State Advocacy Updates

SLP advocates from Arkansas, North Carolina, Michigan, and Nebraska join host Dr. Jeanette Benigas. They all advocate for removing the CCC and ASHA verbiage from their states' billing requirements for full professional autonomy. They face challenges with Medicaid billing and regulatory issues and lead teams to address these through legislative changes and communication with state representatives. No matter where they are in the process, they all emphasize the importance of professional autonomy. Be prepared to be inspired!

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Creators & Guests

Host

Jeanette Benigas, PhD, SLP

Host of Fix SLP

What is Fix SLP?

Fix SLP is grassroots advocacy firm here to challenge the status quo in speech-language pathology by driving real change—from insurance regulations to removing barriers to full autonomy like the CCC. This podcast is your space to learn, engage and take action in the field of SLP. We don’t wait for change, we make it. So let’s fix SLP!
Hosted by Jeanette Benigas, PhD, SLP

Jeanette Benigas 0:00
Hey fixers. I'm Dr. Jeanette Benigas, one of the cofounders of fix SLP. Our platform exists to discuss the biggest challenges that are currently holding back the field of speech language pathology. We present the issues with facts and invite you to be a part of joining this movement to make things better one conversation at a time. So let's fix SLP.

Hey, everybody, welcome back to the fix SLP podcast. This is Jeanette. I have Preston with me at least for the first part of this episode. And then I have a bunch of updates and other people who are jumping in to finish off the episode. But today, we thought it would be valuable to spend some time speaking with everybody in states where there are actions being taken to make the CCC truly optional, so people can have autonomy as a speech language pathologist. So hi, Preston.

Preston Lewis 1:08
Hi. It's great to be with you today. And yeah, I'm, I'm excited to just hear about every state and what's going on. Arkansas in particular has been very, very productive. And I'm proud of it. It's my home state. And it's got some great news because we were one of those states that was sort of indicated to not require the CCC for Medicaid. But in practice, the state Medicaid Department of Human Services has been asking for CCC cards every year. And thanks to a lot of amazing speech therapist here. We've rolled that back and there's some updates and I'm excited about.

Jeanette Benigas 1:46
Yeah. So Preston, I think, maybe with others, and you can correct me if I'm wrong. I started taking some action in the state before I think I ever actually knew who Preston was. So they did this precedent and colleagues did this without the help of fix SLP before Preston knew he was going to be part of fix SLP that was his hazing experience, if you will. He did it. I'm like, come on board. So Preston. Preston, why don't you I think you just kind of explained it. But the problem in Arkansas was, it's not required to build Medicaid, but they were asking for the CCC anyway. So why don't you tell us what you guys did.

Preston Lewis 2:36
So a few former colleagues of mine or former grad students that I went to school with, had really focused in on the right personnel and Arkansas Department of Human Services came up with a very targeted email list of about three or four people that were in the policy writing and enforcement section for Arkansas, Medicaid, Arkansas, like some other states, we have found, has been using the CCC, not necessarily as a requirement, but just as a way to sort of prove that SLPs had certain credentialing. And that was a useful tool for them. But when that email was sent out to say, hey, our policies don't show that the CCC is required. If we look at a strict interpretation of the legal code in Arkansas, we got a very promising response back, which was yes, we realize that we are working on that. And we will have an update very soon. Pass the word along. So we took that as a very positive sign. Flash forward a couple of months later wanted to do a follow up and check and see what the progress was got another great response, which is to say they are rewriting their policy for next year that the CCC will no longer be required to have an act of one. However, Arkansas is going to ask that speech language pathologist show that they have had the CCC at one time. So that's not an entire win. I don't I don't consider that 100% victory yet, but a good incremental change. And I'm not going to scoop as yet. Because there it's still almost 100% Certain but Arkansas is about to have its first speech language pathologist that no longer has an active CCC that's going to be authorized for Medicaid. Again, I'm not gonna go into it in great detail yet. That's coming attraction, but I'm very excited about it. So just to go back and surmise next year speech language pathologists in Arkansas, do not have to have an active CCC in fact, I don't think they do right now. And we'll cover that soon, but it's a good win. I'd like to get it out all together. But right now this is a good first step Genet and I'm really excited about what's in store.

Jeanette Benigas 4:56
When Preston sent me the info that He cannot yet share, I was so excited, I almost got sick. Like, normally I just cry. But this time I got nauseous, like I was like, I'm so happy I'm gonna throw up. Because SLP does weird things. So my body's just... I never know what my body is going to do

Preston Lewis 5:17
the victory is... right now we have to celebrate them as they come. Yeah, I'm excited too. And we will be able to talk more about that in upcoming podcast. And not only just because of what it means for defining speech therapists beyond just this certificate, but also that it shows a path for others and other states to follow. And that we aren't defined by this certificate, there is other worth to be known there. And it's, it's going to be a good story, I'm looking forward to telling it soon, I just don't want to jinx it. Because I feel like we're right there at the two yard line and about to pick it over. And there also need to get some permissions from some individuals before we can talk about it fully. But it's great news, and I can't wait to share the rest.

Jeanette Benigas 6:03
It's like when you're going in for a kiss on the on the first date, the first kiss, you're like, millimeters away, but you haven't connected yet. Like that's where we're at. That's what my that's what my days were like, right there. Um...

Preston Lewis 6:17
The chemistry is there.

Jeanette Benigas 6:21
Once this thing happens, that we're talking about, there's gonna probably need to be some legislative changes, and those will come later. And that will be a much bigger effort, kind of like Michigan is doing right now.

