Report to the General Assembly (Published)

Document Title

Study on the Need to Regulate Speech-Language Pathology Assistants

Author

Department of Health Professions; Board of Health Professions

Enabling Authority

SJR 492 (1999)

Executive Summary

Background

Senate Joint Resolution 492( 1999), patroned by Senator Jane H. Woods, directed
the Board of Health Professions to evaluate the need to regulate speech-language
pathology assistants and, with the aid of the Department of Medical Assistance
Services, to determine the potential fiscal impact of regulating them.

Methodology

The sunrise review methodology detailed in the Board of Health Professions
Policies and Procedures for Evaluation of the Need to Regulate Health
Occupations and Professions (1998) was employed in this study. It must be noted
that successful application of these methods is rooted in the following.

* The Board's ability to accurately determine the risk of harm to the public posed
by the unregulated group.
* Its full understanding of the educational and training requirements for
competent practice of the profession or occupation.
* Clear understanding of the level of autonomy of the practitioners of the
profession or occupation.
* Comprehension of the actual scope of practice of the profession or occupation.
* An assessment of the economic impact of regulating the profession or
occupation based upon economic variables which speak to costs at the level of
the individual practitioner.
* Finally, its evaluation of alternatives to state regulation.

The Board undertook the following efforts to address these issues.

* It conducted a policy literature review that described what speech-language
pathologists and their assistants are known to do, the established guidelines for
supervision, information about the types and prevalence of communication
disorders, and information about the education programs for assistive personnel
in the United States.
* A survey of licensed speech-language pathologists was conducted by the Board
to obtain first-hand information concerning the use of unlicensed assistants in
Virginia. The survey sought to determine the prevalence of their employment
to include information on the types of practices involved (i.e., public, private,
or both), the geographic locations, the supervisory relationships, their specific
duties, and the age group of the clients they serve.
* As part of its literature review, the Board also reviewed similar information
from the Board of Audiology and Speech-Language Pathology's survey of all
its licensees last year. Further, the Board sought to review the results of a
Department of Education survey concerning school systems' use of
paraprofessionals; however, the results were unavailable in time for the Board's
report.
* Current relevant federal and state laws and regulations were examined.
* Disciplinary information was obtained from states regulating speech-language
pathology assistive personnel.
* Relevant, available malpractice insurance coverage information was obtained
as was court case history for malpractice of assistive speech-language
pathology assistants
* Fiscal impact analysis was attempted but information from the Department of
Medical Assistance Services regarding reimbursement for the activities of
speech-language assistive personnel revealed that specific Medicare or
Medicaid billing information on individual speech-language pathologists or
their assistants does not exist in Virginia. This coupled with the fact that the
Board does not know how many assistants are working in Virginia makes fiscal
impact analysis unfeasible.
* Finally, the Board solicited and received public comment in writing and
through a public hearing.

Results and Conclusions

Based upon information obtained, the occupation, referred to as "speech-language
pathology assistant," itself, appears to lack standard definition. Although
assistants are regulated in a number of other states under the direction of speech-
language pathologists, there are no national private credentialing standards (as is
routinely the case for groups seeking regulation) to define entry level
competencies and no professionally validated job analyses to help define exactly
what they do.
There is insufficient information concerning the number of practitioners and their
actual duties in Virginia practice settings (including the schools). Currently, there
are no education programs in Virginia, and although such programs exist in some
other states, there are no accreditation standards. The American Speech-Hearing-
Language Association is considering development of such standards; however, the
Board was informed by the Speech-Hearing-Language Association of Virginia that
they are at least two years in the offing.
Disciplinary information from other states licensing speech-language pathology
assistants indicates that problems have been minimal to nonexistent. There are no
known malpractice cases or liability insurance claims made as a result of the work
of speech-language pathology assistants in Virginia or the nation.
Regarding financial information, according to the Department of Medical
Assistance Services information, there is no available financial information
relative to billing for the services of speech-language pathologists or their
assistants tied to individual providers. Thus, a valid fiscal impact analysis was not
possible.
National and state professional association ethical standards for speech-language
pathologists exist to guide members in supervising unlicensed assistants. In
Virginia, the Board of Audiology and Speech-Language Pathology also has
regulations which speak directly to the supervision and use of assistive personnel
by its licensees.
Malpractice insurance coverage is available to assistive personnel if they so
choose. Those not privately certified by the American Speech-Hearing-Language
Association may obtain coverage from their primary carrier which ranges from
$1 million per event $3 aggregate to $2 million per event $5 million aggregate for
premiums with range from $62 to $97 per year.
From public comment it was learned that the impetus for the study was a request
from the Speech-Language-Hearing Association of Virginia (SHAV). They
contend that regulating assistants may better protect the public, foster the
development of assistants as a profession and aid their own professional
development as supervisors, assist community colleges in justifying educational
programs for assistants, and enable school systems to bill Medicaid for
reimbursement for speech-language service provided by assistants. No speech-
language pathology assistants, themselves, presented any information to the Board.
In their deliberations, the Board members held that they did not have adequate,
objective insight into who (and how many) are doing what to whom and at what
level of competency in Virginia. Further, they had no knowledge of any specific
harm occurring in Virginia. With no empirical basis to render a rational decision,
they chose to take no position on the issue of the need to regulate speech-language
pathology assistants at this time.