Children with Hearing Loss
By: Amber Govey, Karli Kubincanek, & Cassidy Martin
It is estimated that about 131 of every 1,000 school-age children have some degree of hearing loss that can potentially affect communication, learning, literacy, psychosocial development, and academic achievement (ASHA Take Action, n.d.). Therefore, the Individuals with Disabilities Education Act (IDEA) needs strengthened to enforce and clarify the need for educational audiologists for the deaf or hard of hearing children in the school system.
What is the issue? Why is it important?
The role of educational audiologists is to interact directly with parents, teachers, nurses, speech-language pathologists, and other related service professionals to form an educational team, which serves students under IDEA or 504 plans. Specifically, they provide education related to the effects of hearing loss, auditory processing deficits, and ideal listening environment; therefore, it is important that children with hearing loss are consistently provided with optimal, language rich environments (Educational Audiology Association, 2009).
Educational and private audiologists work together to ensure that students are receiving the highest quality hearing technology and support services within a school setting. Hearing loss prevention programs, hearing screening programs and classroom acoustics are other areas within the scope of practice of an educational audiologist. Providing consultation to the school nurse on screening programs, the speech-language pathologist for communication strategies, or a classroom teacher regarding acquisition of the phonemic information critical to literacy -- are all part of the role of the educational audiologist within a school system (Educational Audiology Association, 2009). However, this type of service is not readily available in most school systems under current laws. As a result, many children are not receiving proper audiological services that best suit their needs.
To address this concern and strengthen IDEA, contacting legislators and federal Department of Education is essential. Since IDEA is a federal law, a bill would need to be drafted in order to clarify the role of educational audiologists in the schools. Therefore, to take action, our primary goal is to advocate for this concern and spread awareness to not only the general public, but to those who are able to get a bill introduced. To begin, we will construct a letter to send to the senate and house committee members to bring their attention to the issue at hand. Within the letter we will be asking that a bill be drafted by a member who shows interest in the topic we are addressing. We will also create a Facebook post regarding the issue to bring awareness to the topic. The Facebook post will include statistics, the link to the ASHA Take Action Issue Brief, and a pre-constructed letter addressed to the legislation and federal department of education, with instructions for how to submit the letter.
What can you do?
As you can see, it is of high importance that children with hearing loss are provided with the proper hearing environment in order to learn, develop, and grow to be successful students. To help spread the word, here are some ways in which you can advocate:
1. Educate yourselves and others on the topic.
2. Share the Facebook post to help spread awareness.
3. Submit the pre-constructed letter to legislation and federal department of education in order to address the issue.
Educational Audiology Association. (2009). School-based audiology advocacy series school-based audiology services. Retrieved from
ASHA Take Action. (n.d.). Children with hearing loss. Retrieved from https://takeaction.asha.org/asha/DHHC
By Caitlyn Tucker & Haley Stang
Summary of the issue:
The Affordable Care Act (ACA) requires non-grand-fathered health plans from insurance companies offered in individual and small group markets to offer benefits for 10 essential health benefits (EHB). Habilitation and rehabilitation services and devices are one of the essential health benefits included in the ACA. Speech and language services are considered to be a habilitative and rehabilitative service. Without EHB, speech-language pathologists would be unable to assist many clients with speech, language, swallowing, or cognitive difficulties.
Why is this important?
It is important for these services to be covered by insurance because treatment may prevent further negative consequences for people with communication disorders. Speech and language services aid in the opportunity for children and adults to have the ability to communicate across various settings. Progress in communication not only aids in education and vocational opportunities, but it increases quality of life among individuals who are diagnosed with communication disorders. Children who are receiving speech and language services may benefit from being able to have a better understanding of the curriculum. Speech-language pathologists provide treatment for children with literacy disorders so they can function in a classroom and prepare for their future. Elementary and high school education is crucial to higher education and eventually finding a job. Without speech and language services being funded by insurance companies, we may see a decrease in young adults attending college and becoming successful members of society. Speech and language services are essential for all age populations of the United States. If these services weren’t compensated by insurance companies, the majority of individuals who have suffered from a stroke or disease of the CNS would be at risk for negative impacts in their quality of life based on communication disorders that may follow their medical conditions. For example, a client that has vocal nodules may be able to rehabilitate their voice with speech therapy. However, the client may have to undergo surgery if they are unable to get speech and language services.