Preston Lewis 6:36
Right? Yes, absolutely. In Arkansas, their general legislative session is ended for the year, thank goodness, because man, they can really cause a lot of chaos around here. But nevertheless, they will have another general session next year. And so it'll be a good time to sort of reach out to specific legislators and see if we can get draft legislation similar to what Michigan is doing. But right now, with the legislature being able to session, I don't think that it would be a good time to approach just yet. Yeah, we will. It will also help that next year with a revised and clarified Arkansas Medicaid policy manual, that that will also be another feather in our cap just to keep that momentum going. And I think that once we have that, it's it's going to be just a matter of you know, following that right procedure to say we are defined beyond this, we have a state licensing board in Arkansas, which is fantastic. And it will be something that just continues that momentum. It's like I said, Jeanette, once we can get that model to get that recipe of this is how you go from start to finish. It's a matter of just duplicating it in multiple states, there are a few that have quirky laws that will be more difficult and I think ashes deeper in its entrenchment. But right now, Michigan, Arkansas, North Carolina, we're following that pattern. And we're seeing that change. And I'm excited for speech therapists because it's so these it's going to mean that we have just that greater professional autonomy. And then I think moving on to just starting to get more engaged at the state chapter level, about issues of reimbursement and the things that we all agree on. But right now, for us just finding ourselves beyond the national organization, that's just really, it's out of touch.

Jeanette Benigas 8:31
Yeah. Man, after you're recording these in backwards order, and after having spent the last couple hours recording with all of these SLPs. I'm just so excited by how many just intelligent, motivated, high end thoughtful, brilliant clinicians we have in this field. And it's just, it's so exciting for me, I think, a little bit selfishly, it's disappointing to me that some of these changes aren't going to be done in time for the renewal for 2024 Going into 2025. But I think 2025 is going to be fixed SLP zere. And it just so exciting. Like I'm getting body responses getting goosebumps, because, you know, we want people to have true autonomy, like you said, True choice. And just getting all of this cleaned up is is just the beginning to all of the things that we can do next. So thanks for sharing that update. And thanks for thanks for helping. I'm going to use this moment, I guess, to officially announced that Preston is part of the fixed SLP team. He's got a picture on our website and he has an official name, which he never we love to call him the shot caller in the background, but he never liked officially said, Yes, Jeanette, I will accept that title. So he's if he didn't look at the website, he is hearing it here for the first time. With all of you.

Preston Lewis 10:10
I'm very excited I've made. But you know, I already made one commitment of marriage this year. So Jeanette, I'm just I'm yest out right now. But no, I mean, all kidding aside, I'm excited. It's just, I think the thing that's really great about it is, like you said, hearing from so many talented people out there that just want to step outside of how we've always been defined. And so yes, it's great to be part of this team with you, Elizabeth. mckaela, mckaela. Alexa, everybody. Wow, I'm, I'm cuz I feel like I've got my team here. And it feels great being part of that, and I will get with you on the bio, and we'll work all those things out. I, you know, you you stayed after me? Quite a bit. But it's, it's it's a good partnership. This is a good thing.

Jeanette Benigas 10:57
I gave up. But did you read your title? Did you read?

Preston Lewis 11:00
Yes, I did.

Jeanette Benigas 11:01
Okay, so we'll tell the people. The title I gave Preston is director of public policy and legislative affairs. So he is helping the states that want help or need help. So the call to action here and I'll give it a recorded again, at the end of this episode is, if you are interested in making some changes in your state, please reach out to us. For now. It's just the general team at fix slp.com maybe down the road, Preston will have his own email. But for now, we just have the general one team at fix slp.com Let us know what state you're in, let us know what you'd like to do. Or just if you know I'm here, if you need help, it's always helpful to have your email your phone number, your name, we have a Excel spreadsheet going between the two of us where I can just pop your name into it. And then when when it's time to release the Krakens we could just do it. So you know, especially in Arkansas, we know that's coming. So if you're in Arkansas, if you moving into 2025, if you want to be helping with that type of legislation, maybe setting letters or or doing whatever it is that Preston is organizing, please let us know. We'll get you on the list and then be back in touch with you in a couple months. So...

Preston Lewis 12:22
Right, just finding that strength within ourselves. And another way to network. There are some great ways already. But this is another one. And like Jeanette said, just reach out, contact us even if you don't know yet exactly what direction you want to go in your state. Say hi, let us know you're there. Because we want to reach out to others to find ways in which we can help. And so it's a great call to action. I know that I'm kind of glad I don't have that email yet. I may have it at some point right now I just get those emails that pop in from you at all hours of the night. And it's like the Genet bat symbol is in the sky. So it's working out very well.

Jeanette Benigas 12:58
Except you can't you can't blame that anymore. When I got the like 3:45am email from you. You're just as bad. So

Preston Lewis 13:06
Right, right. Yes. I sent an email the other day at about what was it 315 In the morning or so my text message? Yeah, I get this text message from Jeanette. And it's squared off in this block. Like, you know, WTF, you have no room to talk. So I was very found. I need to start trying to set a timer on those. But sometimes you just you get the motivation to want to fix at all hours and that's okay.

Jeanette Benigas 13:28
Yeah. Yeah. All right. Well, Preston, I'm gonna jump in with North Carolina. We'll see what they're up to. And hopefully you and I are back next week with some kind of profound episode that we've not yet talked about.

Preston Lewis 13:42
Well, I am looking forward to sharing some of that great news to come. It's, it's almost there. Yeah.

Jeanette Benigas 13:47
All right, everybody. Now we're gonna hear from North Carolina.

