language Hearing Association, the body that provides the certificate of clinical competence (CCC) nationally to speech language pathologists.

This bill has been the result of over six years of negotiations with stakeholders and represents a compromise that reflects concerns expressed by universities, otolaryngologists, the Pennsylvania Department of Education, hospitals, skilled nursing facilities and other employers of speech language pathologists. Again, the major components of this bill update the scope of practice of speech-language pathologists, provide for consumer protection by making it illegal for anyone, regardless of setting, to practice speech-language pathology without a license and allows for provisional licensure.

A more in-depth look at these areas will highlight the need for these changes. All of you would likely agree that you would not want your barber, your electrician, your surgeon, your child’s teacher or your primary care physician using techniques and technology that have not been updated in 30 years. Your child’s or family member’s speech language pathologist should also have an updated scope of practice which includes the use of new technology, mandatory continuing education and evidence based practice. The current licensure act is a title act, not a practice act. It defines who we are but not what we do. House Bill 1561 delineates what we do and allows for continued growth as new technology becomes available. Our scope of practice includes the addition of telepractice, cognitive/linguistic aspects of communication, feeding and swallowing as well as the traditional language, speech sound production, resonance, and voice disorders. It allows for the speech pathologist to make a non-medical diagnosis such as apraxia of speech or flaccid dysarthria. It allows them to provide augmentative and alternative communication techniques and strategies, including selecting, recommending and dispensing of augmentative aids and devices; the use, selecting, fitting and establishment of appropriate prosthetic/adaptive devices for speaking and swallowing, the use of instrumental technology to observe, to assess and remediate disorders of communication, voice and swallowing and it mandates the referral of persons with speech, language, voice, swallowing, cognitive and social aspects of communication to an appropriate physician for medical evaluation when indicated based upon the interpretation of evaluation results.

Turning to consumer protection, we strongly feel that all speech language pathologists, regardless of practice setting, need to have a license. Currently, therapists employed in the public schools do not have to have a license. Therefore, a school therapist is not required to complete any continuing education within the field of speech language pathology. While they have continuing education through Act 48 (which currently has been suspended), none of those hours are mandated to be in speech language pathology. In addition House Bill 1561 establishes regulatory control over their clinical practice and offers the consumer a mechanism to file a grievance specific to speech language pathology to the Board of Examiners. Such consumer protection does not exist at present.

After much negotiation and compromise, we have established different category of licenses—full license, school based speech pathology license, provisional license. There will be an exemption for those currently working in the schools. The school based license would be for professionals who wish to work only in the school setting. It requires a Master’s degree in education with a focus in school based speech-language pathology from an accredited academic institution or a Master’s of Science degree with a focus in school based speech language pathology from an accredited academic institution. In addition, the applicant must possess a certificate issued by the Department of Education to work as a speech language pathologist in a public school entity which is continuously maintained after that date.

Current insurance billing requirements, including Medicare and Medicaid require a license in order to bill for services rendered. Because Pennsylvania does not have a provisional license, individuals working toward the completion of their Clinical Fellowship year and individuals with a license from another state have a difficult time finding employment, often moving to a state which offers a provisional license. This contributes to the shortage of speech language pathologists in Pennsylvania. A Provisional License would be granted to a person in their clinical fellowship period as they work toward meeting the requirements of licensure. It would also be granted to someone who holds a valid license from another state until their full license is approved by the Board.

House Bill 1561 does not require speech language pathologists already working the schools to obtain a license, nor will they be grandfathered in. They would be exempt from a license. SLPs currently in the schools that are exempt would be free to move to other schools without having to obtain a license. No one will lose their jobs as a result of this bill. PDE requirements will be unchanged.

In summary, the proposed licensure bill seeks to establish a credential that defines who we are, what we do, and the educational and clinical standards we have achieved to be certified as competent. More importantly, however, licensure is a credential that protects the consumer. It establishes an expectation of excellence in service provision, overseen and monitored by the Board of Examiners, that ensures that citizens of this Commonwealth with communicative, cognitive, and swallowing needs can have them met by the highest quality provider regardless of the setting in which the services are sought.

Susan Langmore -----Testimony

Honorable Chairwoman Harhart , Chairman Readshaw and esteemed Representatives
My name is Susan Langmore, and I am a speech language pathologist in Boston Massachusetts. I am also Director of Speech Pathology Services at Boston Medical Center, Professor of Otolaryngology at Boston University School of Medicine, and Clinical Professor at Boston University Dept of Speech Language Hearing Sciences. I am here today because I developed the flexible endoscopic evaluation of swallowing procedure, known as FEES, which is the primary instrumental procedure being discussed today. Because this seems to be the procedure of most interest, I will devote most of my time to it. However, let me stress that endoscopy is used by the SLP to functionally assess voice and resonance as well as swallowing.