As of now, habilitation mandates are projected to cost less than 1% of the total premium costs. In addition to the benefits listed above, more money will be saved in the future by retaining EHB because more people will receive the services they need by speech-language pathologists. However, the United States will have a larger amount of debt if insurance companies do not provide coverage for habilitative and rehabilitative services because more people may attend the hospitals or doctor’s offices rather than receiving these services. As a result, medical bills from hospital and doctor’s visits will increase which will contribute to more debt.
Medicare Therapy Caps
By Alli Hatcher, Andrea Guzek, & Hanna Love
Summary of issue: Every day someone is in an accident or sustains an injury that requires them to need speech-language, occupational, and/or physical therapy services. Many of these individuals are insured by Medicare. Imagine if you had a loved one who received Medicare and required any of these services after an accident or a traumatic event. Now imagine they were unable to receive the amount of services they needed due to a monetary cap on these services. Unfortunately, this could be the reality if we do not take action. In 1997 the Balanced Budget Act placed a cap on rehabilitation services for speech-language pathology, occupational, and physical therapy services for individuals receiving Medicare. The cap is $1,980 for speech and physical therapy services combined and $1,980 for occupational therapy. This cap is without regard to individual need or medical necessity. Since the bill was enacted, the catastrophic consequences of the cap have been realized and a moratorium of the cap has been implemented. This moratorium has to be revisited and advocated for every year to ensure that it does not go into effect again. In the past when the cap did go into effect it had a detrimental effect on jobs for the professionals who provide these services and the individuals who require the services to regain function necessary for quality of life. This legislation would repeal the Medicare outpatient therapy cap and ensure patients who use Medicare will continue to have access to medically-necessary speech-language pathology, occupational therapy and physical therapy services.
Why legislation is important: This year marks the 20th anniversary since the Medicare outpatient therapy cap has been enacted. Since this implementation, there have been several temporary moratoriums, or exceptions made to the act. The fact that this exception process must be made yearly causes uncertainty and unease for the therapy providers as well as the patients. Medicare recipients who suffer from stroke, traumatic brain injury, Parkinson’s disease, Alzheimer’s, among others, risk the chance of being denied services or being forced to pay out of pocket in order to receive services to help them communicate, move, or perform activities of daily life effectively. The solution is to repeal the Medicare outpatient therapy cap; with this repeal clients and their providers would be rid of the uncertainty of care and this would ensure high-quality, ongoing treatment for Medicare recipients.
What you can do to advocate: We can take action by reaching out to Congress and encouraging them to support the Medicare Access to Rehabilitation Services Act of 2017 (S. 253/H.R. 807). If our House member and/or Senator is not a current co-sponsor, we can contact them and encourage them to sign the bill as soon as possible. We can also educate ourselves and our peers on the issue. We can post about this issue on social media. We can contact physical therapy and occupational therapy organizations, as well as different NSSLHA chapters, to ensure they are actively advocating for and supporting the issue.
Medicaid Block Grants
By Meredith Brown, Katie Kramer, & Alison Wilkinson
Medicaid is a program that helps lower income families afford health care. The Individuals with Disabilities Education Act (IDEA), is a law promising services to children with disabilities in the school systems throughout the United States.
Unfortunately, the government wants to implement block grants on Medicaid for students with special needs, which will prevent them from getting every service they may need. The money would go to each of the students’ needs, but always goes toward the most significant concerns first. These students have multiple needs in some cases and may also have issues with attention and movement, which would also be categorized as more urgent. As such, there may be little to no funding left for speech services. This will prevent special needs students from getting all of the services they need, including speech therapy, which prevents them from reaching their full potential. Having various forms of therapy available to them will lead to students becoming more well rounded.
If these students do not receive these services in the school, they may not receive them at all. Students who are covered by Medicaid are usually from low income families, and blocking the funding for these students’ services would be unethical. The families want the best for their child, but may not have the financial stability to receive services somewhere outside of the school system. It is unjust that these students and families are forced to prioritize certain issues over others when they should be able to help their child in every aspect of their disorder(s).
Special needs programs in the schools already receive static funding through IDEA, which already limits the amount of money they receive. Because of this, schools rely on Medicaid to receive more funding for further services. Districts can be reimbursed for tests or screening that they give, but if Medicaid is providing a block of funding, this will prevent the schools from being reimbursed. If the schools do not get reimbursed for these activities, this may prevent them from providing further services when needed. Schools will have to pay out of pocket for the remaining services that their students need. This means that districts will have to redirect funds from other sources to provide services to those students under IDEA.