We have North Carolina on with their update with me. I have Candice Harrell and Erika Hawkins, two ladies from the group who has been working on the issues in North Carolina. Before we jump into it, why don't you each tell me what area you practice in, like what you do as an SLP? So people know.

Candice Harrell 14:17
Yeah, so I've been SLP in North Carolina now for about seven years. I've got experience on the adult side of things, skilled nursing, and I moved to a hospital with critically chronically ill and now I'm actually an outpatient. So I've kind of run the run the gamut there on settings.

Jeanette Benigas 14:34
And that was Candice. So Erika, what do you do?

Erika Hawkins 14:36
So I'm working on the schools right now, I used to work in preschools in North Carolina, and now I'm actually working via telepractice in elementary schools,

Jeanette Benigas 14:47
Great! So these are issues that affect everyone in every area. So I'm glad we have representation on Candace, do you want to start tell us what the problem was? I know before we started recording, we were So you were kind of telling me about that. So, tell us again, what was the problem in North Carolina.

Candice Harrell 15:06
So the problem was a general confusion about what the actual provider requirements were for billing Medicaid as an SLP. And this kind of came down to a federal definition of what an SLP is. I'm sure other states that are dealing with this are very familiar with this particular federal regulation. But it says that a speech pathologist is someone who has met one of the following conditions, so has the CCC, or has completed the equivalent education requirements and the academic program. So there's the C and D equivalency and that definition, and I think the wording was vague enough for people kind of all over to interpret it very differently. Some people thought you absolutely do not need the sea. Some people said you absolutely do. And there was a lot of gray in between. So people interpreting this in a in a variety of ways. So our main goal was to clarify, you know, and find someone who could actually tell us what you have to do, you know, to Bill, Medicaid and Carolina, but that was the problem we set out with in the beginning.

Jeanette Benigas 16:21
And did you get an answer? Was there a clarification there?

Candice Harrell 16:27
So we I mean, we reached out to many different entities, you know, we the NC State Board, our state, NC JLaw, the the state organization, legislators nctracks, which is the program that people use to actually could enroll in credential. And basically, no one was really willing to outright interpret this for us and give us a yes or no. So after all, that we were able to find contacts at Medicaid here in North Carolina, to try to get some clarification. And so the way we addressed it was, you know, in our view, those requirements in that definition, are the same things, essentially, and functionally that we do for our state license. On the outside, they're the same, you know, there's nothing we're doing for, you know, Asha, that we're not doing for North Carolina. So we put in the time and effort to really go through all the policy to lay out or Medicaid, the similarities between the CCC and our licensure and we put it out to them that we feel the equivalency. Further, that definition is our state license. So anyone that's licensed in North Carolina should be able to submit that and be good to Bill, basically, we added some action items for them of how it could very easily be addressed. You know, one of which is just to remove the the additional document requirement and nctracks that asked for a see. So we submitted that. And unfortunately, their response was that they did not agree with us that our license was the same. And what you know, their move was to submit everything to their legal team that went in the weeds into minutiae of wording. And what to me was not a very fair interpretation of things, but that it is what it is, as far as that goes. You know, as far as differences, they said, like the North Carolina statutes don't specifically mentioned the CAA, they say you need to be accredited. They don't specifically mention the CAA. So to them, that was not an equivalency. They mentioned that Asha, had a definition of full time work is 35 hours a week, whereas our state's statute said 30 was fine for FTE, the overall hours were the same, but because of those little differences. And there were more than just that they were not going to consider our license as an equivalent. So that was the brick wall that we kept running into in this whole process.

Jeanette Benigas 19:18
That's amazing. So Erika, I want to back up to before you started this, I think you'll know this answer. Was this just the two of you working on this. I think there were more people involved and was the state association involved in this in helping did you approach them and what was their response?

Erika Hawkins 19:39
no, it's not just the two of us. Two other SLPs along with the two of us have been working together and we all met on the North Carolina Pumble channel. And it's Brooke Richardson and Mary Kristen Clark and Mary Kristen was especially effective at countering all of those points that Candice mentioned, and doing the deep dives in To the into the technicalities of the requirements. So she pretty much hit back point for point on everything that they brought up. And then it was kind of like radio silence after that. Right, Candice?

Candice Harrell 20:12
Unfortunately, her rebuttal to everything, they did not address it at all. And she really did a phenomenal job with it.

Erika Hawkins 20:20
She did. Now as far as the state association. Candice, do you remember more of a? We did approach them, but I don't remember them being especially helpful.

Candice Harrell 20:32
No, we did approach them. And I think actually, Mary Kristin is a member of that. But like I said, In the beginning, it kind of was like a instance where they weren't really willing to speak on Medicaid policy. Like they didn't feel like that was their, their role. I think they were understanding of things, but they just didn't really feel like they have the authority to to address it the way that we were hoping for. Right?

Jeanette Benigas 20:59
Yeah. And the reason I asked is because the states are all over the place. And Preston and I have kind of decided, as we have watched this play out in multiple states with multiple issues, it's almost better to do it without them. And so that's why I was asking, because I want I already knew the answer. I wanted to point out that you were doing this without the help of the state association, whether or not they were supportive, because adding another Association adds a million people and a million opinions, and way more levels of bureaucracy, and way more time. So as we're watching this happen in real time, you guys see what's going on in your state. But Preston and I see the bigger picture. And the bigger picture is, it's almost better for a team of two, three or four people really three or four seems to be the sweet spot, doing this by themselves. So yeah, there's four of you, and you've done a great job.

