I Found Out Days Before Starting My SLP Clinical Fellowship That Medicare Changed the Rules — Without Telling Us. #ProvisionalNotInvisible

I recently graduated with a Master’s in Speech-Language Pathology, earned a provisional license, and—like thousands of others—must complete 1,260 supervised clinical hours during my Clinical Fellowship to become fully licensed. In March 2025, I accepted a Clinical Fellowship (CF) position at a Skilled Nursing Facility (SNF), excited to start working with older adults on June 16. I followed every rule, every requirement, every deadline. But just days before my start date, I learned that a major policy change had already happened. 

What Changed?

On April 18, 2025, the Centers for Medicare & Medicaid Services (CMS) revised its Medicare Benefit Policy Manual to state that a provisional license is no longer recognized for Medicare reimbursement purposes.
This means CF-SLPs:

• Cannot enroll as Medicare providers
• Cannot bill Medicare for services they provide
•  Cannot treat Part A patients unless a fully licensed SLP is physically on-site
• Must be supervised at a student level for Part B patients

I didn’t hear about this from a university.
 I didn’t hear about it from my employer—they’re still trying to understand it themselves.
 I learned about it from an NSSLHA email sent on June 9 that linked an ASHA article —less than a week before I begin.

Why This Matters:

This change impacts countless new graduates across the country—graduates who have already accepted jobs, moved states, signed leases, and planned their next chapter. Had this been clearly communicated when the policy changed in April, I —and many others—would have chosen different paths. The silence has put our careers and pay at risk.

This isn’t just about us.

• SNFs and hospitals now scrambling to navigate unclear supervision rules
• Medicare beneficiaries who may now face reduced access to care
• A healthcare system that claims to value transparency—yet failed to communicate a change that affects thousands of clinicians and patients

We urge CMS, licensure bodies, and leadership organizations to:

• Provide a temporary exception allowing CF-SLPs to work under reasonable supervision rules. Consider what happens to CFs who would be the only SLP on-site.
• Establish a transition period for those already hired or relocated. 
• Commit to proactive, timely communication of policy changes

• Protect new grads—don’t penalize us for trusting the process

What You Can Do

• Sign and share this petition to support CF-SLPs and protect the future of medical speech-language pathology.
• Leave a comment with your own story—whether you’re a new grad, CF, employer, or someone who values fair communication and access to care.
  (Yes, comments are open—because silencing communication professionals during a communication crisis is ironic at best.)
  We’re not asking for special treatment.

We must remember! This limitation hinders both new graduates and the adults in need of care. The demand for speech-language pathology services is increasing, especially among older adults.

A few of the conditions seen in adults and treated by SLPs:
Aphasia
Apraxia of Speech (acquired)
Cognitive-Communication Disorders
Communication Changes Following Surgery or Illness
Chronic Cough or Throat Clearing
Chronic Hoarseness or Vocal Fatigue
Dementia / Alzheimer’s Disease
Dysarthria
Dysphagia (swallowing disorder) due to neurological disease, cancer, surgery, or aging
Executive Function Deficits
Frontotemporal Dementia
Gender-Affirming Voice Therapy / Needs
Head and Neck Cancer (including related speech/swallowing issues)
Huntington’s Disease
Muscle Tension Dysphonia
Multiple Sclerosis (MS)
Neurogenic Voice and Resonance Disorders (e.g., Vocal Fold Paralysis or Paresis, Paradoxical Vocal Fold Motion (PVFM), Vocal Nodules, Polyps, or Cysts, Presbyphonia, Resonance Disorders such as Velopharyngeal Insufficiency)
Parkinson’s Disease
Post-Intubation Injury
Progressive Supranuclear Palsy (PSP)
Right Hemisphere Communication Disorder
Social Communication Disorders 
Stroke (Cerebrovascular Accident, CVA)
Traumatic Brain Injury (TBI)
Vocal Fold Paralysis or Paresis
Zenker’s Diverticulum
Anoxic Brain Injury

The lack of access to CF-SLPs will only exacerbate this shortage, impacting the accessibility of care for Medicare beneficiaries. 

By allowing CF-SLPs to provide these services, the healthcare system can better meet the needs of older adults, improve outcomes, and ensure that aspiring speech-language pathologists can gain valuable experience without unnecessary barriers.