We want to oppose the block grant or the per capita that Medicaid puts on IDEA students and their services. As inspiring speech-language pathologists, it is important that we support programs that will provide the most assistance to those we serve. These students deserve the same treatment that other students receive, and they should not have less support because the of lack of money the government is willing to give.
Graduate Student Loan Advocacy
By Mallory Newsome, Savannah Rice, & Samantha Mason
What are we advocating for?
We are asking that our congressmen reject proposals by the Trump Administration that would make graduate or doctoral level education more expensive and difficult to pay back. This includes supporting legislation that would allow graduate and doctoral level students to take out federal direct unsubsidized loans, as well as rejecting proposals that eradicate the Public Service Loan Forgiveness program.
What does that mean?
To become a licensed speech-language pathologist or audiologist, education beyond the undergraduate level is required. An additional 2-4 years of education is required, depending on the chose field. Advanced education increases the amount of student loans to be paid back after graduation.
Advocacy for the prevention of changes to the Public Service Loan Forgiveness program is needed. It would also be beneficial towards students in the future to restore graduate student loan benefits by allowing graduate and doctoral level students to take out direct federal subsidized loans instead of forcing them to take unsubsidized loans with a much higher interest rate. Many students have been negatively impacted from graduate loans, especially in the fields of speech-language pathology and audiology.
Within President Trump’s budget request for the 2018 fiscal year, many affordable plans for graduate students to repay college debt would be eradicated. These changes made to the budget would eliminate the Public Service Loan Forgiveness program, established by George W. Bush in 2007. In this program, loan forgiveness depends on work and payment stipulations.
Ten years of providing treatment in a non-profit public setting and completing 120 consecutive payments on the loans will be exchanged for forgiveness of the remainder of the loans. Instead, these changes would require graduate students to adopt repayment plans much like traditional mortgage loan systems. The repayment system would extend from 10 years to 30 years. If these changes are passed, all graduate students with loans originating post October 1, 2017 will no longer be eligible for the Public Service Loan Forgiveness program. It is important to reject the proposals by the Trump Administration to allow graduate education to be easier to pay back. If the Public Service Loan Forgiveness program is taken away, students would not have the ability for their loans to be forgiven after 10 years. Graduate or doctoral students deserve the opportunity to be employed through a non-profit organization for 10 years while paying 120 consecutive payments on student debt before loans are forgiven.
Why is this important?
Both speech-language pathology and audiology are expected to increase in demand in the coming years, so the number of students taking out graduate level loans will also increase. Audiology job openings are expected to increase by 34% and speech-language pathology job openings are expected to increase by 19%. In addition, as a professional level occupation, speech-language pathology is ranked 13th out of the 20 large-growth occupations that require a master’s, doctoral or professional degree to enter the field. People pursuing higher levels of education do not deserve to be punished for choosing a career path that requires a master’s degree, or higher, at job entry. Speech-language pathologists and audiologists pursue these careers to make a difference in people’s lives, not to have to pay back high sums of interest, as well as large amounts of loans. This can be prevented by making individuals seeking professional level education eligible for graduate student loan benefits, as well as keeping the Public Service Loan Forgiveness programs available for use.
What can you do to help?
To prevent punishing individuals for seeking professional level education, contact your state congressmen to advocate for the rejection of the Trump Administration’s 2018 budget request, which will eradicate the Public Service Loan Forgiveness program, in turn inhibiting individuals from getting their loans forgiven after October 1st, 2017. It would also benefit individuals pursuing professional level education to advocate for your state congressmen to support the restoration of graduate student loan benefits.