Candice Harrell 21:54
Yeah, it definitely seemed to be a case of like all of these different, somewhat bureaucratic entities, not being willing to really talk to each other about things, and therefore not really being able to give us a clear answer. So I think if people find the contact that they really need to and just go for that it would save probably some time and blood, sweat and tears.

Jeanette Benigas 22:18
Yeah, and you guys did a great job of really doing that without the help of Preston, you guys kind of started before Preston was fully on the team. He is now a full member of the fix SLP team working behind the scenes doing this stuff, again, all for free. But at the beginning, I think it was Erika, I might have said like, Hey, I'd like you to I'd like to introduce you to my friend Preston. And let me know if he's helpful. Because if he is I, I've got to probably, like, get him on board a little more efficiently. And he has been very helpful. But you the four of you really did it the bulk of this without our help or his help, which has been amazing. So no one would give you answers. So then Mary Kristin that did this rebuttal. And then what happened.

Candice Harrell 23:09
So we set up a meeting with several, I think, three or four people from Medicaid here. And it was odd, because it wasn't actually the people we had been emailing back and forth this entire time. It was another group that got elected to meet with us that day. And it was kind of just going in circles with them, honestly, you know, they the authority they had was really to just keep reading us the legal statement that they were given, they didn't really have the means to offer us much more than that. But I mean, the one good thing that I think came out of that meeting is one of us asked you if you're not going to accept our licensure as the equivalent What are you going to accept, because for that definition, there is an equivalency. And they brought up the they have been thinking of an ad as an attestation form. And you know, lo and behold, a couple months later, it it went official. So the good news is that now people in North Carolina that do not have a current See, you just you check your ad a station form and you have a clear avenue to still enroll and still bill. The caveat is that the standard of the CS still applies. So you are attesting that you have met all of those requirements, and you continue to do so through your continuing ed, and all of that.

Jeanette Benigas 24:28
So that's amazing. That's the result is this form came out. And to further clarify, it doesn't mean that you have to have held the sea. You will be someone who has gone through an accredited program. And if as of right now, if you've gone through the accredited program, you have met the requirements for the CCC as long as you've done your one year or nine month supervised experience, you've done that whole thing. It does not mean that you then have to apply and hold it At any time, you could go your whole career without having the CCC, and still bill Medicaid, which is a key thing. And we had no idea we because I feel like I'm a part of your team by like, Association. We had no idea this was coming. When you guys sent this to me, I think I might have cried. Amazing is such a big deal because I really think it's the first fix SLP inspired when I will never take credit for the work that you guys did. But if it wasn't for fix SLP the four of you would have never gotten together to like take this on. And so I just think it's such a big deal. And I have goosebumps now. It's such a big deal that I paid Instagram to like push it out for three days to announce to the SLP world hey, look, what Look what just happened. So I paid some money. It's like a sponsored ad just to tell people like, Look what just happened. So that's the only time I've ever done that. I know 100 Yeah. So what has you're not done? Yes, you have this pathway. But there's still work to do. So what is going to come next?

Candice Harrell 26:18
Right. So I mean, I think the good thing is, as of right now, the this form does cover the circumstance of like 99% of SLPs in North Carolina right now. But I think as more and more people stop going for the CCC, which we know it's already happening, this is just kind of the progression of what's going to be happening in this field, then you might come into some trouble that, you know, people went straight for the state license requirements, and they don't do that quite as an equivalent. Medicaid might find themselves in a position of our patients and clients having long waitlist to get services, you're going to have SOPs that are completely qualified and you gate kept out of this, and it's not going to be a good look, it's going to be a mess. So I think eventually, that that language of the sea and needs to go away completely, is probably going to require maybe some legislation. I don't anticipate that's going to happen overnight. But you know, that's probably the the longer term goal.

Jeanette Benigas 27:24
Is it the regulation that actually says the CCC or equivalent? Yes.

Candice Harrell 27:31
So our like Medicaid policies referenced the federal, the CFR, the federal regulation, which does list, okay, this uses the or the bullet point.

Jeanette Benigas 27:41
And honestly, like you said, just all of that summed up, it's an access to care issue. Absolutely, the state really cares about the people that they're giving Medicaid to, they really should consider this, that access to care issue is the thing that that's what we see them paying attention to in Michigan, cuz you guys have been tracking along and I don't know what order I'm going to play these in, but I'm recording an update with them to you both have done kind of the same things, except Medicaid responded to you more heavily, and their state representatives are responding more heavily to them. So it's kind of the same issue. So they have a draft bill, the state might address this before Medicaid ever does. And then that kind of eliminates the Medicaid issue. So you know, what they might get done first is actually what you need to work on now. And so again, it's been interesting to watch all of this track and happen in different states. But what we've seen successful there is that this is free to taxpayers. And that's been the key to this is an access to care issue. And it's free to taxpayers, it's something that state representatives can take care of, and Medicaid would not be involved in that at all. You're talking with your state reps and doing, you know, the the legislation part of it. And so I think that's why it's been so effective, because state representatives in Michigan want to look like they're doing something that's positive. And that this is it's not just a look right, it actually is something that's positive. So I think that's what you guys are going to be tackling next.

Candice Harrell 29:18
So I think so, you know, I I feel like I always have to throw this out there. There has has been no part of this, this us that's being like an anti C, anti Asha, anything like that. We're trying to improve care and logistics for all of us in this state. Like in end of story. So, you know, yeah, I'm hoping that we can continue to just kind of work towards what makes sense for for all of us here.

