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How ASHA Turned the SLP Interstate Compact Into a Threat: Otter Voice Meeting Notes

How ASHA Turned the SLP Interstate Compact Into a Threat

Jeanette Benigas35min

Jeanette Benigas

00:03

Welcome to the Fix SLP summer school series where we're schooling the system all summer long. If you're ready to challenge the status quo in speech language pathology, you're in the right place. Subscribe so you don't miss an episode, and if something fires you up, leave us a message on the minivan meltdown line at fixslp.com, grab your favorite summer beverage and let's get to work. Welcome back, Fearless Fixers. We've got a bonus episode for you today. It's also a bonus because sitting literally across from me is Preston. Hi, Jeanette, hi. He likes to look at me. He likes to look at me deep in the eyes.

Preston Lewis

00:44

That's where it gets hypnotic. No, it's great to be in conversation with you today. Thanks.

Jeanette Benigas

00:50

We're on our Fix SLP, retreat, which has been such a treat because Preston didn't like us enough last year to come, so he's here this year. First time we're meeting him in person. Has been awesome, but also to like, do the podcast in person. This is the second recording we're doing, and it's a different it's a different vibe. So we're in a business room with really bad acoustics. So we're gonna do what we do, how we do it quickly before we sweat to death. So Preston,

Preston Lewis

01:24

The Commonwealth of Virginia, things continue to churn there. Yeah, Virginia has come up a lot this year, because, as some of our listeners may remember, and I know you do, Jeanette earlier in the year, in fact, it maybe started happening late last year, Virginia had this rule making decision where they had a submission, we're going to change the rules. They previously were a certificate of clinical competent state where that was required, and then they inserted the basic and and ors in there that other states have, which are graduate from an accredited university with a graduate degree, you pass your praxis. And then there was a third part, which is part C, which we'll get into today, and that involves a topic that is near and dear to you, Jeanette, what is that? Supervision?

Jeanette Benigas

02:15

Supervision.

Preston Lewis

02:18

Part C, and I'll get into the petition in a moment. Part C indicates that you must have evidence of six months of practice pursuant to a provisional license, as described in and he gives the code and submission of recommendation for licensure from an applicant supervisor during practice as a provisional licensure. So several weeks ago, a SLP, who teaches at George Washington University, Melanie Joy Dorn, issued a petition. And in this petition, and it's a little confusing if you go to the Virginia regulatory Board's website, but she is basically asking that that part C that pertains to the supervision and references to the provisional licensure be taken out. Yep. Now this has been an issue because of CMS, which recently said they're going to reverse their decision. And there are a lot of comments here for this petition, some super interesting ones. And so in the spirit of Fix SLP, like we keep saying, let's have a conversation, I reached out to Melanie and we had a meeting last week, and it was a very constructive meeting. Melanie, I would describe her, not as a fixer, but as someone that is reading the seams on a fastball, as we used to say in sports, she is paying attention to the cutting edge issues in our community, and is not afraid to ask the tough questions. And while we'll get into the repercussions and the back and forth of where people stand on this petition. I think she deserves a lot of praise here for the spirit of saying provisional licensure is problematic. We've got to do something about this. And that's what I asked her about. And she said, Absolutely, I want to push this forward, because we have to get away from provisional licensure. I did ask her about the supervision component, and we'll get into that in a bit. But right now, as it stands, the first comment phase will close on August the 13th, which we are recording this on Sunday,

Jeanette Benigas

04:37

Sunday, August 10, so in the afternoon, because I threatened Preston with his life. We're gonna get together a recording that I don't have to edit, and we are gonna just put it out so you all can hear this and go make a comment.

Preston Lewis

04:52

Those threats that she gave me were real. She put me in this Airbnb where they have this one key fob and I can't get out of. The building without the key fob. So I am somewhat doing this podcast under duress, but I am doing it happily to bring this message.