Medicare Therapy Cap
By Kayla Caudle, Natalie Saber, & McKayla Burgess
For the past 20 years, due to wording in the Medicare portion of the Social Security Act, a Medicare cap has existed in the law. This cap would place a limit on how much an individual can be reimbursed for therapy each year. The Medicare cap, however, has not been implemented since 1999 thanks to Congress making exemptions and placing moratoria on the cap. The Medicare therapy cap is now a real danger, however, because the time limit on those exemptions have run out. For 2017, the cap is $1,980 for speech-language pathology and physical therapy services, combined. Even if medical professionals deem the services necessary, the therapy cap is still in place. Ultimately, this cap could potentially prevent those who desperately need therapy from receiving services. For example, individuals who have suffered a life-altering diagnosis, such as stroke, Alzheimer’s, or Parkinson’s disease may be denied therapy, or forced to pay out of pocket for services to regain their ability to communicate. Up until now, Congress has stopped this therapy cap by implementing temporary moratoria and exceptions processes. In April of 2015, Congress passed the Medicare Access and Chip Reauthorization Act, which President Obama later signed into law. This allowed exceptions to the therapy caps for medically necessary services, and individuals who required therapy services were able to receive it. This was not a permanent fix, but is in effect until December 31st, 2017. The Medicare Access to Rehabilitation Services Act of 2017 looks to permanently repeal the therapy cap by amending the Social Security Act. Congress passing this act would mean that individuals who need therapy services would have access to them. Since the cap has been stopped every year up until now, repealing this portion of the Social Security Cap would not come at any additional cost to the American people, but it would ensure them the services they need.
In 1972 a bill was passed in congress to include outpatient therapy services in Medicare coverage. Fast forward to 1997 when congress passed the Balanced Budget Act of 1997; this was the bill that introduced the $1500 outpatient therapy cap that is still in law to this day (though the cap has increased a bit), however, as of right now it is not in effect. The therapy cap actually did go into effect for a short period of time from January to November 1999. Congress saw that the cap was not effective, so they instituted a two year moratorium on the therapy cap to prevent it from going into effect. After that moratoriums and exceptions were passed every time the previous ones expired, but the cap was never repealed. Some people might wonder, “What if the cap is never repealed, and a moratorium or exception runs out and congress does not pass another one?” This actually did occur in 2002. For months people fought against the cap going into effect, but in 2003 the cap finally went fully into effect. The cap was only in effect from September to December 2003, so it did not get a chance to do much damage before another moratorium was passed. Lawmakers have attempted to repeal the cap, but with no luck so far.
Most recently in 2015, an effort to repeal the cap was almost successful, but failed by two votes. Exceptions were extended until December 31st of this year, though. If the cap is not repealed by this date, or another moratorium not put into place, the cap will go into effect. There is a bill currently in congress to repeal the cap, as mentioned above, that is still gaining support.
Repealing the Medicare outpatient therapy cap is a vital piece of legislation that impacts the quality of healthcare. For 2017, Medicare has allotted only $1,980 worth of therapeutic services for speech-language pathology services and physical therapy services combined (ASHA, 2017). Not only does this fiscal limitation prove to be insufficient for our many severe patients suffering from speech, language, and swallowing/feeding deficits, it also does not take into account the severity of these diagnoses or the co-existing medical conditions of the patients, forcing them to continue to split their minute amount of fiscal resources allotted for their recovery between physical therapy and speech therapy. This cap may result in the premature termination of treatment for many patients when they are unable to pay out of pocket for the services that they need and deserve access to, hindering the recovery of a multitude of patients seeking the services of speech-language pathologists. It is the mission of healthcare providers to ensure quality and sufficient treatment to those in need, and it is the ethical responsibility of our government to ensure that these patients are provided with fair and adequate access to the medical services they are in need of.
By Jamie Mulraney, Megan Molnar, & Heidi Dennison
Connect with your Future by Advocating for Telehealth Services
It is an exciting time to be a student studying speech-language pathology. As a profession, we are able to better serve clients than in the past due to the expansion of technology. Because of tele-health services, speech-language pathologists can provide services to clients who might not otherwise have access to them.
What is the issue? Why is it important?
Currently, professionals cannot receive reimbursement for tele-health services through Medicare. Because of this, those who rely on Medicare to cover the cost of their medical expenses may not be able to have their speech, language, and/or swallowing needs met.
There are two bills under debate in Congress regarding tele-therapy, The “CONNECT for Health Act of 2017” and “Medicare Telehealth Parity Act of 2017.” Both bills are very similar with a few minor differences. The “CONNECT for Health Act of 2017” will create new sites for tele-health care, develop a Medicare Remote Patient Monitoring benefit for certain patients (high-risk, high-cost), remove limitations on the use of tele-health, as well provider restrictions in Accountable Care Organizations and Medicare Advantage. This bill also aims to make it a priority for the Secretary of Health and Human Services to assess the appropriateness of tele-health in projects before the Center for Medicare and Medicaid Innovation (CMMI). Finally, once restrictions are lifted, a study will be conducted to analyze the effectiveness of tele-health services.
