ArSHA Response and Resources for Covid-19

Dear Arizona SLPs and Audiologists:

At ArSHA we are closely following the growing buzz around services provided to our clients, patients, and students during this unprecedented time of challenge. We wish to caution you as we offer the following, that we are not a policy or law making organization. We can point you in the right direction for some of the latest information but urge you to work with your employer or representative agency for the regulations and rules that govern your professional activities in their name. While ASHA creates professional guidelines it is our state that truly sets the boundaries for our practice. Similarly, federal agencies can write position statements that Arizona takes under consideration at this time, but individual entities have the sovereignty to determine how they are implemented. We present you with what we have seen thus far.

Federal Government Loosens Restrictions on Telepractice

On March 17th, 2020 the President of the United States and the Department of Health and Human Services announced a historic expansion to Telehealth access in order to help combat COVID 19. In addition, the Office of Civil Rights, US Dept. of Health and Human Services updated their HIPAA Privacy in light of the novel Coronavirus. The update includes important links to CMS Medicare/Medicaid guidelines, Office of Civil Rights HIPAA Guidelines, and Office of the Inspector General compliance alerts, and can be found here: Enforcement Discretion

Now let’s discuss how the Enforcement Discretion might be applied around the state.

School-Based Services

Let’s begin with Arizoa’s schools. There are several agencies that govern our practices in schools, not the least of which is ADE. Several of these agencies overlap with others so it makes sense to present what we know, what are the safe facts.

U.S. Department of Education Clarifies IDEA, FAPE and Telepractice Guidelines
On March 21st 2020, the U.S. Department of Education in conjunction with the Office for Civil Rights and the Office of Special Education and Rehabilitative Services issued a Fact Sheet clarifying compliance with IDEA and Section 504 of the Rehabilitation Act while addressing the risk of COVID-19. See link below.
USDOE Supplemental Fact Sheet

Arizona Department of Education Guidelines
The Arizona Department of Education states that telepractice is an accepted form of service delivery for those enrolled in Arizona public and charter schools (See page 91: Exceptional Student Services, Arizona Technical Assistance System).
Arizona Technical Assistance Document for Speech Language Pathology

School districts are watching all of this carefully and deciding how to implement the details in their organization. We must be careful that within the rules of FERPA and HIPAA and the TEMPORARY allowances, we defer to the individual districts on how they are handling services.

  1. IDEA and ADE allow the servicing of minutes in an IEP through telepractice. Mainly this is because ADE also views SLPs as providers of Specially Designed Instruction. (As such, those few remaining who don't have the CCC could still provide instruction through online means.)
  2. HIPPA and the OCR have rules about the platform used to do item 1 independent of either ADE or medical allied agencies. Districts in Arizona have provided teletherapy at their discretion for several years, but must observe these laws. At the present, HIPPA and OCR have provided exceptions that schools will not be found in violation while providing telethearpy during this crisis. These exceptions have NOT altered the law. This link on Enforcement Discretion will explain more, including recommended platforms for online services.
  3. While school based SLPs may provide this service with their ADE certificates there are some differences from DDD and ACHHS, and the billable status.
  4. SLPs as part of special education are asked to follow suit with what the district is doing on the whole. For example, special education departments are not in violation of FAPE unless failing to offer services when general education instruction is taking place.
  5. Other questions about how to describe services altered during this time in location, frequency, or duration are subject to a school districts interpretation of guidelines and ArSHA does not set these expectations. Providers are deferred to the guidance of their Public Education Agency. PEAs will use information like the following in making their decisions. IDEA Fact Sheet

Division of Developmental Disabilities
Here is an informative link for the latest news at DDD.

AHCCCS
Follow what is happening with AHCCCS and Medicaid here.

ASHA
The ASHA Telepractice Portal can be very helpful.
According to ASHA,“use of telepractice must be equivalent to the quality of services provided in person and consistent with adherence to the Code of Ethics (ASHA, 2016a), Scope of Practice in Audiology (ASHA, 2018), Scope of Practice in Speech-Language Pathology (ASHA, 2016b), state and federal laws (e.g., licensure, Health Insurance Portability and Accountability Act [HIPAA; U.S. Department of Health and Human Services, n.d.-c]), and ASHA policy.”

Advocacy

Telepractice for Audiologists and SLPs Stalls in Arizona Legislature
All of ArSHA's membership has been impacted to some extent by the COVID-19 virus. Among these impacts is the stalling of progress toward adoption of HB2225 (speech and hearing omnibus bill) and HB2536 (telemedicine bill). These two bills would allow for telesupervision of SLPAs and teletherapy, both of which are desperately needed now more than ever. Since HB2225 has not been passed yet, direct supervision of SLPAs is still required at this time. Unfortunately, due to concerns over the COVID-19 virus, the legislature is expected to take a recess beginning early next week and legislators are expected to return a few weeks later. Our bills are still in the queue to be addressed by the Senate, but voting is now delayed.
We will all see the impact lack of telesupervision and teletherapy will have on our clients over the next few weeks. We encourage you and your clients to share your stories with your State Senator as we move to push these bills over the goal line when session resumes. You can find your legislators by visiting the following link: https://azredistricting.org/districtlocator/. After you find your legislative district, use the following link to obtain the name of your Senator and their contact information: https://www.azleg.gov/memberroster/ . We recognize this is an emotional time and ask that you please remain professional in communications with your legislator. We remain optimistic that our efforts will be successful.