Policy Advisory

Policy Advisory Board Policies and Guidelines (Speech-Language Pathology and Audiology)

Date: 12/06/2017
Referenced Sources: Bureau of Health Professions Licensure

Table of Contents

Speech-Language Pathologist Policy for the Administration of Barium During Radiographic Procedures

Policy No. 15-002

Speech-Language Pathologist Policy for the Administration of Barium During Radiographic Procedures

Speech-language pathologists provide evaluation and treatment services including radiographic procedures to evaluate an individual’s swallowing. Such procedures may require the administration of barium to the patient. Barium has been designated a medication. Therefore, the Board issues this Policy to clarify the scope of practice for the use, administration, storage and disposal of barium by speechlanguage pathologists. 

The Board interprets G.L. c. 112, §138 to allow licensed speech-language pathologists who are properly trained to administer barium when necessary for radiographic procedures and evaluations, under the general supervision of a physician, provided that there are protocols in place for emergency response. 

The following guidance has been adopted by the Board for speech-language pathologists when administering barium:

1. Before implementing the use of barium in his or her practice, the speech-language pathologist must review all available clinical information about the use, storage, administration and disposal of barium, as well as management of adverse reactions and follow-up care. This may include but is not limited to any relevant standards or studies issued by the American Speech-LanguageHearing Association (“ASHA”), and facility policies that govern all aspects of the use of barium. 

2. The speech-language pathologist must have an on-going relationship with a physician for referral and communication purposes.

3. The speech-language pathologist must comply with facility policies regarding the use, administration, storage and disposal of barium, which may include directives from the radiology and pharmacy departments.

4. The speech-language pathologist shall follow facility policy and procedure for the performance of radiographic studies, and shall not perform any functions assigned by the facility to another licensed medical professional, including but not limited to the operation of any radiographic equipment.

5. When participating in radiographic swallowing studies, the speech-language pathologist must have access to an appropriate medical professional with appropriate emergency response protocols in place to respond to an adverse reaction.

Policy on Speech-Language Pathologist and Audiologist Licensure Requirements

Policy No. 15-001

Policy on Speech-Language Pathologist and Audiologist Licensure Requirements

The Massachusetts Board of Registration of Speech-Language Pathology and Audiology (hereinafter, the “Board”) maintains licensure standards for speech-language pathologists and audiologists that are based, in part, upon standards created by recognized professional organizations. To reiterate the language in § 2.03 of the Board’s regulations, when “standards created by professional organizations are referenced, the Board does not require that licensees maintain membership in said organization.” In order to maintain high professional standards and ensure adequate preparation for applicants, the Board issues this policy in anticipation of a longer-term regulation change.

Applicants for licensure as speech-language pathologists on or after September 1, 2014 must meet the 2014 Standards for Certification of the American Speech-Language-Hearing Association (hereinafter, “ASHA”) or the then-current ASHA Standards for Certification in Speech-Language Pathology. For the 2014 Standards for Certification, the major differences between them and the prior standards are a greater emphasis on the study and mastery of biological science, the physical sciences, statistics, and the social/behavioral sciences. More information can be found on ASHA’s website: www.asha.org

Applicants for licensure as audiologists on or after September 1, 2014 must meet either the current ASHA Standards for Certification in Audiology or the current requirements for Board Certification in Audiology of the American Board of Audiology, other than any requirement of licensure for such certification. More information can be found on the American Board of Audiology’s website: www.boardofaudiology.com

Speech-Language Pathologist Policy for the Use of Topical Anesthesia

Policy No. 14-001

Speech-language pathologists provide evaluation and treatment services that may require the use of topical anesthetics to complete certain functional evaluation and/or treatment activities. For example, a patient may require the use of a topical anesthetic while undergoing a Fiberoptic Endoscopic Examination of Swallowing (FEES) procedure or Video Stroboscopy for the purpose of evaluating an individual’s voice or swallowing function.

The Massachusetts Board of Registration of Speech-Language Pathology and Audiology (hereinafter, the “Board”) interprets G.L. c. 112, § 138 to allow licensed speech-language pathologists who are specially trained to use topical anesthetics when necessary to complete such procedures and evaluations, pursuant to a physician’s order and under the general supervision of a physician, provided that there are protocols in place for emergency response. 

The following guidance has been adopted by the Board for speech-language pathologists when using topical anesthetics: 

1. The speech-language pathologist must check facility policies to ensure that he or she may apply a topical anesthetic in that facility.

2. The speech-language pathologist must undergo training in the use of topical anesthetics that includes information about negative reactions and follow-up care. It is required that such training be documented in the speech-language pathologist’s personnel file, be updated regularly, and be readily available to the Board upon request.

3. The speech-language pathologist must have an on-going relationship with a physician for information and referral purposes.

4. The speech-language pathologist must inform the patient of the need for the use of a topical anesthetic, and of the right to have a physician (instead of the speech-language pathologist) administer the topical anesthetic. Informed consent forms required by the facility must be signed by the patient.

5. The speech-language pathologist must have access to an appropriate medical professional and/or facility, with appropriate emergency response protocols in place, in the event that an adverse reaction occurs.