Jeanette Benigas

05:07

We also forced him, if you follow social media, we forced him to make us breakfast this morning. Obviously

Preston Lewis

05:13

It was a good breakfast. Everybody was well fed. But back to the petition when I reached out, because that's what we say here at fix SLP, let's have a conversation. Melanie and I visited last week, and I was impressed. This is somebody who is thinking proactively, and Jeanette and I have bounced this back and forth all morning. Does fix? SLP, support this petition on the merits of what it's trying to accomplish, perhaps not, but in the spirit of, do we need to have a conversation? And does some sort of action need to occur? I think yes,

Jeanette Benigas

05:49

Yeah. And I want to say too, it just wasn't you and I bouncing it. We have 80% of our team here, so we were all sitting around the living room with coffee, really going through the nuts and bolts of this. We don't have Alexa with us this weekend, but the rest of us were here, and so it was. It was so great to to have that kind of conversation that we would usually be having via text, in person. So I think we're all on the same page. We all kind of know where we stand. Some things have changed since this petition was put forward. This this petition was put forward after CMS said we aren't going to reimburse for new grads in their supervision year. Preston asked me, does this change what you or what we would say now that it has rolled back? And I said, No, for me, it doesn't, because CMS can make the change again anytime they want to. And now the information is out there, and we know what a gross insurance environment we live in right now. We don't know what private insurance companies have already begun to take action to change their policies in six months from now, Blue Cross, Blue Shield, can come out with the same policy, and we know from working with them to change the CCC requirements that it's going to be real difficult to get that changed if it happens. And we're not trying to instill fear in anyone with that, we're just trying to lay out why we are thinking the way that we're thinking, why we're thinking the points that we're thinking, and why we really want this conversation to continue. Because we live in an environment where insurance doesn't want to pay for services, and CMS gave people away to not pay for our services, and this provisional license remains an issue. But I think we're we've said this before. This is the part where we're going to have to agree to disagree. Should new graduates have supervision? Some say yes. Some say no. I think on our team, we're all saying yes, they should still be supervised. You don't have to agree with us, and that is okay. We understand all points of this. All points are valid. It's just where we personally stand. And so what you see coming from us, anything that we put forward, would include some supervision, but we're also here to collaborate with states and clinicians who don't want that because with fix, SLP, as we collaborate, you don't have to do what we say. We're here to support what the states want, and we've been clear about that from the beginning, I think so, yeah, so this petition that has been put forward would completely eliminate supervision. It would allow people to graduate and get and we're going to use this this term, because we're going to bring in the interstate compact here in a minute, it would allow them to have a full unencumbered license at graduation. And unencumbered might be the key term here that we we use for clarity.

Preston Lewis

09:17

And I would add a couple of points in that conversation with Melanie, because I said, Well, you know, surely you want to have supervision in there. And she said, Absolutely, I'm a firm believer in supervision. And let me go back real quick too. She said, we have a problem with recent grads in Virginia, where we are bumping into either a Mac that won't reimburse a provisional licensure, or in some cases, private insurance. It's a patchwork, and we have to get to that full licensure. So again, that's the goal. But when it came to supervision, she said, Yes, that's why we need to write these things in there. There was a comment also where she said, an obviously, employee. Employers are going to require supervision, and that's where I sort of docked my head just a little bit. And as much as I, you know, really value what she's brought to this, I did push back against that because the life of school of hard knocks, part of me says, Nope, not all employers are going to be that diligent.

Jeanette Benigas

10:18

Most employers won't be that diligent, because just like insurance companies don't want to pay, neither do employers. I just had a huge light bulb moment that we didn't talk about before, and it's this MAC issue. So for our listeners who aren't aware, a MAC is the Medicare Administrative Contractor, and there are a handful of them in the US, not even a dozen, and the states are grouped to MACs. And the MACs are how you bill and receive payment from Medicare. So when you credential with Medicare, you credential through your MAC. And we have seen very specific Macs, and I didn't realize this was happening in Virginia. There is a Mac a little further north west that will not credential new grads in the supervision process. This is even more reason to be having these conversations in states, because this was going on before the CMS issue TRICARE, we called that out before ASHA finally admitted to that being a problem isn't credentialing new grads. So we still have the issue of access to care, credentialing payment. This is still an issue. Yes, CMS rolled back. Thank goodness. Access to Care has improved. Jobs for our new grads are now more abundant, but the issue is still there, and we can't just ignore or act like it doesn't exist, because it will get worse, I think, over time, because of payment and funding issues.