Jeanette Benigas 29:47
Yeah, just like you said, in from fix SLP. None of this is like an anti Asha campaign. I have my own feelings about Asha, which I make public sometimes and sometimes I don't, but this is about out choice and about patient care, and the ability to be autonomous. And just because you guys do this doesn't mean that people don't have to have their CCC anymore, it just means now you get to choose. So if you're someone who doesn't want to get the CCC, you don't have to, because this was the one thing in North Carolina that was holding people back Well, other than employers asking for it. But now, now that can happen, you can't ask employers to change the requirement while it's still required, or, you know, needed to become a provider. But now that that's happened, people can show like, look, there's this form that can be filled out, and it's not actually required. But the other reason that it's important, I think, to to get the CCC out of the regulation is that Asha can change their standards at any time means that North Carolina standards change, and you're leaving your regulation and your requirements in the hands of an organization that can change on a whim, they could change something tomorrow, and that changes what all of you have to have to practice. And that's really not fair, especially when states control their own Medicaid programs. Why are you leaving in the hands of a proprietary product controlled by an organization?

Candice Harrell 31:21
Yeah, and we had even, you know, like, kind of discussed the option of submitting to our, our state board like changes on that. And that would then match Yeah, like this up a little closer. But then like you just said, Asher could change their standards at any time. And just like that, you're not equivalent anymore. So it just it doesn't make sense to, to keep putting that as like the the benchmark for people.

Jeanette Benigas 31:46
Right. So if people want to get involved in North Carolina, what's the best avenue for them to be a part of this because as you get more into contacting state reps, and really getting more to the legal side of this, I anticipate you will need help, even if it's just a letter campaign. So what can people do?

Candice Harrell 32:08
I think the easiest way to kind of join with us is to get on the Pumble channel. That's where we started all of our efforts here. We were posting updates there for a while, we kind of decided to move some of that into private messages eventually, because those are public channels. And we kind of thought other people might be reading them for not so great purposes. But that's the best place to start, I think.

Jeanette Benigas 32:35
Okay. People can also email me at [e-mail] If you're not Pumble, or you don't understand how to use it, or it's just not working. And I can get you in contact with one of the ladies too. Or at the very least, we have a spreadsheet going for each state that has action, we're we're kind of tracking what's going on. And we're tracking the people who are willing to help. So even if you guys don't have anything active and people are reaching out to us, then when you're ready, like if you do a letter writing campaign, I hopefully have some names that I can send your way. All right, anything else, either you want to say?

Candice Harrell 33:10
I want to encourage people to advocate whatever state they're in, you know, and I think the idea that advocacy for this field can only happen with one demographic, or from one institution, one organization, and that people that do things outside of that aren't doing real advocacy, or it's somehow not effective, I think is is a false notion. So I just want to encourage people to align with other people that share your interest and get to work because I think there's more to be done for sure.

Erika Hawkins 33:44
Thank you so much Jeanette. We're just so appreciative of fixed SLP. And the way you connected all of us and the big changes that happen because of that.

Jeanette Benigas 33:52
And I'm, I'm again, I'm just as Preston would say I'm just tickled. He said that. I'm just tickled. I'm just tickled that you guys have done this, like, you know, I obviously I do this for free. My mom is sick a million things are going on. And there's lots of days where I'm like, why am I even doing this, but then it's like North Carolina makes this big announcement and I'm like, This is why we are all doing this. So thank you for doing this and keeping me going especially in the middle of my mom's illness that I've been dealing with. Actually she got diagnosed two days before Christmas. So this has been kind of a long road. But yeah, thanks for keeping it going. And as more updates happen, or as more help as needed, we'll be sure to reach out to our audience and let people know.

Okay, I'm here with the ladies from Michigan. I have Mikayla Treynor from Sandy Speaks Therapy and Alexa Chapman, they're gonna give us an update. They already have an episode. So if you haven't heard their episode go listen, access to Karen Michigan. Is that the name? Yeah. Go listen to their episode. But since this is an update episode, we're gonna brief everybody. Mikayla, why don't you tell us just briefly what was? Or is the problem in Michigan that prompted you all to take some action.

Mikayla Treynor 35:25
So right now, CCC is required for Medicaid billing. Except in your if you're in the schools, however, a lot of schools within their districts still require it. But that's a different issue. But overall, CCC is a requirement currently in our state for Medicaid billing. And we really want the option to renew or not renew with ASHA, to be voluntary. And at this point, when it's tied to billing, it doesn't feel like it's voluntary at all. So that started our initial episode where we talked about where we went and met with a state representative and we have draft legislation going through.

Jeanette Benigas 36:08
So it is required per state regulation. Correct. It's not just an avenue for application to be a provider or not. It's literally the law to bill Medicaid, you must have the CCC, correct? Correct. Okay. So when you started, did you involve the state membership association? Did you ask for their help? How did that work out?

Mikayla Treynor 36:37
We have in the past reached out to MSHS, and we did not receive responses that were collaborative. They did say to us, if we wanted to join the association, then we could learn more information.

Jeanette Benigas 36:53
I'm asking everybody this, though. And the reason I'm asking is, is because you're doing this without their help. A couple of you got together, you decided, okay, well, we'll do this on our own. So you identified the problem, you decided on collaboration or not. And what happened next?

Mikayla Treynor 37:14
So we reached out to Michigan Medicaid, we did try to collaborate with them. We also had a meeting with ASHA, when Medicaid was pretty dismissive. And the initial meeting with Asha was way back in March. And we didn't make a whole lot of headway. So we decided that we would then go ahead, start a petition and seek out meeting with state lapse.

Jeanette Benigas 37:41
Let's talk about the Medicaid route. First, what has gone on with Medicaid? Have you made any progress? You know, over in North Carolina, they just all of a sudden had this change with Medicaid? So how has that gone for you?

