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SLP&
Audiology Assistant Bill
MSHA welcomes respectful dialogue and inquiries about the Assistant Bill. To email the MSHA Public Policy Chair, Shelby Midboe, with comments and concerns, please click below.
*This page will be updated as soon and as often as possible with more information, with the most recent information on top.
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APRIL 20, 2022:
At this time, the problem with Medicaid billing for Aides has been resolved. If you know of a problem, please let us know right away. On March 10, Lucy Richards, the Executive Director of the Board of Speech-Language Pathology and Audiology, emailed MSHA to let us know that the RFP (Request for Proposal) for the creation of Assistant Exam would be ready to be released soon. We have not received an update since then. The process of getting a psychometrically sound exam in place for Assistant Licensure is taking much longer than anticipated. MSHA has been in contact with the Research Director of the Montana Federation of Public Employees, to help explain the parameters of the licensure of assistants and what it may mean for school pay matrices, and this work is ongoing. If your district/co-op is in negotiations this spring and want to work on making a place for assistants, please notify Shelby Midboe, Public Policy Chair, by clicking the button above, and she will help as much as possible to answer any questions you may have. Further updates will be posted as they become available.
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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 mshapresident@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.
September 13, 2021​
HB 210 (2021) sponsored by the Montana Speech-Language Hearing Association (MSHA) was passed by the Legislature during the 2021 Session. Under this bill there is no longer registration for unlicensed speech-language pathology or audiology aides. To be clear, there will be no aide registration this year or in any subsequent years since the board no longer has authority to require registration of unlicensed aides under this new statute that takes effect on 10/1/21.
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The other main piece of HB 210 is the creation of speech-language pathology and audiology assistant licenses. The board is currently working on rules to implement these new license types. The original timeline would have allowed individuals to begin applying for assistant licenses toward the end of the December 2021. However, as was recently discovered and discussed by the board at its meeting the morning of 9/13/21, there is in fact no appropriate assistant licensing exam available for all potential applicants to the requirements of Montana's new statutes under HB 210. Therefore, the board will need to go out for bid in order to find a contractor to write and administer an appropriate licensing exam which likely means the assistant licenses will not be available until Fall 2022.
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One final note with regard to billing practices and regulations. Laws pertaining to billing, including private insurance and Medicare and Medicaid are still outside the board's jurisdiction and regulatory authority just as they were prior to the passage of HB 210. As a licensee you are expected to comply with other state and federal laws that pertain to your scope of practice. However, it is not this board that regulates those specific areas so if you have questions regarding billing and unlicensed individuals working under the supervisor of a licensee you could trying contacting the Office of the Commissioner of Securities and Insurance and the Montana Department of Public Health and Human Services for more information. You could also try contacting your state and/or national professional association(s) to see if they have any recommendations regarding resources.
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If you would like to stay current on the board's progress to implement assistant licenses you can request to be added to the board's interested parties list. Those on the interested parties list receive all board meeting agendas and notices of all proposed rulemaking. E-mail questions and/or your request to be added to the list to dlibsdhelp@mt.gov. You can also check the board's website at https://boards.bsd.dli.mt.gov/speech-language-pathologists/. Recordings of board meetings, including the 9/13/21 meeting, can also be found on the website.
Sincerely,
Lucy Richards, Executive Officer, Speech-Language Pathologists & Audiologists