Unknown Speaker

12:03

Some of I don't I know that there are issues with MACs. Most of my conversation with her centered around insurance.

Jeanette Benigas

12:12

Yeah, yeah. I mean, so we need to push

Preston Lewis

12:14

private insurance

Jeanette Benigas

12:14

Yeah, we need to push forward

Unknown Speaker

12:15

those MACs, and just to put a button on that point for some people that are still maybe having a hard time wrapping their heads around it. Imagine the United States cut up into these regions and little divisions. And I think there are what, like eight of them, nine, I can't remember there's and I know it's not a dozen. There's less than that. And so within your states, every state has a Medicaid division with their own rules. With each state, Medicare is cut into these regions where it's kind of a goofy looking map, because it's not sort of in one zones and sort of squiggles around the country along state lines, but some states are oddly grouped together. That's what we're looking at here. She mentioned the private insurance aspects. But I want to get to one other thing that she mentioned is that as soon as she laid this petition down on the table, and it was printed at Virginia town hall. Guess who? She got a phone call from?

Jeanette Benigas

13:06

Ring a ding, ding, hello. It's ASHA on the line.

Preston Lewis

13:10

Big Daddy is calling. They were not too pleased, and they're

Jeanette Benigas

13:16

sit in the corner. Yes, ma'am.

Unknown Speaker

13:19

And one of the things, and we have bumped into this at a couple of other states.

Jeanette Benigas

13:25

We sure have

Preston Lewis

13:27

and the thing that is being used as a fulcrum is part of our complaint against what ASHA is doing. They are opposed to this petition. In fact, they have released an official letter, which we will get to soon. But their opposition is, of course, where we share some concern about taking supervision out of going after a full licensure. But they leverage using something else, and what is that?

Preston Lewis

13:56

The interstate compact ofwhich is not their baby.

Jeanette Benigas

14:00

It is not, nor is it allowed to be. So I've talked about this a little bit too, but if you're new to listening, or maybe we'll run this as a preview, I have been sitting in interstate compact meetings for several years, well before Fix SLP ever existed, with a team of concerned clinicians who wanted to ensure that ASHA did not wrap themselves up into the regulations of the interstate compact. There are many, many stakeholders of this compact. Yes, ASHA is a major funder, but they are not the only funder, and the Compact Commission has been excessively clear that stakeholders cannot benefit from the interstate compact. So if they are trying to influence the compact rules and regulations, that warrants a complaint to the Compact Commission, the words that they have used are. There are firewalls in place so this does not happen. There are lawyers who run this commission to ensure that stakeholders like ASHA can't influence what is happening. Interestingly, through this Virginia process, inquiries have been submitted, and the Compact is now taking a look at what the supervised experience year should look like. So in a nutshell, what the compact currently says is, any state entering into the compact has to require a supervised experience from from the the clinician who would be taking advantage of the Compact privileges. So if I, as a clinician in Ohio, want to take advantage of those privileges, I have to have gone through a supervised experience. That's where the definition ends. They don't give years, they don't give hours, they don't give months. All it says is you have to do it. Now the Compact is looking at requiring a supervised experience that directly reflects the rules and regulations of the ASHA. CFY, and that's a problem. It's a huge problem because now ASHA is using publicly in a public comment, they are using the compact as a way to instill fear into the state of Virginia and the clinicians who live in there almost as a threat, if you do this, you're not going to be able to take advantage of those privileges that you've signed into. You're going to be out of compliance. Well, there's other ways to do this. Number one, okay, we can still get supervision without the SE. Why the supervised experience here or the Cfy, we can still ensure that there is supervision without calling it that, and without influencing the compact to make the rules reflect what you already require, because that's what you did in the all of the states, which is why we're sitting here in the first place.