6. Speech-language pathologists should review relevant scope of practice documents, position statements, and related ethics issues prior to implementing the use of topical anesthetics in their practice.

Providing Speech-Language Pathology and Audiology Services by Electronic Means

Policy No. 2019-001

Amended August 1, 2022

 

Policy: Providing Speech-Language Pathology and Audiology Services by Electronic Means

The Board of Registration of Speech-Language Pathology and Audiology (“Board”) issues this policy, as amended on August 1, 2022, on providing speech-language pathology and audiology services by electronic means, which the Board refers to as “telepractice” as defined in this Policy.

 

DEFINITIONS

The following terms used in this Policy are defined as follows:

“Board” means the Massachusetts Board of Registration for Speech-Language Pathology and Audiology.

“Client” means a natural person who is a consumer of speech-language pathology or audiology services either in person or through telepractice.

"Facilitator" means a person who is physically present with the client and facilitates telepractice services at the direction of a speech-language pathologist or audiologist.

“State” means a state or territory of the United States, the District of Columbia or Puerto Rico.

“Telepractice” and “telepractice services” mean the application of telecommunication technology to deliver speech-language pathology or audiology services, as defined by G.L. c. 112, § 138, using audio-visual mechanism in real-time (synchronous), stored and recorded sessions (asynchronous), or a combination of real-time and recorded sessions (hybrid models).

“Telepractitioner” means a speech-language pathologist or audiologist who provides telepractice services after obtaining the initial training described in this Policy.

 

POLICY

Telepractice is a permitted mode of practice in Massachusetts subject to the terms of this Policy.

 

Licensure

  1. All persons who provide telepractice services to clients who reside or are located in Massachusetts must be licensed by the Board.
     
  2. Massachusetts-licensed Speech-Language Pathologists and Audiologists must comply with statutes, regulations and policies of the state or country where the client is located and with applicable Massachusetts statutes, regulations and policies to the extent they do not conflict with the applicable law of the state or country where the client is located.  If the client receiving telepractice services is located in Massachusetts, Board licensees must comply with all Board statutes, regulations and policies, including compliance with the American Speech-Language-Hearing Association’s Code of Ethics pursuant to Board regulation 260 CMR 1.03(17).

 

Standards
 

  1. A telepractitioner must be competent in the type of services provided and in the methodology and equipment used to provide the service.
     
  2. A telepractitioner must be competent in the type of services provided and in the methodology and equipment used to provide the service.
     
  3. Before providing telepractice services, a speech-language pathologist or audiologist must obtain ten (10) hours of training in telepractice in classroom courses or via distance learning. Training must include equipment and technology, clinical practice via telepractice, security and encryption of data, and compliance with Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA). Telepractitioners must maintain documentation of their training for inspection by the Board upon request.  Licensees are encouraged to remain current on any changes or updates regarding the provision of telepractice services.
     
  4. A telepractitioner may begin a client relationship via telepractice following an evaluation of the prospective client by a licensed speech-language pathologist or audiologist to assess the prospective client’s need for services and candidacy for telepractice. Licensees must use their best clinical judgment to determine whether the use of telepractice is the appropriate mode of practice to diagnose and/or treat the client, taking into consideration any issues, including but not limited to, audiological, anatomical, physical, cognitive or behavioral issues, which may impede, limit and/or affect the use of telepractice with the client.
  5. Prior to initiating telepractice services, a telepractitioner must:
     
    1. Document whether the client has the necessary knowledge and skills to benefit from the type of telepractice provided by the licensee;
       
    2. Obtain informed consent of the client to use a private environment with a secure connection;
       
    3. Assess the equipment and environment to be used by the client for the telepractice services, or ensure that such an assessment has been performed;
       
    4. Provide orientation and training to the client in the use of telepractice equipment and the telepractice protocol at an appropriate level for the client;
       
    5. Provide orientation and training to a facilitator, if needed for the client, in the use of telepractice equipment and the telepractice protocol;
       
    6. Give the client written notification of telepractice services, including notification of:
       
      1. The limitations of using technology in providing telepractice;
      2. The potential risks to the confidentiality of information due to technology used in telepractice;
      3. How communications can be directed to a specific licensee;
      4. Options for service delivery by telepractice and in person;
      5. The client’s right to refuse or discontinue telepractice services;
      6. Instructions on filing and resolving complaints; and
         
    7. Obtain the signature of the client or the parent or guardian of a minor client on this written document, and maintain this document in the clinical record.
       
  6. The office or off-site location from which telepractice services are being transmitted should be controlled and managed for security and confidentiality of client information in compliance with HIPAA and FERPA guidelines and all other applicable state and federal laws.
     
  7. Telepractitioners must know and comply with existing law, rules and regulations regarding security, privacy protections, reimbursement for services, licensure, liability and malpractice.
     
