MONTANA SPEECH LANGUAGE HEARING ASSOCIATION

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

1) 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.  Following the passage of the bill, David Lopez, Executive Officer for the Audiology and  Speech-Language Pathology Licensing Board, sent out an email and there was a 10-day comment period. The rules for SLPAs are still in draft form and the Licensing Board was preliminarily scheduled to meet in August to make those revisions.  MSHA will work with different agencies to help them understand the size and scope of SLPA work once rules are officially created.  Thank you Sen. Edie McClafferty for carrying this bill and Rep. Bob Carter for sponsoring it in the House. Thank you to ASHA for submitting a letter of support for this bill.

2) SB214 MSHA introduced legislation for Montana to join Audiology and Speech-Language Pathology Interstate Compact. This bill did pass and will allow AuDs and SLPs privileges to practice in other states who are also members of the compact. Although most of the rules are part of the Compact, new Rules pertaining to MT licensees who wish to opt in to the Compact will also be discussed in the August meeting.  Because the Compact required federal level background checks, new Rules are proposed that all individuals seeking MT licensure will be required to get that background check. The rules proposal also includes that people who are currently licensed in MT will NOT need to get a background check unless they wish to become ASLP-IC members.   Thank you Sen. Edie McClafferty for carrying this bill and to Rep. Ed Buttrey for sponsoring it in the House. 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.  THIS BILL DID NOT PASS BUT THERE IS GREAT MOMENTUM TO MOVE A BILL LIKE THIS FORWARD IN THE 2025 SESSION. 

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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INFORMATION ON BILLING WITH ASSISTANTS:

Once rules are established by the Board, MSHA will try to work with Montana Medicaid to ensure we maintain status quo for billing until Assistants have time to become licensed.  

HISTORICAL INFORMAITON ON BILLING WITH ASSISTANTS:

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.

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.