Preston Lewis

17:22

Go back to Melanie. I asked her, I said, Does the CMS decision reverse your thinking here and you want to pull this? She said, No, because I want this conversation to occur. And so yes, she got the phone call. And then today, we read the letter dated August the seventh, which I'm guessing as we look back, that would have been what last Thursday, I believe

Jeanette Benigas

17:45

August the seventh was, yes, Thursday. So

Preston Lewis

17:51

shall we get into the letter? Let's do it. And it's, it's a peculiar letter, because I going on to the podcast today, I wondered if we should even discuss it, because there's sort of a strange ending to it, and the signature is a little bizarre too. But this is very much an ASHA speak. I will try to be brief, because reading a letter out over a podcast is not always interesting. But it is addressed to Kelly moss, the executive director for the board of audiology and speech language pathology in Virginia. Dear Ms Moss, on behalf of ASHA, I write to oppose the petition to remove the supervised professional experience required by the board of audiology and speech language pathology. And then here's the ASHA, you know, sort of flex statement about their national 241,000 members. Yip yip yada, over 5170 ASHA members reside in Virginia, and I want to jump in real quick. The other thing Melanie mentioned is that Virginia has a disproportionately low number of SLPs in the market. There have been studies about that as well. So as part of that rulemaking decision to reduce the regulatory burden, she's also saying we've got to clean this up in order to get SLPs out there that can work in these settings, like we said earlier. And

Jeanette Benigas

19:08

I imagine it's because there are so many state lines around them that people can leave the state to go

Preston Lewis

19:13

work. And gee, wasn't Virginia just before a few months ago, one of those CCC mandatory states. So there you go back to the letter recently, CMS updated chapter 15. This is the decision that we talked about, where they previously said, No, we're not going to allow provisional licensure SLPs to be reimbursed. ASHA goes on to say, however, last week, CMS notified ASHA that they reversing its previous interpretation. They have a quote from that communique. I won't go into all that we've already discussed. It the reversal of CMS is previous interpretation eliminates the need to move forward with this petition for rulemaking. So that's an important distinction as well. Ash is almost saying there that they could have stayed at. Out of this, but they called before. That's the thing here. The timeline doesn't match up. They voiced their opposition as soon as this thing dropped. CMS, however, had not pulled back their decision until after so when they say this, it's almost a little duplicitous. The reversal of CMS interpretation eliminates the need to move forward. So it's like, well, this is the whole reason we're here. At least it's part of their argument, at least. Additionally, removal of the requirement for a supervised professional experience would put the Commonwealth out of compliance with House Bill 2033 adopted in 2023 which is the aslp compact. It requires that participation in the compact include a supervised, postgraduate professional experience. This is what Virginia was talking about. Excuse me, Virginia, this is what Jeanette was talking about. If Jeanette or wow, I am really transposing,

Jeanette Benigas

20:55

we're late on sleep and yes, heavy on the fun. If

Preston Lewis

20:59

Virginia were to remove the supervised professional experience, the Commonwealth would likely be found out of compliance and unable to participate in the compact. Fear, fear, fear, fear, fear. And then thank you for your consideration of Ash's position. If you or your staff have any questions, please contact Susan Adams ashes, Director of state legislative and regulatory affairs, and then it gives her email. I have a name for Susan. Actually, it's the lady behind the corner because we've been in meetings before, and Susan's often there no camera

Jeanette Benigas

21:31

on, camera on and she's listening. She's there monitoring and also, but interestingly, she is in the compact meetings, so she is well aware of the things that these lawyers have said, because she's in there with her camera off on those ones too, where usually my camera's on, but hers is off, still. Letter

Preston Lewis

21:52

signed sincerely. A B Mayfield Clark, PhD, CCC, SLP, 2025 ASHA president, and then, kind of peculiarly, there's a question mark after President there. And I, I've not seen a lot of correspondence with the current ASHA president, but so I wasn't familiar with the AB initials. Perhaps that's being part of other communications. There is going to be another comment period, as Melanie had pointed out in our conversation, this is the initial comment period, which she encourages people to weigh in, and it will close on Wednesday the 13th, but then the board will consider those comments and the petition will finally get to a decision later in December. But I think there will be other opportunities to weigh in on this at that point.

