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The information below is from oral testimony provided in opposition to House bill 2061, An Act Relative to Speech-Language Pathologists. Many people have requested a reminder about the bill and what it would do, as a way of explaining why MSHA is so opposed to the bill. We need broad based, grassroots support for our position- the integrity of your licensure as a Speech-Language Pathologist or Audiologist is at stake.
If you would like to review the text of the bill itself, go to www.mass.gov. Go to the General Court page and search for H2061.
Thank you for your help- we all need to work together to ensure that consumers are protected from the unlawful practice of unqualified people. If you have further questions, do not hesitate to contact Past President Suzanne Harris.
House Bill 2061
House Bill 2061 would provide an outlet for those who have been illegally engaged in practice as a speech pathologist or audiologist since 1983 or before, to potentially obtain a license. It waives the requirements that all other ethical professionals in the commonwealth must adhere to and puts patient care at risk.
AN ACT RELATIVE TO SPEECH LANGUAGE PATHOLOGISTS.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Not withstanding sections 138 to 147 inclusive, of Chapter 112 of the Massachusetts General Laws or any other law to the contrary, the board of licensure for speech-language pathology and audiology ("the board") shall waive the requirements set forth in subclause (b) of clause (2) and clause (3) of section one hundred and forty- four of chapter one hundred twelve of the General Laws for applicants who were actively engaged in the practice of speech-language pathology in the commonwealth before January 6, 1983 upon proof of professional practice satisfactory to the board. The board shall also waive the requirements set forth in clause (3) of said section one hundred and forty-four of said chapter one hundred and twelve for applicants who were actively engaged in the practice of audiology in the commonwealth before January 6, 1983 upon proof of professional practice satisfactory to the board. The board shall waive the examination requirements set forth in clause (4) of said section one hundred and forty-four of said chapter one hundred and twelve for applicants who were actively engaged in the practice of speech-language pathology or audiology in the commonwealth before January 6, 1983.
SECTION 2. All persons who were actively engaged in the practice of speech-language pathology or audiology in the commonwealth before January 6, 1983 shall apply for a license in speech-language pathology or audiology within one year after the effective date of this act.
SECTION 3. The provisions of this act shall take effect upon its passage.
Why we are opposed to this bill
- It represents an attack on the integrity of our professions and minimizes the complexity of the services we provide;
- It demeans the value of professional licensure in general, as it is doubtful that this regressive tactic would be acceptable to other professions within the Commonwealth;
- It bypasses the specific authority of the Board of Registration, whose sole purpose is to maintain consistency and high standards in protecting the consumers of the state;
- It provides for no oversight regarding who can apply under the bill, nor does it define “actively engaged in practice”;
- It rewards the behavior of those who have exhibited blatant disregard for the law and the standards governing their profession;
- It does not respect the changes that have occurred in the professions, including the significant expansion in scope of practice and preferred practice patterns;
- It does not provide any limits on the kind of practice someone who might be granted a license in this context could provide;
- It violates language in the No Child Left Behind Act that requires services be implemented by the highest qualified provider;
- It is contrary to the requirements of CMS, which dictate that providers who bill Medicare or Medicaid meet ASHA requirements, including possession of at least a Master’s Degree;
- It sets a legal precedent for further challenges to our licensure in the future;
- It places an undue burden on legislators to determine who should qualify to practice as a speech-language pathologists or audiologist, rather than Board of Registration members who belong to the profession;
- Most importantly, it places consumers at risk. They must rely on the validity of the credentials that are offered to ensure that they are being evaluated and treated by a competent professional who has met all requirements. Being seen by an unlicensed or unqualified professional can lead to lengthier times in treatment, greater financial burden and in some cases, harm or loss of function.
Conclusion
House Bill 2061 unwisely and unnecessarily places consumers at risk, offers an applicant with substandard credentials an opportunity to gain credibility they have not earned, and violates regulations and statutes relating to reimbursement and special education. For these reasons the Massachusetts Speech-Language-Hearing Association urges you to oppose passage of this bill and respectfully requests the Joint Committee on Public Health recommend that it ought not to pass.
The History of the Greene Bill: An Act Relative to Speech-Language Pathologists
Many people have asked about the history of this bill, currently filed as House Bill 2061. Here is a brief history, as we know it.
In 2003, the state department of education conducted an audit of the Billerica, MA school district. Among its findings, it identified 3 people practicing as speech-language pathologists without proper licensure. (In MA, all clinicians are required to have a state license, issued by the Board of Licensure, regardless of where they practice. In addition, SLPs who practice in the schools are required to obtain and maintain a separate credential, now called a DOE license. It was previously known as teacher certification.) The district was given a corrective action plan to address this issue.
On May 13, 2003, Representative Greene filed the original bill, House Bill 3957. This bill directed the Board of Licensure to grant a license to practice SLP to the 3 specific individuals who were found in the course of the DOE audit. This version of the bill moved through the committee structure in the house, including the committee on House Rules, The House Committee on Health and the Committee on Steering and Policy. It was given a favorable report at each stage and was placed on the House calendar on July 30, 2004. Through the considerable efforts of MSHA members and with ASHA support, the bill was stopped in third reading.
