Licensureand

Sunset

Licensure History Lesson• 1140 - King Roger of Normandy

decreed that doctors must present proof of competency before being allowed to practice medicine.

• 1765 - John Morgan tried to start an inter-colonial medical licensing agency in Philadelphia. He failed, thanks to bitter infighting among the doctors.

• 1883 - Dentistry was the first profession in the U.S. requiring licensure.

• NOW - Over 800 professions licensed in the U.S.

Individual states have power to protect health, safety, and welfare of their citizens.

States may license professions when:

o unqualified practitioners pose a serious risk to consumers’ health, safety, well-being

o the public can’t accurately judge practitioners’ qualifications

o benefits to the public justify creation and support of a licensing agency

Is licensure the same as certification?

• No. Certification is voluntary, not written into law, not overseen by a governmental body, and usually does not prohibit someone from practicing.

Purpose of Licensure• Licensure is intended to safeguard

the public through the establishment of a minimum level of education, experience and competence.

• State law imposes: – minimum qualifying standards for

practice – legal description of the activities

a licensed professional can perform(scope of practice)

– procedures for disciplining professionals who deviate from the standards

Licensing statutes are classified as “enabling acts”. The licensing statute is a

law which can only be changed by the legislature.

Common features of licensing statutes: definitions board structure and functions licensing requirements scope of practice continuing education grounds for disciplinary action penalties for violating the law

Our Licensing Act

• TEXAS OCCUPATIONS CODE

• TITLE 3. HEALTH PROFESSIONS

• SUBTITLE G. PROFESSIONS RELATED TO

HEARING AND SPEECH• CHAPTER 401. SPEECH-LANGUAGE PATHOLOGISTS

AND AUDIOLOGISTS

Administrative codes provide procedures for implementing the law. Texas Administrative Code Title

22, Chapter 741, is a set of rules that can be changed by

the State Board of Examiners. Individuals or an association like TSHA can petition the State Board to make a

rule change.

Who is the licensing authority in Texas?

• The State Board of Examiners for Speech-Language Pathology and Audiology establishes and implements regulations related to licensure and adjudicates complaints against licensees.

• Administered by Dept of State Health Services

• Board has 3 SLPs, 3 audiologists, 3 public members, one of whom is a pediatrician or ENT

A professional association (such as TSHA) strives to promote, protect, and enhance professions. Practitioners voluntarily join. TSHA

does not credential anyone to practice.

A licensure board aims to protect the public. It credentials

practitioners, regulates and disciplines the professions, and is supervised by the legislature and

the courts.

Licensure – the Good Guy

• Ensures quality of service• Establishes educational

and ethical standards• Promotes continuing

professional education• Protects against

fraudulent, incompetent practice

• Minimizes professional isolation

Taylor, CDQ, Summer 2006

How does licensure protect the citizens of

Texas?• TOC Chapter 401 authorizes

the State Board to develop “procedures to identify and monitor license holders who represent a risk to the public.”

• Texas Administrative Code Title 22, Chapter 741, Subchapter D (Code of Ethics) specifies the duties and responsibilities of license holders.

Licensure Exemptions

• Chapter 401 “does not restrict activities of”:– Physicians– Nurses (limited screening)– Fitters & dispensers (related to hearing aids)– University professors (if not practicing or supervising)– University students (if identified as “trainees”)

• Permits TEA to issue a certificate for school SLPs (but TEA hasn’t issued certificates since 1995)

Licensees’ Duties and Responsibilities

• Practice within the scope of the licensee's competence (not just the scope of practice)

• Ensure a safe therapy environment and provide services safely

• Provide services as specified in the treatment plan and document them

• Seek medical consultation and make referrals when needed (and not engage in medical treatment)

Licensees’ Duties and Responsibilities

• Maintain objectivity• Be sure equipment is working and

calibrated• Terminate a professional relationship

when the client is not benefiting • Provide accurate information to the public• Reported suspected abuse• Observe universal

precautions

Licensees’ Duties and Responsibilities

• Supervise interns and assistants appropriately– Supervise no more than 4 licensees– Have 3 years of experience– Document supervision activities– Ensure that supervisees maintain

license, use correct title, practice within scope, and follow all licensure rules

Licensees’ Duties and Responsibilities

• Not guarantee results

• Not delegate services requiring professional training

• Not have sexual relationships with clients assistants, interns, or students

• Not evaluate or treat solely by correspondence

• Not use alcohol or drugs which adversely affect provision of services

Licensees’ Duties and Responsibilities

• Not reveal confidential information unless required by law

• Not participate in activities that create conflict of interest

• Not use professional relationships for personal gain

• Not misrepresent training or competence

• Not falsify records

Possible Penalties

• Permanently posted on Board website:– Denial of license – Revocation of license – Surrender of license

• Posted for 7 years on Board website:– Suspension of license – Reprimand – Administrative Penalties

Licensure The Texas

Story

1971

• Some Texans got together and decided licensure was needed.