Jeanette Benigas

22:47

And so this isn't the final conversation. This is the first step of the conversation. We're not necessarily against what the ASHA president has written. We are against one thing that they whether they meant to or not, that they are using the interstate compact as a bargaining chip or scare tactics. Yeah, they're being manipulative. We don't like that, but what she said isn't necessarily a bad thing. You just heard me say, I think we need supervision. So what ASHA does is they do whatever they can to protect their product. Interestingly, though, Virginia only requires a six month supervision period we have, we brought that into the field. That information as the CMS. Thing happened. We said every state, whether they require this, Cfy or not, has a supervision period, except for North Dakota, which doesn't have one at all, and Virginia, which has a six month period. So we have, we have some little weird things here that you know maybe needs to be addressed with the compact. And I think that's going to be an episode for another day. Maybe we'll bring it up before we close. So we don't have a problem with that. We have a problem with the manipulation. The other thing we have a problem with is that they don't offer solutions, so they are protecting the integrity of their product as the all and be all without giving a solution, like, if this thing passes, what do we do or we don't like this? Keep it like it is. It's just, it's a messy and it's reflective of ASHA having the final say. Everybody follow Big Daddy's word? Where we at Fix SLP want to give some solutions to these problems as part of this conversation. And so what we have proposed, and what we are proposing, and what we are actively doing in a state with a state senator, and we can't reveal that yet. Where, who, how there is a state right now actively rewriting their rules via a committee with a senator, and what, what we're looking at is taking that first year where, in that state, traditionally, new grads haven't had to do continuing education because they're doing that supervised experience. And so what they the state is looking at doing is giving new graduates a full license upon licensure, and in the first year, requiring whatever number of hours they come up with. We don't know yet. It won't be a full 12 months, because how do you do that for the people working in schools? So it probably will land somewhere around the nine month mark. We're not opposed to that. We have to continue every job setting, but it'll be in 12 months probably. So you know, those who get pregnant or have babies or family emergencies, you don't have to get it done in the nine months. It just has to be done in that first 12 and it's this, instead of CEUs, it's continuing education via mentorship, and also the person who's Mentoring can then get CEUs for doing such a crazy thing, right? So this is a win win for everybody. Mentorship is being provided. The person providing the mentorship can get continuing education for doing this, and then it gets reported, just like it's being reported. Now, the infrastructure is already there. Now they're probably going to tighten it up. We've said you're a little lax with what you're requiring. We know that people are saying, I wasn't ready out of school. I had a horrible experience. I said, this is, or we have said, This is your opportunity to look at those complaints. Survey, you know, survey your state, SLPs, find out what those complaints are and address them with these new policies that you're putting into place, and then if you don't do it, throw down the hammer if somebody, because we all know there's people out there who don't do their C or their continuing education hours, and just hope they don't get audited or don't get caught. Well, in this case, every first year must report, and if they don't do it, kick them out like I don't, that's pretty extreme, but don't allow it to them to continue to practice unless you know, again, we're not saying there can't be extensions or things like that for emergencies, but make it have accountability. Really scary to try to not get caught, right? So that way, yeah. So that way there's accountability. There is a way to do this where everybody wins, where speech pathologists come out of school with licensure, but also get that support that they so desperately need, and also get better support than is required right now by the American Speech Language and Hearing Association in the Cfy process. Boom, done. Why does this have to be a thing?

Preston Lewis

28:04

Well, and there's the tone difference, because what we are articulating here is a vision forward that addresses the CMS issue in a permanent and an indelible way. It addresses the insurance loopholes that exist. It brings SLPs ready to go and injected and supervised into the market with accountability. This is a message of forward thinking versus gaslighting in an attempt to protect that Cfy process and sell the damn certificate of clinical competence. So I am happy that we had a phone call with Melanie. We had I had a meeting. I met someone who is thoughtful, who is looking out for her students, and is challenging something new and possible in Virginia and not just a maintenance of that old guard thinking. And ASHA had every opportunity to have that same kind of conversation they have every opportunity in this letter to put that forward, but instead, more fear, more gaslighting, using the compact, which is not their child and not their club to swing and so again, do better. ASHA, please do better. When something like this happens, don't dispatch Susan Adams to be like the Wizard of Oz behind the curtain back there, you know, creating this big storm, just for crying out loud, be part of the solution. Yeah, you've got, you know, you flex about all those members and all of that power, and how you are this giant cornerstone in this field? Well, let's talk to some state reps and state senators in the Commonwealth and their assembly. So there's that opportunity there to lead with an image that says we are looking forward to a solution, and perhaps this one isn't it, because we do need supervision, but we applaud you. Right? And even though we may oppose this petition right now, we agree something needs to be done, and we would like to be at the table to help facilitate,