Representative Greene refilled the bill in December 2004. It was referred to the Joint Committee on Public Health in January 2005. The bill was sent to committee for further study in July 2005, and was effectively killed.
In January 2007, Rep. Greene again filed the bill, House 2110. This version of the bill no longer mentioned the original 3 constituents of Rep. Greene. Rather, it directed the Board of Licensure to waive all requirements and grant a license to ANYONE who had been practicing Speech-Language Pathology or Audiology since 1983, when licensure became effective in the Commonwealth. The only requirement was that they had to demonstrate that they were employed at that time. This version of the bill is more concerning because it opens the licensure law for a period of a year, when an untold number of unqualified people may take advantage of this bill’s passage. In addition, it includes Audiology, which is now a doctoral level profession.
The bill was referred to the Joint Committee on Public Health. A hearing was held on May 2, 2007. MSHA presented oral and written testimony at the hearing. A copy of that statement is available below. The bill was held in committee until 3/18/08, when it was given a favorable report and sent to the Joint Committee on Health Care Financing. The bill was passed favorably out of that committee in May 2008. It was then referred to the House Committee on Steering, Policy and Scheduling. Again following significant effort by MSHA, the bill was sent to Ways and Means. It was not addressed by the Committee on Ways and Means prior to the end of the formal legislative session in 2009; it was effectively defeated for that session.
In January 2009, Rep. Greene filed House Bill 2061, An Act Relative to Speech-Language Pathologists. This version of the bill is similar to House Bill 2110. It again includes Audiology, and allows those who were “employed” in the professions to receive a current license to practice. It directs the Board to waive all requirements for the license, and it appears to remove any discretion the Board has in determining whether the individuals who would apply under this law are qualified to receive the license.
MSHA has grave concerns about this bill, as in previous sessions. It not only undermines the integrity of our licensure, but it sets a dangerous precedent that would not seem acceptable for any other licensed professional discipline. A summary of talking points about the bill is available on this page.
SOURCE: Insta-Trac, Legislative Tracking software
(Please Note: House Bill 2110 referenced in the testimony below has subsequently been refiled as House Bill 2061)
May 2, 2007
STATEMENT
OF
SUZANNE M. HARRIS, MS CCC-SLP, PRESIDENT
MASSACHUSETTS SPEECH-LANGUAGE-HEARING ASSOCIATION
House Bill 2110, An Act Relative to Speech-Language Pathologists
Background
The professions of speech-language language pathology and audiology have been in existence since before World War II. These two autonomous professions share a common focus on minimizing the significant impact of communication disorders across the lifespan. The fields of speech-language pathology and audiology are broad and complex, and include areas of practice that are connected to life functions (swallowing disorders/dysphagia) and many areas that are integrally connected to quality of life.
Licensed speech-language pathologists are health care professionals who diagnose, treat and manage individuals with a variety of speech, language, swallowing, cognitive and literacy disorders. Speech-language pathologists work in hospitals, schools, short and long-term care facilities, private practice, Early Intervention, home care and public agencies. They work to maximize functional communication skills, such as improving articulation, fluency or vocal function; speech-language pathologists also address receptive and expressive language skill deficits and improve the ability to effectively communicate in a variety of contexts. Speech-language pathologists provide direct treatment, collaborative multidisciplinary intervention and consultative services. Examples of areas addressed by speech-language pathologists include working with preterm infants in the neonatal intensive care unit; assisting patients with dementia to maximize their memory and organization skills; helping students with a variety of language based learning disabilities master academic curriculum, and assisting a stroke survivor learn to speak or swallow again. (From the American Speech Language Hearing Association website)
Licensed audiologists are health care professionals who diagnose, treat and manage individuals with hearing loss and balance problems from birth through adulthood. Audiologists dispense and fit hearing aids as part of a comprehensive rehabilitative program. Audiologists also work collaboratively with physicians when hearing and balance issues require medical or surgical intervention or treatment. Audiologists work in private practice, hospitals and medical centers, clinics, universities, rehabilitation centers and nursing homes. They work closely with government agencies, physicians and hearing aid manufacturers. Examples of areas addressed by audiologists include conducting diagnostic hearing evaluations across the lifespan; working on cochlear implant teams; providing counseling and advocacy training to adults with hearing loss; providing client education and training in the use of amplification and a variety of assistive listening devices; conducting hearing conservation programs and participating in research. Audiologists provide an important entry point for services for infants diagnosed with hearing loss. They also work collaboratively with speech-language pathologists and others in aural habilitation and rehabilitation. (From the American Academy of Audiology)
In the 1960’s, it was determined by the American Speech-Language Hearing Association that a Master’s Degree would be the entry level educational requirement for both disciplines. When licensure was enacted in Massachusetts in 1983, the Board of Registration in Speech-Language Pathology and Audiology oversaw a period of time where those who had already been practicing with a Bachelor’s degree, and who met the requirements for licensure, could be granted a license on approval from the board.
