Vice-President for Legislative Affairs
Kim Stewart, MS, CCC-SLP
msha@showmemsha.org
Welcome to the Legislative Affairs web page. This page will provide MSHA members with information regarding legislative and regulatory issues, which will affect our practices of speech-language pathology and audiology. Both area of governance influence our clients and their families and our practices, the legislative process more generally and the regulatory process more specifically.
This web page will include information regarding current and upcoming federal and state activities, links that will give members access to state and federal legislative bodies, regulatory agencies, and other groups and associations that advocate for the same clients we work with.
The emphasis on regulatory affairs is necessary because our state and federal governments provide for regulatory agencies to oversee many aspects of those areas that the legislature creates policies for. Legislatures pass laws that are fairly broad. Regulatory agencies issue specific rules that implement legislative decisions in ways that specifically affect services we offer to our clients and the ways in which we provide those services. Our efforts to advocate must be directed to both legislation and regulation.
Advocacy is essential to our practices. Simply being aware of issues affecting our clients and us is not enough. We must actively engage ourselves in supporting the interests of those we serve in our professions by voicing our questions and concerns to those directly involved in making the decisions that affect us.
Both state and federal legislatures are currently preparing for special sessions, including veto sessions. Regular sessions will begin shortly after the new year begins. This page will include issues of interest as those issues arise.
MMAC-MO HealthNet – Septmember 18, 2023
Hello MSHA Members:
As you may know, in August 2022, the MO Board of Healing Arts reinstated the provisional license for SLP Clinical Fellows (CFs) to align with licensing standards of the other partner states participating in the Audiology/Speech-Language Pathology Interstate Compact (ASLP-IC). While the compact agreement is still not yet an active license option as of the writing of this notice in September of 2023, there have been many questions as to the status of MO Medicaid/MO HealthNet billing privileges of those with the MO provisional license (CFs) in school and clinic/hospital based settings. Many agencies and schools have opted to not have CFs bill, as at the time of the enactment of the MO provisional license there was no formal statement made by the Missouri Medicaid Audit and Compliance Office (MMAC) that this would be permitted.
On September 5, 2023, MSHA received written verification that MMAC (Missouri Medicaid Audit and Compliance) will enroll provisionally licensed SLPs. As such, those SLPs holding the MO provisional license (CFs) can apply for a NPI number and may bill MO Health Net directly. This holds true across all work settings. This is well received news for CF-SLPs holding the provisional license in MO, and for those employing CFs.
This confirmation has been a year in the making, with many thanks to Brent Hemphill, MSHA Lobbyist, Melanie Stinnett, Representative of MO District 133, Theresa Pierce, SLP, Kimberly Stewart (former MSHA VP of Legislative Affairs), Jennifer Stevenson (former MSHA President), Angie DeMoss (former MSHA VP of School Services) and Doanne Ward-Williams (ASHA Director of State Affairs). Without their voice and persistence, this billing issue may have gone unresolved. We hope this notice helps clarify any questions or concerns regarding the status of SLP provisional licensure with respect to MO HealthNet/ Medicaid billing.
ASHA Letter re: SB 410 DEI
Click to view letter to the Honorable Andrew P. Koenig Missouri Senate ASHA Opposition Letter to MO re SB 410 DEI
Important bullet points that impact Missouri Audiologists and Speech-Language Pathologists – August 4, 2022
- The presidents of the Washington Speech-Language-Hearing Association and Missouri Speech-Language-Hearing Association met with staff of Senators Patty Murray (D-WA) and Roy Blunt (R-MO), the chair and ranking member of the Senate Appropriations subcommittee on Labor, Health and Human Services, and Education, to encourage the creation of a technical assistance center on communication/speech disorders within the Department of Education.
- The House of Representatives passed the Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040), which would extend Medicare telepractice authority for audiologists and SLPs through December 31, 2024. ASHA supports the bill, but GAPP continues to work to add audiologists and SLPs to the list of permanent eligible Medicare telehealth providers by supporting the Expanded Telehealth Access Act (H.R. 2168/S. 3193).
- Senate Majority Leader Chuck Schumer (D-NY) and Senator Joe Manchin (DWV) announced agreement on legislation to be considered through expedited budget procedures that includes a three-year extension of subsidies to help lower-income individuals obtain health coverage through Affordable Care Act exchanges. The bill does not include provisions from the Medicare Audiologist Access and Services Act, which was not unexpected. Senate leaders will try to pass this legislation before adjourning for the August recess. The House, while currently in recess, is expected to return to D.C. for a brief period upon Senate passage.
- GAPP helped craft a letter to congressional committee leaders signed by more than 100 health care provider organizations calling on Congress to stop steep cuts to Medicare Part B reimbursement scheduled for next year. The letter highlights that the cuts “continue to generate significant instability for health care professionals moving forward, threatening beneficiaries’ timely access to essential health care services.” GAPP continues to work with allied stakeholders to develop long-term solutions to Medicare payment threats.