Alexa Chapman 37:55
So there was a Michigan Medicaid meeting that we were in attendance to. It had to do with both the clinical side of billing Medicaid and also had to do with the educational side. But mostly the clinical side was discussed in the meeting with some reference to billing Medicaid in the schools and the qualified provider signatures was addressed there. But many of us submitted questions to that meeting. And many speech pathologists were in attendance to that meeting. And we asked the question prior to initiating the meeting, it was not addressed in the meeting, I raised my hand during the meeting, I asked the question if this was going to be addressed, because so many of us had submitted questions prior to it. And they basically said something along the lines of we are reviewing this provider qualifications and we will send you an email when we when we know more about it. It was kind of disheartening to be totally honest, because I thought this was going to be addressed in the meeting because it was a Michigan Medicaid question. And I had spoken to Kevin, and I know that he was kind of talking about this being addressed, but it wasn't I think that they're going to kind of solve this internally as opposed to having it be a collaborative thing that we discuss.

Jeanette Benigas 39:25
So you haven't gotten a lot of help from Medicaid. You've met with them sort of unsuccessfully, maybe something will happen. In North Carolina, the resolution that they got was literally out of nowhere and they were not notified before so we will remain hopeful there. But then you're taking a Second Avenue, which is through your state legislators. Mikayla, you want to tell us about that?

Mikayla Treynor 39:53
Sure. So Alexa was able to get us our initial meeting with Representative Joseph Fox back in March. And that meeting, when as well as it possibly could have, and Representative Fox and his assistant were willing to help us come up with draft legislation. And we are hopefully getting that bill proposed here very soon. But in the meantime, we are getting other representatives on board as well, we're not just waiting on this specific representative.

Jeanette Benigas 40:29
So in terms of the draft legislation, it's pretty simple. It's just like one sentence, basically, that would change everything, which is what you guys need for true autonomy, true access to care. Right now, they came up with this whole plan, like it's going to be introduced on speech pathology Day, which I didn't even know existed. But right now, it's sort of tied up with legal right.

Mikayla Treynor 40:58
So no recent update from when I emailed a few days ago, we were notified that it would be pushed back a little later than anticipated. However, you are right, that it's a simple one liner. And we the beauty of it is we don't even really have to change too much. We're just trying to get Michigan Medicaid to truly follow the federal guidelines, as they say they are already doing,

Jeanette Benigas 41:27
Which they have pointed out, doesn't cost taxpayers a dime, which is really important. Yeah. So what we can expect is it's going to get through this legal it'll be introduced to the floor. And then that's one of the other reasons why you're trying to get more support. Correct. So when it's introduced to the floor, people aren't opposing it or speaking out against it, or...

Alexa Chapman 41:52
Once it gets introduced, it will go into a subcommittee and based on that bill, and what it is, it gets sorted into a subcommittee, we think that it's going to get sorted into health policy. And then everyone who is on that committee in health policy will get the opportunity to vote on it. And then if it passes, in that subcommittee, it will go to the floor officially, but it just needs to get sorted into a committee right now.

Jeanette Benigas 42:22
So even more reason to get more support, because I've lost track. Do we know who's on that committee? Or are you specifically targeting them to make sure you have their support?

Alexa Chapman 42:33
So we do know who's on the subcommittee, but between Mikayla and I, we have reached out to and Mikayla, correct me if I'm wrong, it's like 110 representatives between both of us we've sent letters to we've called them, we've followed up with them, we've sent emails, we've reached out to every single representative in the state of Michigan and call them

Jeanette Benigas 42:54
and you guys are getting a great response I feel.

Mikayla Treynor 42:58
We checked it out, Alexa and I had 110 letters out in the mail within two weeks. And that as well, we were working full time plus, taking care of families, seeing friends still having some level of a life, but we were just like, alright, this is important. So we're gonna make a little time every day. Check it out. And then of course, we are still following up as far as phone calls go and things like that. But as far as getting the letters out, we're like two weeks, we're gonna do.

Jeanette Benigas 43:32
And there's the thing is there's responses, people are generally positive. You've not had anybody say no yet that no, we don't support this. And I assume maybe those are the people you're not hearing back from but we also can't automatically assume it's a no, just people are busy. And they might not understand how important this is just because it's important to us and feels like an emergency. It's not to anybody else. Right. Yeah. So, moving forward, our hope is that, you know, this continues to move along. Quickly. Obviously, we would like this to be wrapped up before December 31. So people have the choice to renew or not, probably won't happen this year. I think we're all hopeful. We'll see a change next year in 2025. Right?

Mikayla Treynor 44:26
That's the hope. So in the meantime, we are recruiting as many Michigan SLPs as are willing to write their local state representatives for the cities that they live in and where they work. And I will send you all of their contact information. I will send you the exact letter that you can edit yourself and an example of one that I have sent and if you are mailing multiple representatives, and don't want to spend all your money on stamps, I I will even send you stamps that Fix SLP. So nicely sent to me to disperse, and I will send you snail mail with fun stickers.

Jeanette Benigas 45:10
So you're recruiting people to send letters still very helpful. I think these representatives, it's important that they're viewed as taking action. So something like this where it's an access to care issue, it's not costing anybody anything, this is like a really easy win for them. And it's not going to come up against much opposition. For the most part, people are going to support this. So getting in touch with your local representative, where you live and where you work is important because the more people who jump in on this, the more these representatives know that it's an issue that their constituents care about. So who can they contact if they want to get that stuff from you.

