MONTANA SPEECH LANGUAGE HEARING ASSOCIATION

The Public Policy Committee is working on several issues for the 2023 Legislative Session.  

1) We are following the Department of Labor and Industry's proposed changes to our licensure language through their Red Tape Initiative that has been going on in the latter half of 2022.  If you are interested in learning more, please see the DLI website link here.  The results of the initiative have been introduced as HB152.  New language pertaining to SLP/AuD Licensure can be found throughout the proposed language, but here are two key parts that look different: 1) The proposal would move the language about our Limited Licensure to a place common to all occupational licenses, and re-name it a Provisional License. This proposed language is in Section 11 on page 10;  2) Language specific to SLP/AuD Licensure is in Section 22 on page 15.   The first hearing was scheduled for January 18, 2023.  MSHA provided testimony in opposition to the bill as presented and urged adoption of amendments that MSHA drafted with DLI attorneys.  As of 2/24/2023, this bill has not been voted on in committee.

2) SB 300 is an amendment to last session's Assistant Bill bill (HB2010, 2021) that will incorporate language changes by DLI.  The new target date for licensure of Assistants, proposed by the Licensure Board and DLI in their revisions, will be January, 2024.  MSHA provided testimony in favor of this bill on February 17, 2023. SB300 passed unanimously out of Committee (9-0) and unanimously in Second reading (50-0).  Thank you Sen. Edie McClafferty for carrying this bill. Thank you to ASHA for submitting a letter of support for this bill.

3) SB214 MSHA introduced legislation for Montana to join Audiology and Speech-Language Pathology Interstate Compact.  If this bill is passed, optional membership would allow AuDs and SLPs privileges to practice in other states who are also members of the compact.  MSHA provided testimony in favor of this bill on January 31, 2023. SB 214 has passed through the Senate and will be transmitted to the House in March.  Thank you Sen. Edie McClafferty for carrying this bill. Thank you to ASHA for submitting a letter of support for this bill.

4)HB736 Under the leadership of Sam Schmidt of MT APTA (PT version of MSHA), HB736 was introduced and it calls for Medicaid reimbursement be at 95% of Physician rate for OT, PT, and Speech Therapy services. This would be a game-changer for many companies that are struggling to provide services to Medicaid clients.  This bill was heard in committee on Friday, February 24 and Jenni Kingan represented MSHA for this bill.  Thank you, Jenni! Thank you to Rep. Tony Brockman for carrying this bill.

Thank you to all who joined us for Hill Day to talk to legislators!  Members of NSSHLA from the University of Montana, Amy Glaspey, Shelby Midboe, Kelsey Storm, Jenni Kingan, Shanna Stack, Michael Crews, Kimberly Foote.  Thank you to our lobbyist, Robin Turner, who has provided excellent service to us in this legislative session!

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AUGUST 26, 2022:

Shelby Midboe, MSHA Public Policy Chair, met with Lucy Richards, the Executive Officer of the Board of Speech-Language Pathologists and Audiologists on August 18, 2022.  Lucy reported that "the department/board went out to bid twice last year (2022) to find contractors to submit proposals to write and administer a licensing exam(s) for SLP and audiology assistants. No one submitted a proposal either time."  Since there does not seem to be any "interest in bidding or developing a licensing exam for the state of Montana...the board cannot proceed with implementing assistant licensure and will not be going out for bid again this year. This means that everyone...working under the supervision of a licensee in the state will continue to be an unlicensed individual under the supervision of a licensee for the foreseeable future (at least through the 2023 Session). There is no longer an official title for unlicensed people since the term aide was repealed from statute [with HB210, 2022]. Aide registration was also repealed [with HB210, 2022] and no longer exists" (Lucy Richards via email to former MSHA President Kathleen DeLapp-Cohn and Shelby Midboe, August 2022). 

MSHA is working with the licensing board to consider options to resolve the situation, and is considering a few different routes to rectify the situation so that Assistants can be licensed in Montana in the near future. For the time being, unregistered individuals can continue to provide services under the supervision of a licensed SLP or AuD as they always have done under the former title "aide."  While this is not the situation we hoped to be in at this time, MT clients can continue to receive the services they need, which is important.  Please email Shelby Midboe at slp.shelby.midboe@gmail.com if you have any further questions.   

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OCTOBER 27, 2021: 

As many of you know, there have been a number of questions surrounding Medicaid billing for assistants and aides with the implementation of HB 210.  HB 210 allows for the licensure of SLP and audiology assistants, as well as eliminates the registration requirement for aides and assistants.  The State SLP and Audiology Board has been working diligently on preparing for the October 1 effective date of HB 210, but has run into a roadblock because  ASHA will not allow states to use their examination for state licensing purposes, but any member who is seeking ASHA assistant certification may take that exam upon completion of prerequisites.  Our licensing board feels strongly that licensure should not include mandatory membership/certification in any national association, so they will not require SLPs, AuDs or Assistants to go through ASHA certification in order to be licensed.  As a result, there is not currently an option for an examination, so the licensing board is going out to bid for creation of the examination. Additionally, work on resolving the exam issue brought to light additional regulatory changes necessary for Medicaid billing.