Audiology/Speech-Language Pathology–Interstate Compact (ASLP-IC) HB 2149 SIGNED by Governor Parson on June 7, 2022
Governor Mike Parson signed HB 2149 on June 7, 2022, which adds Missouri as a member of the Audiology Speech Language Pathology Interstate Compact (ASLP-IC). Thank you to Representative Brenda Shields (District 11-Buchanan County and parts of Platte County) for sponsoring HB 2149, professional licensing bill, which was presented and signed by Governor Parson. This bill will be effective August 28, 2022.
Successful testimony was previously provided for the ASLP – Interstate Compact during the beginning stages of the legislative process:
- HB 2138 hearing was conducted on February 9, 2022 in the House Professional Regulations Committee. Thank you Representative Ann Kelley (Jasper and Cedar Counties) for sponsoring the bill. Testimonies were given by Jennifer Stevenson, MSHA President; Shannon Locke, VP for Communication; Kim Stewart, VP for Legislative Affairs
- SB 978 hearing was conducted on March 7, 2022. Thank you Senator Karla Eslinger (Ozark County) for sponsoring the bill in the Senate Professional Regulations Committee. The following MSHA Executive Board members testifying: Jennifer Stevenson, MSHA President; Andrea Richards, VP for Professional and Public Relations; Kim Stewart, VP for Legislative Affairs
THANK YOU ASLP-IC Task Force and MSHA members for your active support during the legislative process for the ASLP-IC. Your emails of support moved the ASLP-IC bills through the legislative process faster! Also, thank you to Brent Hemphill and Liz Henderson, MSHA Lobbyists, for diligent work with completing legislative process.
ASHA update: The ASLP-IC Commission initially met in January 2022 to establish rules and bylaws to implement the Compact. This process can last a year or longer, meaning the Commission could begin issuing privileges to practice in Compact member states by late 2022 or early 2023. Jennifer Stevenson and Kim Stewart were guests for the ASLP-IC Commission bylaws meeting on June 9, 2022, noting the Commission is working diligently to complete the rules and bylaws.
The ASLP-IC offers several benefits to the public.
- Improves continuity of care
- Improves portability for military spouses
- Improves access to audiology and speech-language pathology providers
- Increases choice of audiology and speech-language pathology providers
- Facilitates alternate delivery methods (Telehealth)
- Simplifies/speeds up the current process
- Addresses portability & barriers to access
- The practice of audiology and speech-language pathology occurs in the state where the patient/client is located at the time of the patient/client encounter
Note: The licensee has the option to remain with the single state license or the ASLP-IC license.
Privilege to Practice: Once the Interstate Compact is fully operational, licensed audiologists and speech-language pathologists will be able to apply for a privilege to practice in-person and through telehealth in ASLP-IC states.
Note: The licensee has the option to remain with the single state license or have the ASLP-IC license.
22 states have ratified the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC), a project spearheaded and funded by ASHA, clearing the way for implementation. Alabama, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Mississippi, MISSOURI, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Utah, West Virginia, and Wyoming. https://aslpcompact.com/
Legislation is pending in Illinois, Delaware, and New York. Legislation not enacted: Minnesota, Washington, and Vermont. ASHA expects more states to introduce legislation as the state legislatures are starting their 2022 sessions.
HB 77 – Public School Retirement System
Currently, any teacher retired from the Public School Retirement System of Missouri may be employed in a position covered under the Public Education Employee Retirement System (PEERS) without stopping their retirement benefit. Such teacher may earn up to 60% of the minimum teacher’s salary as set forth in Section 163.172, RSMo, and will not contribute to the retirement system or earn creditable service.
The employer’s contribution rate will be paid by the hiring employer. If such person is employed in excess of these limitations, the person will not be eligible to receive their retirement allowance for any month the person is employed and such person shall contribute to the retirement system if he or she is in an eligible position.
This bill excludes from this provision any person retired and currently receiving a retirement allowance in accordance with Sections 169.010 to 169.141 employed by a public community college.
This bill is similar to HB 2335 (2018).
CCS SS SCS HCS HB 399 – Healthcare
This bill modifies several provisions relating to the health care services.
Offender MO HealthNet Benefits
This bill specifies that MO HealthNet benefits shall be suspended, rather than canceled or terminated, for an offender entering a correctional facility or jail if the Department of Social Services is notified of the person’s entry into the correctional center or jail, the person was currently enrolled in MO HealthNet, and the person is otherwise eligible for MO HealthNet benefits but for his or her incarcerated status. Upon release from incarceration, the suspension shall end and the person shall continue to be eligible for MO HealthNet benefits until such time as he or she is otherwise ineligible.
The Department of Corrections shall notify the Department of Social Services within 20 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in a correctional center or jail and within 45 days prior to the release of such person whose benefits have been suspended under this bill. City, county, and private jails shall notify the Department of Social Services within 10 days of receiving information that person receiving MO HealthNet benefits is or will become an offender in the jail (Sections 217.930 and 221.125).
Unanticipated Out-of-Network Healthcare Services
Currently, utilizing the unanticipated out-of-network process is optional. This bill requires health care professionals to utilize the process outlined in statute for claims for charges for unanticipated out-of-network care (Section 376.690).