• At the annual convention of the Texas Speech-Language-Hearing Association, they proposed “that the TSHA support a licensing bill to control the activities of speech pathologists and audiologists of the State of Texas”.

1971• Not everyone

thought licensure was a good idea!

• But in 1977, a bill was proposed. . .

19771977• Governor Dolph Briscoe

vetoed SB 440, which would have established licensure for the professions of audiology and speech-language pathology.

Licensure Achieved!

• Senate Bill 813 established licensing and regulation of speech-language pathologists and audiologists.

• The Act was effective September 1, 1983; required licenses by September 1, 1984.

19901990• Texas Education

Agency presented a plan to upgrade certification, requiring a graduate degree plus 18 hours of education courses for a TEA certificate

19921992Preparing for our 1st Sunset

• The idea of “Sunset” for licensing agencies started in Colorado, and Texas instituted the process in in 1977.

• Sunset allows legislatures to increase their oversight of professional regulation.

• During the Sunset process, the legislature determines whether licensure needs to continue.

In Texas, agencies typically undergo Sunset review once every 12 years.

Sunset is guided by a 12-member Sunset Commission appointed by the Lieutenant Governor and the Speaker of the House of Representatives.

Sunset staff members prepare an assessment of the licensing agency, and provide information to the Legislature about program necessity and workability.  http://www.sunset.state.tx.us/guide.pdf

19931993• SB 1077, extending

licensure until 2005, passed on May 29, 1993.

• Added intern licenses, changed “Committee” to “Board”, and allowed audiologists to fit, dispense, and sell hearing instruments.

19951995• Texas Education

Agency ended certification of SLPs.

• Licensure became the single credential for all employment sites in Texas!

2003 – 2003 – SLP Shortage SLP Shortage Creates a “Sticky” Creates a “Sticky”

SituationSituation

2003 - HB 28222003 - HB 2822• House Bill 2822 was proposed to reduce

the shortage of SLPs and increase speech services in schools

• HB 2822 :– required at least three members of the State

Board to be school district employees– established a limited license to practice in

the public schools as a fully licensed speech-language pathologist with a Bachelor’s degree

2003 - HB 28222003 - HB 2822• Limited license:

– Did not require any practicum experience

– Did not require any courses in speech/language disorders

– Allowed the individual to perform all assessment or therapy tasks “approved by a multidisciplinary team in the school district”

– Did not require supervision by an SLP

•HB 2822 dies HB 2822 dies in session . . .in session . . .

–Thanks to . . .Thanks to . . .

The “Killer D’s”!• Summer 2003: Governor Perry calls a

special session

• Lacking the votes to defeat the proposed congressional redistricting plan, Democrats fled to Oklahoma and New Mexico for 46 days,preventing a quorum.

• The session ends with no action taken on HB 2822.

So what did happen in 2003?

• Legislature:– Required all health professions to

move to biennial renewal of licenses– Authorized administrative penalties

up to $5000 per day of violation– Authorized licensure boards to

perform criminal history checks with FBI and Department of Public Safety

–AND. . .

2005 2009 • Sunset review for the State Board of

Examiners in Speech-Language Pathology and Audiology was moved to 2009.

2005 Senate Bill 2005 Senate Bill 22• Mid-March: Texas House forwarded a school

finance bill to the Texas Senate• May 2: Senate committee returned amended bill;

the 65th amendment proposed to reduce SLP standards – allowed individuals with bachelor’s degrees in

communicative disorders to be hired in public schools– no supervision required– Texas Education Agency would provide continuing

education for evaluation and therapy skills

2005 Senate Bill 2005 Senate Bill 22

• Legislature took no action on SB 2 before its regular session adjourned on May 30.

• On June 19, Texas Gov. Rick Perry vetoed the entire $33.6 billion school budget, forcing the Texas legislature into a special session.

• Sometimes in Texas, the best legislative session is when nothing gets done!