Also according to ASHA’s website, the “Medicare Telehealth Parity Act of 2017” will phase in the expansion of tele-health services in several notable ways.:The bill aims to increase the number of qualified providers, ultimately increasing the number of services available to the public. These professionals include: , audiologists, speech/language pathologists, respiratory therapists, physical therapists, and occupational therapists. Another goal of the bill is to eliminate geographical impediments that are currently in place under current law, and permit the facilitation of tele-health services in rural, underserved, and metro areas. This would increase accessibility to tele-stroke services regardless of geographical location, enabling remote patient monitoring (RPM) for clients with chronic conditions such as heart failure, chronic obstructive pulmonary disease (COPD), and diabetes. Finally, the bill will allow for the home of the client to be the site for which care is provided whether it be home dialysis, hospice care, eligible outpatient mental health services and home health services.
How can you help?
2. Spread the word! Tell your friends/family etc. why this issue is important for society
Steve Gleason Enduring Voices Act
By: Mariah Eberhart, Ronica Hensley, & Paige Riddick
What is the Steve Gleason Enduring Voices Act?
What if you woke up one morning without the means to communicate with your family, friends, or co-workers? It would probably be terrifying! Many individuals deal with this on a daily basis and cannot communicate verbally, so they rely on devices to help them communicate with others. The Steve Gleason Enduring Voices Act makes speech generating devices (SGDs) available for continued use by Medicare recipients who qualify for the devices. The American Speech- Language-Hearing Association (ASHA) explains that SGDs are communication systems that allow individuals with degenerative diseases, such as amyotrophic lateral sclerosis (ALS) or Parkinson’s disease, to communicate. Before this act was introduced, Medicare policy limited an individual’s access to these devices by placing a cap on reimbursement. The act was passed in 2015 to remove these limitations, and is currently being reviewed for renewal. The renewal of this act will allow individuals covered under Medicare services to have ongoing and permanent access to necessary speech generating devices.
Why is it Important?
The Steve Gleason Enduring Voices Act was built onto the Steve Gleason Act of 2015. It is important to note that the Steve Gleason Act of 2015 expires on January 1, 2019. Even though that date may seem far off for most, the legislative process of bills being signed into law tends to be a fairly lengthy one. It is crucial to urge members of the House of Representatives along with those from the Senate to pass this law to ensure that individuals continue to receive ongoing and permanent access to their personalized SGDs covered by Medicare. If this legislation expires, the bill will have to start over from the very beginning of the legislative process. This could leave SGD users without access to the devices they need.
Previously, Medicare refused to pay for SGDs if users lived in a nursing home, hospice, or hospital. SGD users still needed a means of communicating in these settings, and many of those facilities were unable to provide individuals with a proper substitute. Medicare also prohibited devices equipped with non-speech functions, such as eye-tracking, which may be crucial for individuals with significantly reduced physical abilities (i.e., a patient with ALS). All of the above provisions were set forth by the Centers for Medicaid and Medicare Services (CMS), and it was this agency that announced that changes had to be addressed through legislation rather than internally.
According to ASHA, speech-language pathologists (SLPs) are the only professionals with the ability to recommend Medicare covered SGDs through a formally written evaluation. SLPs work diligently to not only find the device the best suits the needs of their client, but they are also responsible for programming the device and training the client to use it for communication purposes. It is crucial that current and aspiring professionals advocate for this Act because our clients may be directly affected by the expiration or renewal of the Steve Gleason Act of 2015.
What Can You Do?
As you can see, the use of SGDs can be crucial to the way a person is able to communicate. In fact, some individuals would not be able to successfully communicate at all without the use of an SGD. It is of high importance that those who need one will have access to one on a daily basis in any setting. Here are some ways you can advocate:
The more active you are in your advocacy, the more awareness you will raise. Let your passion for this issue shine and get people excited!
Welcome to the SLPAdvocacy.com Blog. Here you will find posts submitted by professionals, students, and consumers. These posts will highlight important legislative and policy issues in the speech-language pathology. To submit a blog post, email your entry to firstname.lastname@example.org!
Craig Coleman, M.A., CCC-SLP, BCS-F (Editor)