Mikayla Treynor 45:55
So if anybody wants to write their state reps, they can reach directly out to me through my social medias at Sandy Speaks Therapy on Facebook, or on Instagram. You can also email me at my first name, [e-mail]. And yes, if if needed to if you can't find all that feel free to reach out to the Fix SLP and I will get that information forwarded to me.

Jeanette Benigas 46:24
It's best if you email me at [e-mail] I can't really get to my emails more than once a week. So if you don't hear back from me immediately, I do check them. It typically for the stuff on to Alexa or Mikayla and then they'll get with you. I at least acknowledge Hey, I got this importing it on so team at fix slp.com is the best way just because if you message it to me when I sit down to work, it will be lost. So that's where you're at no major change. But definitely, I think more progress with your state representatives for a change in legislation, which is the actual thing that's needed anyway. Then with Medicaid. Alexa, do you want to give us a list of some of those state representatives who are supporting at this time?

Alexa Chapman 47:16
Absolutely. So Representative Brian BeGole out of Shiawassee County, I've spoken with him and he has been really wonderful through this process. He's very interested in our bill. Representative Betsy Coffia out of Lebanon County has been wonderful to work with. She is a social worker, and she's also on the Health Policy Committee. And she's also very interested in this bill and what we're doing. Representative Emily Dievendord is out of Lansing. She was wonderful to speak with I spoke to her representative for almost an hour 45 minutes to an hour on the phone. We talked a lot about the outcome of the bill how it gets sorted into committees and she was super supportive of this movement and everything that we're doing. Representative Neil Friske has been really wonderful to work with as well as spoken with his team quite a few times. He's out of Charlevoix, also poor parts of Cheboygan, Tom Kunse out of Big Rapids, he mailed us a letter, we sent him a letter, this was someone who I worked with, she sent a letter and I sent a letter. And not only did he call us back, but he also wrote us a letter and snail mailed it to her house, which I thought was so wonderful. It was a super long, lengthy letter, and it had all these different points about why he was interested in this movement. And I was so impressed by him. I have a phone call with him next week in my schedule, but he has been amazing. And then of course, Kelly Breen has been working with Mikayla and she has been awesome. She's been very supportive. So this is just a handful of people that we've spoken to at length regarding the bill regarding our efforts and who have been very supportive of the movement.

Jeanette Benigas 49:06
Great! Anything else you want to say before we wrap up?

Mikayla Treynor 49:10
I think it's just important to keep the momentum going. I think that as time goes on, it's easy to be like, oh, yeah, well, we'll see how it plays out. And we are at a point right now where we are in a little bit of a waiting game, as the draft legislation gets gets sorted into the committee and gets moving along here. But for any SLPs that truly want the CCC to be optional, I would appreciate if you reached out and I will set it all up for you to write your state reps. And that's that's my whole goal here is trying to make it optional. So if you want to keep your Cs great, but I think that it should be a choice.

Jeanette Benigas 49:53
Well said, now I don't have to say that myself. Alexa's clapping you guys can't see it. So you guys do a great job. of hitting socials and updating so you can watch Fix SLP stories or Sandy Speaks Therapy right? Michaela?

Mikayla Treynor 50:06
Yes.

Jeanette Benigas 50:07
Okay. Yep. So follow along. We often have things in stories that are great about keeping people updated. If you want to get into send letters, Sandy speaks therapy is the best way but also you can contact Fix SLP. Alright ladies, thank you.

I've got Rachel Shirk, from Nebraska on with me, Rachel, tell us where you practice.

Rachel Shirk 50:34
I'm in Lincoln, Nebraska. I've I'm PRN. So I'm acute care. I've done the gamut of NICU to end of life.

Jeanette Benigas 50:42
Wow. So your situation is a little bit different than some of the other states that we're working with? I've asked all of the other states, did you approach your state association? So far, they all have and so far, they have not gotten good responses. But you started the same way? Because it just makes sense. Like maybe getting on board with the state association having this kind of help having those lobbyists etc. Could be helpful. You know, the why don't you tell us? What happened? Tell us about that.

Rachel Shirk 51:14
So I when I first started, I got one of the letter templates off of fixed SLP about, you know, the Medicaid regulation. And I edited and plugged in our specific State Administrative Code. And I sent it to them with a proposed language change and was connected with a couple of leadership, I guess, within niche law, which is our state association, I got a very mixed bag of responses. One was, hey, I'm an audiologist. But I'm on the board. I've been reading a little bit about this started following fixed SLP. And this is very interesting. I want to know your thoughts. Let's talk. The a couple of other responses, or one for sure. response was, hey, I looked it up. And I noticed that you're not a member of Michela, here's the link to join. So that was, you know, it's interesting to to get one board member that says yes, let's chat and another that says Not until your your member of our state association. But since that time, they kind of appointed a initial appointed person who was actually somebody. So I should back up, I had a list of 30 or 35 speech pathologist in Nebraska, that were willing to put their name on this email that I drafted to Nicola just saying, hey, it's not just me, I'm not running solo here. I found out after the fact that one of the names I was given somebody that I didn't know personally is on the national board. And so ultimately, she's going to end up taking kind of as the point person through Nicola to try to see if we can get a position on whether they're, they're willing to pursue this or not. So they had a meeting with five SLPs that are involved with initial a few weeks ago, and four out of the five were very much in support of wanting to get this Medicaid regulation change. And the fifth one was not a fan of the idea at all. So they they essentially took really good notes, talk to me in detail that day, and the new point person is going to present it to the full national board this coming week. And we'll hopefully hear very soon, if they're going to take a stance in support of getting us out of our Medicaid code.

