IHP community works with Massachusetts Speech-Language Hearing Association to provide provisional licensure to first year Massachusetts Speech-Language Pathologists
For years, Massachusetts carried the dubious distinction of being the only state in the country to consider it fraud for trained and qualified speech language pathologists to bill insurance companies during their first year of practice, known as their clinical fellowship (CF).
That all changed Friday when Governor Baker signed into law House Bill 5094: An Act Providing for Provisional Licensure for Speech-Language Pathologists (SLPs).
This will directly impact current CFs and studying speech-language pathologists who, prior to this bill, were unable to bill for their services under Medicare B, Medicaid, and certain insurances, despite the American Speech-Language-Hearing Association considering CFs to be qualified professionals.
Passage of the law is largely the result of advocacy from the Massachusetts Speech-Language Hearing Association (MSHA) and lobbyists Rick Branca and Bill Malloy. Barbara Wilson Arboleda, a 2001 alumna of the MGH Institute of Health Professions' CSD program and a current SLP at Beth Israel Deaconess, Lisa Moran, Assistant Director of External Clinical Education at the MGH Institute of Health Professions, and Jenn Mackey, Director of Clinical Education at the MGH Institute of Health Professions, are members of MSHA and volunteered their time and efforts in helping this bill to pass.
“We couldn’t be happier,” beamed Mackey, “It’s been a long fight. Finally, our CFs don’t have to move out of state to work in settings they are passionate about. We want them to stay here in Massachusetts and fill the many open jobs in our state. We did this for every SLP graduate student in MA, as well as for the integrity of our field.”
Once the remaining logistical political steps are completed, this bill will allow trained and qualified SLPs to bill insurance companies during their first year of practice.
The new law has two immediate impacts:
Patients needing communications or swallowing care will see an expert quicker because not as many SLPs will need to leave the Commonwealth. Unto this point, newly graduated SLPs were leaving for greener pastures – states where they could be hired easily because they could bill insurance for their services, therefore not requiring their employers to pay their salaries out of pocket.
Hospitals and schools will have an easier time filling SLP positions left open by the workforce shortage, one exacerbated by SLPs leaving Massachusetts. Organizations will save money because they won’t be paying out-of-pocket to cover a first year SLP’s salary.
That a law like this is even necessary might surprise most; the limitations on first year SLPs certainly stunned those within the SLP field more than a decade ago.
“All of us were ignorant to it,” shared Moran. “Prior to joining the IHP, I worked for a very large organization that had its own compliance and regulation department. When I heard rumblings about this billing issue, I specifically emailed my compliance and regulation department, and it became clear that even they weren’t aware.”
The situation is complex and the prior regulations, archaic.
How It Started
Back in 2010, Wilson Arboleda was working as an SLP in private practice and looking to hire a staff speech-language pathologist. After receiving an influx of resumes from potential candidates, she wanted to learn more about registering these individuals with her insurance. In digging deeper, she discovered that neither Medicare nor the private insurance companies she contracted with would reimburse her for the services provided by an SLP in their Clinical Fellow year, because there was no full license before their first year of practice was complete.
It was then that Wilson Arboleda reached out to her state representative Paul McMurtry to file the first bill. During the first few legislative cycles she learned more about legislation and the legal process than she ever wanted to know. She spent time educating veteran SLPs about the riskiness of billing in their first year SLPs under their own licenses. It was at this time that she learned there was a groundswell of legislation in other states establishing provisional licensure for speech-language pathologists, but not in Massachusetts.
Eventually she connected with MSHA and while the reach of the campaign increased, it still wasn’t getting the traction it needed - not because anyone was against it, but because it wasn’t garnering enough attention or understanding.
Enter Moran, who was involved with MSHA at that time. Moran has long been working with the organization, first on the MSHA Executive Council in 2007, and since holding numerous positions including the Co-Chair of Membership, VP of Administration and Planning, President, Past-President and VP of Advocacy, and Government Affairs Committee (GAC) Lead. She joined the IHP in 2015 and brought her advocacy knowledge along with her, teaching the community about the barriers this lack of provisional licensure brought to first year SLP clinicians. Mackey, has been the VP of Advocacy for MSHA for the last two years, and has been working at the IHP for over twenty years.
“I knew it was time for me to stop complaining and act,” Mackey shared. “MSHA had been working so hard for a decade. Our lobbyists, as well as the MGH Office of Government Affairs, were excellent guides in this bill’s advocacy.”
Over the last two years, Mackey continued to work closely with the lobbyists to gather letters of support, testify in legislative committees, and share information about the bill. Simultaneously, she led webinars on advocacy for several speech-language pathology programs in MA to teach students about the Provisional Licensure bill and advocacy in the field.
It was the collaboration among members of the IHP community that lead to such a successful push for change. With Wilson Arboleda as an alumna, and Mackey and Moran as faculty, there was a direct line of student involvement, bringing in more voices to spread the word and more hands on deck. All on a volunteer basis.
The path to getting the bill signed was not smooth and in fact, there were often delays, most of which resulted from a lack of understanding.
“There were people who didn't believe us,” Mackey said. “Even now, after all these years, there are people that don’t really understand the issue."
The Impact of the Bill
The lack of provisional licensure has had a ripple effect on students, organizations, schools, hospitals, universities, and the general population of Massachusetts.
For students, job opportunities were limited for their first year of work, directly impacting their options and paths thereafter. Jobs in medicine, for one, were hard to secure given the funding that medical institutions receive from insurance and the CF’s inability to access this funding for their work. This applied similarly to school systems. There are positions left unfilled across the state in different sectors and recent graduates could easily fill them if they could bill for their services.
This often limits SLP’s career trajectories as it limits experience and oftentimes, geography. For example, if an SLP student dreamed of working in a hospital, but upon graduating from a Massachusetts SLP program finds they cannot legally bill for services in such a setting, they may leave the state. With this, the Commonwealth has been losing qualified SLPs and would have continued to do so if it weren’t for this bill.
“There are open positions not being filled while we have perfectly trained candidates available,” Moran shared. “This impacts us all, and then impacts those in the area by limiting their access to care and quality of care. It also impacts us as an institution because we don’t have our alumni in the state to collaborate with or hire to train our future SLPs.”
Looking Ahead to What the Future Holds
With the new law on the books, the future looks bright for all in the SLP field.
For students looking to enter the SLP field, provisional licensing will offer them new opportunities to do so to begin their career. The drive from Mackey, Wilson Arboleda, and Moran was critical all along.
“To me, this situation felt patently unfair,” Wilson Arboleda shared. “We were driven to give these students the opportunities they needed to have the careers they deserved. As an employer, there were so many times we would have great students doing their clinical externships, but once they graduated, if a position opened up, we couldn’t hire them in their first year. Ultimately, we missed out, and couldn’t provide the best care as a result.”
Looking ahead, Mackey sees more steps to take in widening opportunities for students.
“At the end of the day, we want more people thinking about advocacy, because there is more to this movement,” she said. “We want to do an interstate compact, which would allow SLPs to be licensed in multiple states. Advocacy is an incredible opportunity to work together for the causes you believe in. It’s a long journey, but we want others to get involved.”
While Mackey, Wilson Arboleda, and Moran have spent twelve years turning hope into reality, their journey with it is far from over. Making the SLP field more equitable while providing better care for all will continue to drive them.