A FEES exam entails passing a very small tube (about 3.2 mm or 1/7 of an inch)in diameter) through one nostril to the back of the nose and then moving the tip of the scope down the throat to rest just behind the tongue. In this position, the examiner is able to view the throat and airway. The patient then takes some food or liquid and swallows it. The examiner is able to see directly whether the food or liquid went through the throat safely or went into the airway. If the food or liquid enters the airway, the examiner’s job is to figure out why this happened and intervene to remedy the problem. Obviously, the more the examiner knows about swallowing and swallowing disorders (dysphagia), the better the exam is for the patient.

Otolaryngologists have used flexible laryngoscopy as a tool to diagnose medical pathology since the late 1970s. FEES is not a procedure to diagnose medical pathology, but rather it employs the same tool to assess how the structures work for swallowing; it is a ”functional exam.” I published the first paper on FEES in 1988 (the second author, Nels Olson, was an otolaryngologist who collaborated with me). Three years later, in 1991, our national organization, ASHA, put FEES in our scope of practice. ASHA has also published guidelines for training and competencies that any SLP should meet before performing this procedure. 

The FEES procedure has spread in use, and today, it is performed by all states neighboring PA and in every state in the union plus most other countries around the world where swallowing is assessed. The value of this and other instrumental procedures cannot be overemphasized. Swallowing problems significantly impair people’s lives, both socially and medically. People with swallowing problems are often not able to eat foods they enjoy, and can become nutritionally deficient as a result. They cannot share food with others during social occasions, which contribute to feelings of isolation and depression. Moreover, people with swallowing problems are at risk for serious medical complications, including pneumonia. Using a common example that may resonate with many of us and our loved ones, patients with stroke, a disease whose victims are at great risk for swallowing disorders, are three times more likely to die if they develop pneumonia than they would if we could prevent their pneumonia. FEES and other instrumental tests identify hidden problems that can cause pneumonia.

Who can perform a FEES procedure? In other words: “Who can pass the scope—the physician or the SLP?” The answer depends on the setting, the personnel, and of course the politics.  Who should pass the scope? What difference does it make? For one thing, whoever passes the scope can bill for the FEES procedure—hence there is some competition in these days of lower reimbursement for medical services. There are two other considerations, however, that are significantly more important for patients with swallowing problems. These are safety and expertise of the examiner. Is this a dangerous procedure? The answer is unequivocally NO. There is no published or publically known incident of harm done to a patient from a FEES procedure when conducted by a SLP. 

I have performed approximately 6000 FEES exams over the past 25 years and have only needed medical assistance once. In this instance, a patient suddenly lost consciousness before the scope had even entered his nose. We called for medical help and the patient was fine; he had just fainted. I have occasionally seen a small amount of blood as I passed the scope through the nose, but never to the point where I needed to remove the scope and stop the exam. This just doesn’t happen because I can see where the scope is going—I am directing it through an open passageway. 

In summary, FEES is a safe procedure. 

To insure the highest safety for patients, the Pennsylvania Regulations will include a requirement for medical backup to be available should any problems arise. Safety will be further guaranteed by requiring rigorous training of every SLP before he/she can perform the procedure alone, thus further protecting the patient.

Finally, it is important to distinguish the areas of expertise and role of the two specialists who may perform FEES. Certainly, ENT physicians who want to perform FEES may do so - and there is no question that they are proficient in passing a scope. But passing the scope is only the first skill needed to conduct a useful FEES examination. More importantly, it is also about analyzing the swallowing problem and determining the most appropriate treatment for that problem. In the US, SLPs have much more extensive training in dysphagia at the university level and through continuing education courses. Physicians—ENT or other specialties —typically refer patients with swallowing problems to SLPs because we are recognized as the experts for identifying, analyzing, and treating this disorder. It follows that we need the tools to perform a thorough exam, and this includes flexible laryngoscopy.

Another possible concern is that SLPs, as non-physicians, will miss a medical diagnoses such as cancer when evaluating patients with swallowing problems. This doesn't make sense, however, because SLPs can only see Medicare patients (and most insured patients) at the request of a physician. If the referring physician is concerned about something like cancer, he/she should refer the patient to an ENT physician. In fact, many of our referrals come from ENTs after they have examined patients for a suspected medical pathology. Likewise, if an SLP who is performing a FEES exam sees an anatomical feature that is suspicious for abnormality, he or she will refer the patient to ENT for a diagnostic laryngoscopy examination. 