At the end of the grandfathering period required by the initial licensure law, this window was closed. Subsequently, all professionals since 1983 who have obtained a license to practice in Massachusetts have had to meet the minimum requirement of a Master’s Degree and adhere to other standards regarding continuing education. This ensures consistency, patient protection and quality of care. At this time, the profession of audiology has moved to the Doctorate Degree as the entry level for practice, and licensure regulations have been updated to reflect this change.
In the past 25 years, the depth and breadth of both fields have changed significantly. This is reflected in modifications and expansions of our Scopes of Practice, broadening of our requirements for continuing education, and an increased emphasis on evidence based practice. In addition, our codes of ethics (from the American Speech-Language Hearing Association and the American Academy of Audiology) provide structure and guidance in how to provide the highest level of clinical service while protecting consumers.
Requirements to Practice for Speech Pathology
In order to practice as a speech-language pathologist in Massachusetts, one must complete the following:
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Obtain or meet the requirements for the Certificate of Clinical Competence (CCC), which includes the following components:
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Minimum of a Master’s Degree in Speech-Language Pathology (including several hundred hours of supervised clinical practice)
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Passing score on the National Examination in Speech-Language Pathology
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Completion of a residency, known as the Clinical Fellowship Year that provides for close supervision during the first 9 months of full-time employment
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Obtain a license from the Board of Registration, which includes the following components:
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Completion of the Clinical Fellowship year/supervised clinical practice
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Passage of the National Exam
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For school based practitioners, they must also have a license from the Department of Education
It should also be noted that both national certification and state licensure carry annual requirements for documented completion of continuing education.
Requirements to Practice for Audiology
In order to practice as an audiologist in Massachusetts, one must complete the following:
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Obtain or meet the requirements for the CCC, including the following:
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Minimum of a Master’s Degree until 2011, after which time a Doctoral degree will be required for entry into the profession;
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Passing score on the National Exam in Audiology
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Completion of a residency, to consist of 12 months full time supervised clinical practice
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Obtain a license from the Board of Registration, as noted above
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Audiologists can also elect to complete requirements for Board Certification from the American Board of Audiology; this certification currently requires the Doctoral degree as entry level and has stricter qualifications
Currently, our certification and licensure are global in nature; the license allows for practice from “cradle to grave.” Certification and licensure are not setting specific, meaning that one can practice in multiple settings and in various clinical areas simultaneously or over the span of time.
However, our code of ethics requires that we only engage in those areas of the discipline where we have appropriate training and expertise
. We now also have the option of specialty certification in some areas of clinical practice, where advanced knowledge and skills are needed.
In summary, speech-language pathologists and audiologists are highly educated and rigorously trained professionals, who must meet multiple sets of requirements in order to practice. As outlined above, our training goes well beyond the advanced professional degree, and includes robust clinical training and requirements for ongoing education. It is critical that we maintain the highest standards possible for anyone who would be providing services to those affected by communication and swallowing disorders.
House Bill 2110
House Bill 2110 would provide an outlet for those who have been
illegally
engaged in practice as a speech pathologist or audiologist since 1983 or before, to potentially obtain a license. It waives the requirements that all other ethical professionals in the commonwealth must adhere to and puts patient care at risk.
Why we are opposed to this bill
-
It represents an attack on the integrity of our professions and minimizes the complexity of the services we provide;
-
It demeans the value of professional licensure in general, as it is doubtful that this regressive tactic would be acceptable to other professions within the Commonwealth;
-
It bypasses the specific authority of the Board of Registration, whose sole purpose is to maintain consistency and high standards in protecting the consumers of the state;
-
It provides for no oversight regarding who can apply under the bill, nor does it define “actively engaged in practice”;
-
It rewards the behavior of those who have exhibited blatant disregard for the law and the standards governing their profession;
-
It does not respect the changes that have occurred in the professions, including the significant expansion in scope of practice and preferred practice patterns;
-
It does not provide any limits on the kind of practice someone who might be granted a license in this context could provide;
-
It violates language in the No Child Left Behind Act that requires services be implemented by the highest qualified provider;
-
It is contrary to the requirements of CMS, which dictate that providers who bill Medicare or Medicaid meet ASHA requirements, including possession of at least a Master’s Degree;
-
It sets a legal precedent for further challenges to our licensure in the future;
-
It places an undue burden on legislators to determine who should qualify to practice as a speech-language pathologists or audiologist, rather than Board of Registration members who belong to the profession;
-
Most importantly, it places consumers at risk. They must rely on the validity of the credentials that are offered to ensure that they are being evaluated and treated by a competent professional who has met all requirements. Being seen by an unlicensed or unqualified professional can lead to lengthier times in treatment, greater financial burden and in some cases, harm or loss of function.
Conclusion
House Bill 2110 unwisely and unnecessarily places consumers at risk, offers an applicant with substandard credentials an opportunity to gain credibility they have not earned, and violates regulations and statutes relating to reimbursement and special education. For these reasons the Massachusetts Speech-Language-Hearing Association urges you to oppose passage of this bill and respectfully requests the Joint Committee on Public Health recommend that it ought not to pass.
Suzanne M. Harris, MS CCC-SLP
Speech-language pathologist
MSHA President
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