Jeanette Benigas 53:24
So kudos to them for talking to you I love that they were like, so open, of course, there's always going to be pushback from everywhere. Not everybody agrees with the fix SLP agenda, and that is fine. But truly, this is about choice. And so I'm so glad that they've decided to talk with you now. It will be interesting to watch. If they say yes, we're about this, we're going to do the work to see if it takes longer than it does in some of these other states, where teams of SLPs have just decided to go forward and do this themselves. But I think we're in this limbo now where we're not sure if they're going to support it. And if the answer's yes, are they going to do the work? Or are they just going to give you a statement to say, yes, we're in support of this - Godspeed.

Rachel Shirk 54:16
Right. So it's interesting to in that meeting I had a few weeks ago, a couple of the comments were like, Hey, I think you know, if we come out with a position in support of this, what how's that going to be perceived by the public? And I'm going oh, no, she's gonna say, negative perception. And everybody wants to keep their seats. And she goes, think about how many people might be willing to join our state association to see that we're listening to the people who are potential members or current members, I think that they would consider doing it themselves based on the kind of the vibe that I got from that last meeting, but I don't they didn't say explicitly if it would spearhead that.

Jeanette Benigas 54:50
If they decide they're going to do the work. That's awesome. If they don't decide they're going to do the work, like maybe they say, Yes, we support it. It's not on our agenda, or we can't get Based on our agenda for another year, probably you're going to need a team to move forward and probably replicate what's been happening in Michigan, where they reached out to state representatives to start getting some legislation change. Because Nebraska is in this like weird gray area situation. And while working with Medicaid is great, and kind of the response they've gotten in North Carolina, Medicaid responded, some things have changed. But now they still have to hit the legislation. Nebraska is in this weird spot. So why don't you explain to all of our listeners what the actual issue is in Nebraska, and then hopefully people will understand kind of why it needs to be a regulation issue.

Rachel Shirk 55:46
Yep. So the administrative code for the state that governs Medicaid and HHS, the language in the code actually says something to the effect of, you know, a speech pathologist is defined as somewhat defined as someone that calls themselves a speech pathologist speech therapist. And this is the key part and has completed the requirements of the American Speech, Language and Hearing Association to practice speech pathology. So there's no reference to CCC, there's no reference to any specific requirements that Asha or you know, that second part of that sentence, there's nothing specific in there. And so it's that gray area of okay, well, then I'm saying that we required Asha requirements to be completed. Does that mean the CCC? That's the assumption? So that's, you know, a lot of people in the state are saying, well, it says Asha right there in the in the regulatory code. So the question then was, I went to the Medicaid office and said, Okay, are you You know, when somebody applies to be a provider? Are you requiring a copy of their cease or their ashes? Number? How are you enforcing this? They said, No, we only require the state license, Nebraska is a little bit of an odd duck to and that we have a lot of school SLPs that never get their state license. They are all only operating under a teaching certificate that has a speech therapist endorsement on it, and they never get a state license. So I replied, after a lot of runaround, I said, Okay, what about teaching certificate or accepting a teaching certificate, and I never did get a response. My initial contact, also tried to do the same thing never got a response. So at this point, it appears that they're just, you know, if they were truly going by the book, they're just not enforcing that part of the code. No one, you know, I went through and I looked at what the actual application looks like, there's not a section requiring you to to submit the CCC, even when you know, when you renew it every five years, you're not having to submit that. So at the end of the day, it's just seems like, are they not enforcing it? Or could that just be thrown out? It wouldn't make any difference at all? I don't know.

Jeanette Benigas 57:53
And that remains the question. And so that's why the feeling is seems like kind of what the state association, my thoughts, like you just get that regulation address. So podcasts or that. And so I guess going forward, you're just gonna wait, everybody's gonna wait. But this is going to air actually Good morrow morning. So if you're listening, this is June 3 2024, this episode is going to come out AdvoCare isn't yet a response to the state membership association. That's what we're waiting on. So we'll probably have it back in a week or two or three, maybe to give some thoughts. I'll be reaching out to them once I hear from you updates, and then there'll be some next steps. That's it. And so in the meantime, if this is something that ends up having to take on yourself, you're probably going to need some people to work with you. Would you like people to reach out to fix SLP? If they're willing to join you moving forward

Sure.

Okay.

Rachel Shirk 58:51
I mean, I don't mind the more names we have on the list, the better.

Jeanette Benigas 58:55
Okay, so precedent, and I have a spreadsheet that we're keeping email us at [e-mail], we will get you on the list. And as soon as Rachel is ready to deploy people, if there is a time and a need for that we can send that information on to her. You have anything else you want to say Rachel?

Rachel Shirk 59:13
No, we're just kind of going a little bit of a holding pattern right now.

Jeanette Benigas 59:17
Short and sweet, but worth the update because we haven't really talked about it at all on the platform or the podcast. So thanks for being so flexible and jumping on and hopefully in another week, we have some answers and I'll get to talk to you again.

Rachel Shirk 59:32
Sounds great.

Jeanette Benigas 59:33
All right.

So that's our episode for today. If you love what we're doing, please give us a five star rating and review. You can give us a written review on Apple podcasts or you can give us feedback on every episode over on Spotify. I am truly grateful for all of the work that every clinician is doing to make the CCC truly optional. If there is advocacy happening in your state and you did not hear an update today, please, reach out [e-mail]. Hopefully as time goes on, we will continue to have more and more awesome updates for all of you. So that's it for today. We'll see you next week. Thanks for fixing it!

Transcribed by https://otter.ai