Multiple Employer Welfare
The bill allows multiple employer self-insured health plans having a certificate of authority approved by the Director of the Department of Insurance, Financial Institutions and Professional Registration to offer such plans to the public. Health carriers acting as an administrator for a plan shall permit any willing licensed broker to market such plans (Sections 376.1040 and 376.1042).
Healthcare for Persons With Disabilities
This bill adds therapeutic care for “developmental or physical disabilities,” as defined in the bill, to the insurance coverage mandate for autism spectrum disorders, and makes the mandate applicable to policies issued or renewed on or after January 1, 2020, rather than to group policies only. The bill specifies that autism spectrum disorder will not be subject to any limits on the number of visits an individual may make to an autism service provider. Coverage for therapeutic care provided under the bill for developmental and physical disabilities may be limited to a number of visits per calendar year, provided that additional visits shall be covered if approved and deemed medically necessary by the health benefit plan. Provisions requiring coverage for autism spectrum disorders and developmental or physical disabilities shall not apply to certain grandfathered, pre-empted, or supplemental plans as described in the bill.
This bill repeals a provision of law directing the Department of Insurance, Financial Institutions and Professional Registration to grant small employers waivers from the coverage requirements under certain circumstances. The bill also repeals a provision requiring the department to submit annual reports to the legislature and requiring health carriers to supply certain diagnosis and coverage information for the report.
These provisions apply to policies issued, delivered, or renewed on or after January 1, 2020 (Section 376.1224).
Methods of Reimbursement
This bill prohibits health carriers from restricting methods of reimbursement which require health care providers to pay a fee to redeem the amount of their claim for reimbursement.
Health carriers changing the reimbursement method used shall notify health care providers whether any fee is required to receive reimbursement through the new or different method. For health benefit plans issued, delivered, or renewed on or after August 28, 2019, the provider will be able to select an alternative method of reimbursement which does not require a fee.
Violation of these provisions shall be deemed an unfair trade practice under the Unfair Trade Practice Act (Section 376.1345).
CCS SB 17 – Public Employee Retirement Systems
This bill modifies provisions relating to public employee retirement systems.
Teacher and School Employee Retirement Systems
This bill allows a retired member of the Public School Retirement System (PSRS) or Public Education Employees Retirement System (PEERS) who has elected a reduced retirement allowance to provide for survivor benefits for his or her spouse to have the retirement allowance increased to the single life annuity amount, with no survivor benefits, if the member and his or her spouse became divorced prior to September 1, 2017 or if they get a modified dissolution decree that provides for sole retention by the retired person of all rights in the retirement allowance after September 1, 2017 (Sections 169.141 and 169.715).
Public School Retirement System
Currently, anyone retired from the PSRS may be employed by an employer included in the retirement system in a position that does not normally require a Missouri teacher certification. He or she may earn up to 60% of the statutory minimum teacher salary without a discontinuance of the person’s retirement allowance.
If any such person is employed in excess of the limitations, the person shall not be eligible to receive the person’s retirement allowance for any month during which the person is employed.
This bill exempts any person retired and currently receiving a retirement allowance from PSRS employed by a public community college from these provisions (Section 169.560).
SCS SB 101 – Hearing Aid Distribution Program
This bill requires the Missouri Commission for the Deaf and Hard of Hearing to establish, subject to appropriations, a statewide hearing aid distribution program to provide financial assistance to certain low-income individuals who are deaf or hard of hearing to obtain hearing aids. All assessments for need and distribution of hearing aids shall be performed by a licensed audiologist hearing instrument specialist or licensed physician. The bill creates the “Statewide Hearing Aid Distribution Fund,” which shall not include any funds from the Assistive Technology Trust Fund or the Deaf Relay Service and Equipment Distribution Program Fund. The Commission may accept gifts, donations, grants, and bequests for the program.
Other Legislation Not Passed
SB 235, HB 205 – Hearing Aids
The bill requires accident and health insurers to provide coverage for medically necessary hearing instruments, as defined in the act, and related services for individuals under the age of 18 when prescribed by a hearing care professional. The coverage is subject to out-of-pocket payment requirements, shall provide for one hearing aid for each ear every 36 months, shall include related selection and adjustment services when deemed necessary by a professional, and may include medically necessary repairs to the instrument.
Neither the House nor the Senate bill were heard in committee.
SB 45 – Disability Healthcare
The bill adds therapeutic care for developmental and physical disabilities, as such terms are defined in the act, to the insurance coverage mandate for autism spectrum disorders, and makes the mandate applicable to policies issued or renewed on or after January 1, 2020, rather than to group policies only. Medical necessity of coverage provided under the act shall be determined by the health benefit plan.
The bill was perfected and passed in the Senate. The bill was then heard in a House committee; however, it was not perfected.
SB 48 – Short Term Medical
The bill specifies that all short-term major medical policies sold in the state shall include on applications and fact pages a conspicuous and clearly labeled paragraph stating that the policy may not cover preexisting conditions or essential health benefits, and a recommendation to discuss the policy with the individual’s insurance broker.
The bill was voted do pass out of a Senate committee; however, it was not perfected.