  8. In addition to the above requirements, licensees must address the particular impact of telepractice on every aspect of providing speech-language pathology services or audiology services, by taking action including but not limited to:
     
  9. Maintaining appropriate documentation of all services provided to the client;
  10. Taking into account cultural and linguistic variables that affect the assessment and treatment of individuals receiving services via telepractice;
  11. Evaluating the effectiveness of services provided by telepractice and measuring their outcomes;
  12. Ensuring the confidentiality and privacy of patients and their transmissions, and complying with all Massachusetts, HIPAA and FERPA requirements and any other applicable state and federal requirements regarding patient records and confidentiality of patient information; and
     
  13. Collaborating with physicians for timely referral and follow-up services as necessary.
     
  14. Where Speech-Language Pathology or Audiology Assistants are providing services via telepractice, the Board’s regulations and policies, including but not limited to rules on supervision, remain applicable: at least 10% of services rendered by the Assistant each month must be provided under Direct Supervision and an additional 10% of the Assistant’s services must be supervised either directly or indirectly.
     
  15. Licensees who supervise clinical fellows or graduate students should follow ASHA and CFCC guidelines regarding their participation in telepractice.

Board of Registration for Speech-Language Pathology and Audiology  Procedure for Review of CORI  (Criminal Offender Record Information)

Approved April 5, 2019 


To assist applicants in understanding when a crime may lead to a license denial, the Board has created this policy, which explains when a conviction rises to the level where it could lead to a license denial.  Pursuant to Chapter 69 of the Acts of 2018 (An Act Relative to Criminal Justice Reform), the Board is required to provide "a list of the specific criminal convictions that are directly related to the duties and responsibilities for the licensed occupation that would disqualify an applicant from eligibility for a license."  The Board has determined that no single conviction, on its own, would disqualify an applicant from being eligible for a license.  However, other factors, such as a conviction being very recent, the applicant having a history of other criminal convictions, or the conviction involving aggravating factors (such as a crime being caused by substance abuse issues, the crime being part of a pattern of violence, the matter leading to a level 3 Sex Offender designation, etc.) might justify denying a license to an otherwise eligible candidate.  As a result any conviction could lead to a license denial.  This includes ALL the crimes listed on the Master Crime List issued by the Massachusetts Sentencing Commission and found at this link:

https://www.mass.gov/files/documents/2016/08/my/mastercrimelist.pdf 


The Executive Director is authorized, in conjunction with Board Counsel, to review the records of criminal convictions and pending criminal cases received from the Department of Criminal Justice Information Services to determine whether review or an appearance before the Board is necessary for an applicant, for any of the Board’s professions, who has answered positively in response to an application question or renewal application disclosure regarding the existence of past convictions.  For the purposes of this procedure, ‘conviction’ is the same as the definition of conviction appearing in the Board’s regulations at 260 Code Mass. Regs. § 2.02(4), as follows: 

The term “conviction” means any of the following:

(a)    a final judgment entered after a jury verdict of guilty or a judicial finding of guilty;
(b)    a plea of guilty;
(c)    a plea of nolo contendere (no contest); or
(d)    any other plea or finding which is treated by the court as a plea or finding of guilty.

The standards in 260 CMR 2.02(4)(a) through (d)  shall apply regardless of the law of the jurisdiction in which the disposition occurred.  

In determining who must appear before the Board, the Executive Director and Board Counsel shall act in a manner consistent with the following guidelines. 

An applicant must be reviewed and/or appear at a Board meeting where:

1.    The applicant has been convicted of any felony other than a motor vehicle offense involving operating under the influence of alcohol or any other controlled substance, where such conviction entered within five (5) years of the application date;
2.    The applicant has been convicted of any motor vehicle offense involving the loss of life;
3.    The applicant has been convicted of two (2) or more misdemeanors within the past ten
(10)    years;
4.    The applicant has a pending criminal case concerning an open felony criminal charge, not including motor vehicle operation related offense, for which a disposition has not yet been entered;
5.    The applicant has been convicted or has a pending criminal case that involves sexual misconduct or physical harm; and
6.    The applicant has been convicted or has a pending criminal case that related to fraudulent activities in his or her profession practice.

In addition to the above, the Executive Director or Board Counsel is authorized to require Board review and/or an appearance before the Board related to any applicant whose record contains any conviction or pending charge that the Executive Director or Board Counsel believe the Board should review.  In evaluating whether an appearance is necessary, the Executive Director and Board Counsel will consider multiple factors, including but not limited to: whether the applicant has been convicted of or charged with an offense that involves sexual misconduct, fraud, dishonesty or deceit or an offense that calls into question the applicant’s ability to practice one of the Board’s professions in accordance with accepted standards of sound professional practice. 

Applicants who fail to disclose their complete and accurate conviction information in response to the application question or the renewal process shall be notified by the Executive Director or Board Counsel and may be allowed the opportunity to amend their application or renewal response.  In the case of an applicant’s or licensee’s refusal to amend or where there is concern regarding an applicant’s or licensee’s misrepresentation or lack of candor in a response, the Board will review for denial of an application or renewal for six (6) months or more, after which time an applicant may submit a new application or renewal.   

Downloads for Board Policies and Guidelines (Speech-Language Pathology and Audiology)

Referenced Sources:
Feedback