20072007• Was a

quiet session, but. . .

2005 2009 2013

• Sunset was moved again—to 2013!

2009 Session2009 Session• Sunset changes again!

• Now 2011

The Sunset Process

• Licensure board submits Self-Evaluation Report• Sunset Staff evaluates report and develops

review plan• Licensure board educates Sunset staff about its

operations through overview meetings

• Sunset staff meets with interested groups (like TSHA) and affected parties (like Fittersand Dispensers’ board)

Sunset Staff Considerations

• Need for licensure

• Potential for merger

• Board composition

• Should protect public from potentially serious threat

• Groups with similar practice might be consolidated under one board

• Boards must have odd number, with at least ½ public members

Sunset Staff Considerations

• Revenue

• Qualifications for license

• Licensing revenue should meet or exceed expenses

• Education and experience requirements should not restrict entry into practice or place undue burden on applicants; licensure is only required to ensure minimum level of competence

Sunset Process

• Over 3 to 8 months, Sunset staff evaluates the licensing agency, develops recommendations, and publishes report

• Sunset Commission conducts public hearing

• Commission prepares their recommendations to Legislature

What changes can be made

through Sunset review?• Commission’s report

recommends that the agency continue, be abolished, or be modified.

• If continuation is recommended, the Commission must provide draft legislation to the Legislature to continue the agency for up to 12 years, and correct any problems identified during the Sunset review.

• Since Sunset began in Texas, 54 agencies have been abolished; 12 have been consolidated.

Roles for TSHA members

• Provide input to Sunset staff through TSHA.• Review Sunset reports, including licensure

board self-evaluation and Sunset staff reports.• Testify at public hearings. Comment on the

importance of licensure and respond to the Sunset staff’s recommendations.

• Take part in the legislative session. Grassroots advocacy can help ensure that the legislature understands why licensure is needed.

Sunset Issues

• Shortages• Portability• Reimbursement• Scope of practice• Autonomy• Telepractice• Support personnel• Loss of “highest qualified provider” clause

with IDEA 2004• Consumers’ lack of awareness of our roles

and skills

Sunset Issues

• Shortages – some people think licensure restricts the supply and increases shortages

• Portability – can the Texas license be used in neighboring states and vice versa?

• Reimbursement – does licensure clarify who should qualify to be reimbursed for assessment and treatment of communication problems?

Sunset Issues

• Telepractice – will we allow telehealth (by practitioners in Texas? Outside of Texas?)

• Autonomy – there may be challenges to our role as independent practitioners

• Scope of practice – will other groups of practitioners claim that we are encroaching on their territory?

Scope of Practice Partnership (SOPP)

Created by a coalition comprised of the AMA, six national medical specialty societies and six state medical associations (CA, CO, ME, MA, NM, TX). Members of the coalition agreed that it was necessary to concentrate the resources of organized medicine to oppose scope of practice expansion by allied health professionals that threaten the health and safety of the public.

Pilch, S. AMA Resolution to Limit Licensure of Allied Health Professions. National Council of State Boards of Examiners for Speech-Language Pathology and Audiology Annual Conference. Atlanta, Georgia.

Sunset Issues

• Support personnel – is the assistant still the most appropriate type of support personnel? Are the educational and clinical requirements appropriate?

• Replacement of “highest qualified provider” with “highly qualified” in the current version of IDEA – means states are given the authority to decide who is qualified to provide services in schools

“Solutions” Around the U.S.• Because of shortages, some states are

developing alternatives– “Speech specialist” or “implementor”—

teachers with 1 or 2 courses in communication disorders

– Assistants working unsupervised – Communication development specialist (CA)

• Bachelor’s + 1 (undefined courses)• No supervision• Cover all the “educational stuff” while

SLPs cover “medical stuff” like cleft palate and cochlear implants

Sunset Issues

• Lack of awareness – the general public, members of the Sunset Commission and their staff, and members of the Legislature are generally unaware of what speech-language pathologists and audiologists do, and the importance of maintaining standards for education, experience, and competence

• What is TSHA doing to prepare for Sunset?

The TSHA TCASE Two-Step

TSHA formed a Joint Committee with Texas Council of Administrators of Special Education to study shortage of SLPs in schools and share constructive ideas for addressing the problem

Consumer Network

• TSHA is identifying consumers across the state who would be willing to share their stories with the Sunset Commission and the legislature.

What lies ahead?