Jeanette Benigas

30:08

yeah, and so I think what our solution is is that we're having this call to action. You need to get in and say something, and we're not going to tell you what to say. I think what we want you to say is clear, but this is up to you in Virginia to decide on what we are going to do as an advocacy firm who walks alongside clinicians. Is we're going to work with Melanie joy, or maybe some other stakeholders in Virginia to very quickly get a second petition in that takes care of this hole, because we were playing devil's advocate upstairs. Well, what if this? What if this? What if this, and if this were to go through, what would happen is there would be people who would just graduate, get their full licensure, move on with their lives, no supervision, and we don't want that. It wouldn't necessarily put and I don't know the intricacies of the rules, and this is where we need to get some answers. There is a meeting for the compact that is coming up this week that I will be sitting in the 14th the public comment period for this petition, as it stands, closes at 11:59pm on 813 the compact meeting is the next day. So we need to gather a little bit more information. We do have some questions, so we'll have more answers later this week. But also, if Virginia takes the approach that we're suggesting, where they get supervised within that first year, then still the names of their new grads wouldn't get reported for for compact privileges until they complete that first year and report. So the safety net there within the Compact is a full unencumbered license and completion of supervision. So the reporting process would be the same. They would get the full unencumbered license at graduation, but they wouldn't yet have that supervision piece. So it's almost like a switch, right? I don't know it's it's giving them one of two targets, but you have to have both targets in order to take advantage of the privileges. So it's not changing anything as long as they build it in somewhere. It doesn't matter what it's called or how they do it, as long as it's done, that's all that matters. And so sure give them the unencumbered license at graduation. That's going to take care of, like we said, CMS. It's going to take care of these MAC issues. It's going to eliminate any private insurance issues. And you know what else it's going to do? It is, it's these employers who lean into this. Well, you're not fully licensed, so I'm going to pay you less. It's going to eliminate that excuse. So it's going to do a lot for our Virginia clinicians, and it's it's also going to maintain the integrity of what we do and what we need, and maybe, if done right, fix some issues, which is what we're here to do,

Preston Lewis

33:02

paint the way forward. Yeah, I like it. So we're

Jeanette Benigas

33:05

going to work with either Melanie or some other stakeholders to get that petition in as quickly as possible. So if you want to say, Yes, I support this, but there needs to be another piece, and I would support that too, if it comes forward to let them know, like, yes, we want this, but not this alone. It needs to stand with something else.

Preston Lewis

33:27

So thank you to Melanie for bringing this forward and for having a conversation with us. And we are here to help. And however we can to marshal Virginia SLP, fixers that are out there that want to be part of this process to communicate with lawmakers, if needed, but we are not here to scare people with a compact or to sell a product or a process that is what proprietary to our own aims and objectives and profit for 80 something percent of our organization, we are not here to do that, and so we encourage those Virginia SLPs to go on there, put your thoughts and ideas forward, talk about the change that you want to see in your state. And stay tuned to this, because we will be following

Jeanette Benigas

34:10

this. And as always, we have content that comes out with our podcast. Listen Preston's going to the gym. The ladies are going up the street to the Starbucks Reserve roastery. Look that up. So probably there we will get ourselves a $50 cannoli and a $97 cup of coffee, and I will get this process posted, and then we will start writing some content. I imagine I will also get something linked at the top of fixslp.com, so all of the information you need is in one place. This is happening in real time. We are working on this trip, but we're also trying to have a little fun together,

Preston Lewis

34:47

too. Jeanette, enjoy your coffee. I'm going to go to Tim Hortons and into the gym. I'll

Jeanette Benigas

34:53

see you later, because we're going to record one more time. All right, guys, thanks for fixing it!

Jeanette Benigas

34:57

Thanks for listening to the Fix SLP podcast. You. This episode, help you feel more informed or empowered. Take a second to leave a five star rating and review. It helps more SLPs find us. Fix SLP runs on $5 sustaining partnership donations that small monthly support pays for everything behind the scenes, including our website, legal fees and advocacy work. Want to be a part of it. Join us@fixslp.com enjoy the sunshine. Stay scrappy and we'll see you next time you.

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