In addition to FEES, SLPs may use instrumental technology such as videostroboscopy for evaluating voice disorders. They also conduct radiology exams (modified barium swallow studies) for the assessment of swallowing disorders. PSHA has received letters from a variety of ENTs and physicians to support the use of instrumental technology which will also be presented to the committee for their reference.

Thank you for the opportunity to address this committee. Dr. Helfrich-Miller and I would be happy to address any questions you may have.

 

Posted July 21, 2013

As you may know, House Bill # 1561 on SLP Licensure has been introduced in the House of Representatives by Representative Oberlander and it is now in the House Committee on Professional Licensure. It is imperative that we mobilize support for this bill. The process of passing any bill is long and arduous. The first of three steps involves moving it out of the Licensure Committee. For this first step, the members of the Professional licensure Committee need to hear from us.

We are asking for you to do two things now! The first is to write a letter to each of the members of the committee (a sample letter follows). The members are: Harhart, Julie, Chair; Hickernell, David S., Vice Chair; Brooks, Michele; Christiana, Jim; Cox, Jim; Cutler, Bryan; Gillespie, Keith; Gillespie, Keith; Maher, John; Mustio, Mark; O'Neill, Bernie; Quinn, Marguerite; Scavello, Mario M; Sonney, Curtis G; Toepel, Marcy; Readshaw, Harry, Democratic Chair; Kortz, William C., II, Democratic Vice Chair; Gibbons, Jaret; Briggs, Tim; Galloway, John T.; Gergely, Marc J.; Harris, Jordan A.; McNeill, Daniel T.; Parker, Cherelle L.; Sims, Brian.  You can find all the contact information for each member of the Committee by clicking on the links provided above.

Contact Sample Letter - pdf 
Contact Sample Letter - word.doc

Secondly, if one of the members of this committee is your representative, please let me know as soon as possible. We are mobilizing PSHA members to “adopt” a committee member to take further action. You may find your legislator by clicking here.

The Representatives should be in their offices from now through the first part of September, so calls and letters should occur during these summer months. You can find the name and contact information for your legislator by going to www.legis.state.pa.us. I thank you in advance for your support. If you have any questions or concerns, please don’t hesitate to contact me at staltari@duq.edu.

Kind Regards,
Caterina
VP Governmental Relations

 

 

Questions Concerning the New Licensure Law

Provisional License

Although the new law took effect on August 31, 2014, those portions of it that need regulations in order to be managed, such as the provisional license, cannot go into operation until those regulations are fully approved.  This is because the Licensure Board, known as the Board of Examiners in Speech-Language and Hearing (BOE) needs to have the specifics of how you qualify for a provisional license, how you apply for one, how the BOE approves it and much more spelled out and made public before anything can happen.  Doing that requires the BOE to approve a proposed regulation package, reviews by the Governor’s General Counsel, Policy Office, and Budget Office as well as the Attorney General.  That is by followed initial publication in the PA Bulletin, a public comment period of at least 30 days and possible comments from the House and Senate licensure committees and the Independent Regulatory Review Commission (IRRC).  Then we have further review by the BOE accompanied by another review by General Counsel, Policy, Budget and Attorney General.  Finally, upon publication of the final form regulation, a vote must be taken by IRRC.  As you might imagine, this process will take a while - perhaps up to a year!  "Like" PSHA on Facebook and check the PSHA website for updates.

New Education Specialists Certification

No one will be required to obtain this certificate, especially if you already have an Instructional Certificate. It is not an additional requirement. Similar to provisional licensure, no regulations currently exist for the Education Specialists Certificate. Once PDE has established those, things will be clearer. This will be an alternative to the instructional certificate and most likely tied to licensure. Right now, school SLPs do not have to have a license to practice in the schools. This did not change in the new law. The Education Specialists Certificate will be a way for those in Pennsylvania or coming into Pennsylvania to work in the public schools without having to obtain the instructional certificate. They will not be classified as “teachers.”

Once again, be assured that if you already have the appropriate credentials to work in the schools, there are no new requirements.

I am currently an SLP in in another state. I want to move to Pennsylvania and work in the school system. However, with the new bill being passed I am unsure about what test I would need to take.

I have already taken the 2 of the 3 test needed to get an initial teaching license but I need to take the Fundamental Subjects Content Knowledge Exam. However with all the new info coming out I am not sure if I still need to take that test.

If you are interested in working in the school setting, you should know that the licensure act (Act 106 of 2014) does not refer to the school setting.    Providers should continue to refer to The Pennsylvania Department of Education (PDE) requirements for certification regulations in the schools. PDE - Teacher Certification

Also, PDE is currently working on the "Education Specialist" certification for SLP-A.  At this point in time, providers should continue to follow the current regulations until further notification is received from PDE. 

