Great news for SLPs: A long-awaited update from CMS

We have some wonderful news to share that many of you have been waiting for. After a lot of advocacy and conversation, the Centers for Medicare & Medicaid Services (CMS) has officially clarified its rules for Speech-Language Pathologists. This update is a big deal for the entire therapy community, especially for clinical fellows and the practices that support them. 

Let’s break down what this means for you, your practice, and the clients you serve. 

What is the big change? 

In simple terms, CMS has aligned its policy with state-level licensing requirements. They now officially recognize that SLPs holding a provisional or temporary license—including dedicated clinical fellows (CFs)—are qualified to provide and bill for services under Medicare Part B. 

This is a reversal of a previous interpretation that created a lot of uncertainty. Now, we have clear, written guidance that validates what so many practices and professionals have known: clinical fellows are skilled, essential members of care teams. 

Why this update is great 

This news feels like a collective sigh of relief for the field. For so long, private practices and outpatient clinics faced a frustrating roadblock. There were passionate, knowledgeable CFs ready to make a difference, but navigating Medicare billing for them was a major headache. Some were even being denied enrollment. 

This clarification changes a lot. 

• It validates clinical fellows: This decision formally acknowledges the skills and qualifications of therapists during their clinical fellowship year. It respects the rigorous training they’ve completed and empowers them to fully contribute to client care. 

• It strengthens practices: Practice owners can now confidently hire and integrate CFs into their teams without worrying about Medicare reimbursement hurdles. This helps solve staffing challenges and ensures the growing need for rehab services can be met. 

• It improves access to care: Most importantly, this removes a significant barrier that could have limited client access to therapy. With more qualified therapists able to bill for their services, more individuals in the community can receive the timely, high-quality speech and language therapy they need. 

How this affects your practice and your clinicians 

Let’s get into the practical side of things. What do you need to know and do now that this guidance is in place? 

For practice owners 

This is a huge win for building your team. You can now confidently recruit and onboard clinical fellows to serve your Medicare clients. The administrative cloud of uncertainty has lifted, allowing you to focus on what matters: mentorship and providing excellent care. 

By bringing CFs into your practice, you’re not just filling a role; you’re investing in the future of the profession. You get the benefit of their fresh perspective and enthusiasm, while providing a supportive environment for them to complete their fellowship and grow into seasoned clinicians. 

For clinical fellows 

Your path just became much clearer. You can now provide services to Medicare clients in an outpatient setting and be recognized as a qualified therapist for billing purposes. This is a massive step forward for your career. 

Here’s what you need to do, especially if you’re in a private practice setting: 

1. Get your National Provider Identifier (NPI): If you don’t have one already, you’ll need to apply for your individual NPI. This is your unique identifier for all billing. 
2. Complete Medicare provider enrollment: You must enroll with Medicare as a therapist. This allows you to bill for the services you provide under your own NPI. 

These steps are crucial for ensuring you can practice and bill in line with the new rules. 

A note on supervision 

It’s important to distinguish between supervision for billing and supervision for certification. The new CMS guidance means that for Medicare payment purposes, your services don’t require a specific level of co-signature or direct supervision from your mentor. 

However, you still absolutely must meet all supervision requirements set by your state and by ASHA to earn your Certificate of Clinical Competence (CCC). Your CF supervisor remains a vital part of your journey, providing the mentorship and guidance needed to develop your clinical skills. 

A few things to keep in mind 

While this news is overwhelmingly positive, it’s always wise to be thorough. This clarification applies specifically to Medicare Part B outpatient services. 

Remember that some private insurance companies and state Medicaid programs may still have their own separate rules regarding provisional licenses. Before you start billing, always take a moment to verify the requirements for each individual payer. A quick call or email can save you a lot of trouble down the road. 

A moment to celebrate 

This change didn’t happen on its own. It’s the result of incredible advocacy from ASHA, state associations, and nearly 20,000 therapists and practice owners across the country. The collective voice of the therapy community made it clear how vital this issue was for the profession and the people served. 

This is a powerful reminder of what can be achieved when we work together. By sharing your stories and highlighting the real-world impact of these policies, the therapy community created meaningful change that will benefit clinicians and clients for years to come. 

So, let’s celebrate this victory and continue to support the next generation of therapists as they begin their amazing careers.   

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