Current regulatory and statutory provisions are as follows:

1.        ARM 37.86.605(3) prohibits an assistant or aide from enrolling in Medicaid as a provider.  

2.       ARM 37.86.606(2)(a) requires that services provided by assistants or aides may only be billed by the supervising SLP.

3.       Consequently, even under current law (pre-HB 210), assistants and aides never billed independently.

4.       ARM 24.222.701(6) requires aides and assistants to annually register pursuant to MCA 37-15-313, which HB 210 repealed.

Conversations with DPHHS have revealed that because ARM 24.222.701(6) remains on the books, but there is not registration process, Medicaid cannot reimburse for aides or assistants.  This would be the case regardless of whether there was an exam or not. 

Happily, the solution is relatively simple. but can not be completed immediately: 

 MCA 37-15-102(10) still defines an assistant as someone who “works directly under the supervision of a licensed speech-language pathologist.”  Consequently, the supervising SLP still exists.  Additionally, as was discussed at length on the legislative record during the hearings on HB 210, the licensing process set up under HB 210 allows to assistants to be licensed.  It does not, however, prohibit aides from continuing to work under the direction of an SLP.  HB 210 merely eliminates the requirement for either aides or assistants to register. 

In other words, paraprofessionals practicing prior to HB 210 may choose one of two routes:  continue work as an aides or pursue licensure as an assistant.  The Department of Labor has issued a memo to the state licensing board confirming this interpretation.

Aides and assistants are both acknowledged under the relevant Medicaid rules of ARM 37.86.605 and 606.  The issue that DPHHS Medicaid staff identifies right now is that ARM 24.222.701(6) requires both aides and assistants to register, but there is no registration process.  The solution is that ARM 24.222.701 needs to be amended.  ARM 24.222.701(1) needs to eliminate the first phrase “Per 37-15-313, MCA,” and ARM 24.222.701(6) needs to be repealed in its entirety.  Additionally, ARM 24.222.301 definitions will also need to be amended.  If these changes are implemented, DPHHS Medicaid will be able to reimburse for aides who bill under the supervising SLP, just as will happen even after the testing is in place and assistants can be licensed.  However, for now, assistants will be able to bill as aides until the testing is in place and those paraprofessionals who chose to do so are able to pursue licensure under HB 210.

 

The state licensing board met today and approved an RFP to obtain a psychometrically sound and legally defensible assistant examination.  MSHA will continue to work closely with board staff as implementation of HB 210 moves forward.  MSHA did also provide comment today to the board regarding the rule amendments needed to address the Medicaid billing issues.  MSHA will be coordinating with board staff to prepare the needed rule amendments, which will need to go through the regular rulemaking process with publication and public comment, so stay tuned for updates.

 

 

Abigail St. Lawrence

Attorney at Law

MSHA Lobbyist

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UPDATE OCTOBER 24, 2021:  The licensing board will be meeting October 27 to discuss going out for bid for a psychometrically sound exam to be used for implementation of HB210.  MSHA will be represented by our board and also by our lobbyist, Abigail St. Lawrence.  Multiple other MT agencies will also be represented as we work towards a solution that will help practitioners in settings across the state know how they can use "Aides" at this time.  Please stay tuned for an update following that meeting.

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UPDATE OCTOBER 13, 2021:  MSHA has been made aware that an unintended consequence of not being able to implement HB210 may include an impact to Medicaid billing for services provided by Aides.  MSHA Is working with affected stakeholders (including OPI and the Licensing Board) to come up with an interim solution until the state can get a third-party testing agency on board. Please be aware that we are aware of the situation and are working on a solution as quickly as we can. 

 

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UPDATE SEPTEMBER 13, 2021

As all Montana SLP/Audiology license-holders were notified by email from the MT Board of Speech Language Pathologists and Audiologists on September 13, 2021,  implementation of HB 210 is delayed for the time being while an Assistants exam is created.

 

What does this mean for businesses/schools with Speech or Audiology Aides?  As of October 1, 2021, Aides are no longer a registered entity in Montana.  To be clear, aides have never been licensed, only registered.  Everything Aides do is, and will continue to be, under the ethical purview of the licensed professional (AuD, SLP).  Schools and clinics can continue to use individuals to help with speech therapy and audiology activities in the same manner they have been, they will just not be registered. In other words, continue as usual. 

 

Stay tuned to this page for further information on the licensing of assistants, and what will be required for those who are already serving in an "aide" capacity who wish to become licensed assistants when licensing becomes available. 

 

For questions, email slp.shelby.midboe@gmail.com , or contact the licensing board (information in the email below).  

 

Individuals wishing to become an ASHA Certified SLP or Audiology Assistant can find more information at https://www.ashaassistants.org/

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Congratulations to Montana's first ASHA Certified Assistant,  Brandi Pauley, C-AA from Billings, MT.  Brandi has been certified since April, 2021.