Thank you for posting the information on your website regarding the new legislature that was just passed.  I am thrilled to see the outcome of PSHA's efforts. 

I see that telepractice was deleted from the new bill.  I am currently exploring virtual speech therapy/ tele practice for schools.

I am aware that cyber schools, such as Commonwealth Connections Academy, currently offer virtual speech therapy and occupational therapy .  As I explore the avenue for service delivery for my agency, I want to be sure that any and all PA state regulations and guidelines are in included. 

Can you provide me any information regarding  PA stance on tele practice / virtual speech therapy? 

Can you clarify what the statement ....."Removes teachers of the hearing impaired"

Telepractice was taken out of the bill because there will be regulations coming out of the legislature that will govern telepractice for all therapy and medical practices. Leaving it in the bill may have made it more or less restrictive than other laws pertaining to it. Therefore, it was just eliminated from the law. This does not mean we cannot do telepractice in the same manner as it has been done. ASHA guidelines should be followed while the legislature determines other regulations governing it.

The teachers of the hearing impaired asked to be removed from our licensure bill. Therefore, this bill does not include them, it only covers SLP and audiology.

Please contact the PSHA Office, psha@psha.org if you have questions on the new licensure law.

 

 

Licensure Frequent Asked Questions

Can you advise me as to the impact the new licensure bill may have on SLP’s (bachelors and masters) working in nonpublic school settings?

An SLP working in a nonpublic school setting would see no change in work situation if he or she holds a certificate from PDE.  I know that PDE does give certification to people in nonpublic schools, so there may be some out there who have the certificate and can continue to practice as long as they maintain the certificate.

For those SLPs in nonpublic schools who do not have a certificate but do have a license from the BOE, they are okay and will see no change in their work situation. 

It is only those SLP in nonpublic schools who do not have either a certificate or a license who will have some difficulties.  It is recommended that you take the opportunity right now, before the bill passes and then goes into effect, to immediately complete whatever requirements are necessary to obtain the PDE certificate or a license.  The certificate will no doubt be easier to get.  All the bill requires is that you have a PDE certificate at the time the bill takes effect and then that you maintain the certificate for as long as you wish to work in the schools.

Would the SLP license eliminate the PDE instructional certification?

No, the Pennsylvania Department of Education will still require instructional certification for SLPs working in the schools.

Who will determine the qualifications and requirements for SLPs working in the schools? 

The PDE will require the instructional certification. Local school districts or Intermediate Units will still evaluate the performance and track the qualifications for all SLPs working in the schools. The employer determines financial compensation packages based on their school board contract. Like any professional field, we are bound by the rules of the setting we work in (e.g., the public schools) AND by those of our field (professional licensure).  Once the new licensure bill passes, persons wishing to work as SLPs in the schools will be required to obtain a license from the BOE as an SLP or as a school-based SLP.  The requirement will be waived for those working in the schools prior to the passage of the bill.


If I currently work in the schools, and do not have a SLP license, will I lose my job?

No, you can continue to work in a district or Intermediate Unit. Only new hires will be required to obtain and maintain a license.  We are committed to making those changes so that the bill clearly states that people will NOT lose their jobs or be required to remain in the same district for the rest of their career.

If I have a SLP license and instructional certification, can I still join the school Bargaining Unit (Union)? 

Yes, as you will have your instructional certificate. You will then receive all the benefits of collective bargaining and the contractual benefits that other teachers receive.

 

Legislative Links

  • Don't know who your federal or state elected officials are?
    Go to http://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/
  • A treasure trove of government links can be found through the Mesa State
    University Political Science home page, www.mesastate.edu.
  • The American Speech-Language-Hearing Association (ASHA)
    Our professional association has a well-maintained web site (www.asha.org) that can help you learn about issues relating to the profession, and how you can advocate for political change. Resources include information on the legislative process; writing, calling, or visiting your elected officials; definitions and other legislative links; action alerts; etc. You can join ASHA's electronic advocacy networks, HealthNet and EdNet, via the web site search.

ASHA Advisory Council
Barbara J. Amster - SLP
Joy Peterson - Audiology

You can also call the ASHA Director of Grassroots Advocacy at 301-897-5700.

 

State Board Of Examiners Brochures

Let's talk about....Audiology

Let's talk about...Speech-Language Pathology

Pennsylvania Speech Language Hearing Association
700 McKnight Park Drive, Suite 708 | Pittsburgh, Pennsylvania 15237
412-366-9858 | 412-366-8804 fx
psha@psha.org
ASHA.org
 
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