What Is an SLPA? Speech-Language Pathology Assistant Rules in Every State

Yes, there is. A speech-language pathology assistant (SLPA) carries out speech and language treatment that a licensed speech-language pathologist (SLP) has planned, and works under that SLP's supervision. 31 states and DC issue a license, registration or certificate for SLPAs, and Kentucky licenses them for public schools only. The rest either let unlicensed assistants or aides work under an SLP's rules, or have no provision at all.

What changes at the state line is how closely the SLP has to watch. Some states set percentages for the first 90 days, some count hours a month, some require the SLP to see each patient every 30 or 60 days, and a few require the SLP in the same building. Most states cap an SLP at two or three assistants. And one thing doesn't change: Medicare does not recognize SLPA services, in home health or in outpatient therapy.

I'm an occupational therapist, not an SLP, so I've stuck to what the rules say. Each state's rule is quoted and linked to its official source below.

This isn't legal advice. I checked every rule on November 9, 2026, on the state's own legislature, code or board site. Your board's current rule is the one that counts.

The Short Answer

• 31 states and DC credential SLPAs: 16 by license, 11 by registration (DC included) and 5 by certificate. Kentucky adds a license that is "limited to the public schools." (KRS 334A.033 (opens in a new tab))
• 11 states have no SLPA credential but allow assistants or aides under their act or rules: Connecticut, Georgia, Iowa, Kansas, Mississippi, New Mexico, Ohio, Pennsylvania, Rhode Island, Virginia and Wisconsin. Georgia, Mississippi and Ohio credential aides instead; New Mexico licenses apprentices who are in a master's program.
• 6 have no SLPA provision at all: Colorado (school authorization only), Hawaii, Michigan, New York, Utah and Vermont. I couldn't read New Jersey's rules.
• First 90 days: 11 states set a heavier starting dose, usually 20 to 30 percent supervision. Alaska and Wisconsin start at 50 percent.
• On site: Alabama and Pennsylvania require the SLP in the same facility or location whenever the assistant works. Florida does unless a signed board protocol lets the SLP supervise by live video, and DC requires the SLP in the facility or watching by live video. Eleven jurisdictions count real-time video as direct supervision.
• Ratio: usually two or three assistants per SLP. Delaware and Rhode Island allow one; Texas allows four interns and assistants combined.
• Medicare: "Services of speech-language pathology assistants are not recognized for Medicare coverage," says CMS's own manual. (Medicare Benefit Policy Manual, ch. 15, § 230.3(C) (opens in a new tab))

What an SLPA Is, and What ASHA's C-SLPA Means

An SLPA is a support role, not a junior SLP. ASHA's scope of practice for SLPAs describes the job as carrying out tasks the SLP "prescribed, directed, and supervised," and says "Under no circumstances should an assistant have their own caseload." (ASHA, SLPA Scope of Practice (opens in a new tab))

ASHA runs a national certification for assistants: "In December 2020, the ASHA Assistants Certification Program launched," and a certified assistant uses the letters C-SLPA. (ASHA, SLPA Scope of Practice (opens in a new tab)) To earn it, ASHA says you must "Complete 100 hours of clinical field work," take three one-hour courses (ethics, universal safety precautions and patient confidentiality), and pass ASHA's assistants exam. (ASHA, Apply for C-SLPA (opens in a new tab)) There are three education routes, the first being a "2-year SLPA program degree from an accredited institution," and the others a bachelor's in communication sciences and disorders, or another degree plus SLPA coursework. (ASHA, Education Pathways to C-SLPA (opens in a new tab))

The C-SLPA is a national credential, not a license to practice. Your state's rule still decides whether you can work. A few states build ASHA in: Delaware requires the C-SLPA for a license, Idaho requires ASHA's SLPA exam, and Arkansas and South Carolina accept it toward their requirements.

ASHA's own supervision guidance is a recommendation, not law. It says an SLP should not supervise "more than three full-time equivalent (FTE) SLPAs in any setting," and that "100% direct supervision (synchronous or ‘live’ telesupervision is acceptable) of SLPAs for medically fragile students, patients, or clients is required." It also lists what an SLPA "should NOT" do, starting with "representing themselves as the SLP" and including "writing, developing, or modifying a student's, patient's, or client's plan of care in any way" and "discharging a student, patient, or client from services." (ASHA, SLPA Scope of Practice (opens in a new tab)) Many state rules copy that list almost word for word.

Every State at a Glance

No specific rule means the act, the rules and the board's published statements say nothing specific about assistants; the cell quotes what does govern. Not set means the state credentials SLPAs but the rules I read set no number. Each citation links to the official text I read.

Where the SLP Has to Be in the Building

For home health, the most important question isn't the percentage. It's whether the SLP has to be physically nearby. Five jurisdictions tie the SLP to the building or location for all or most SLPA work, two of them with a live-video alternative.

• Alabama. "Supervision requires the physical presence of the licensee in the same facility one hundred percent (100%) of the time when the assistant is carrying out assigned clinical responsibilities. The licensed supervisor must document direct observation of at least ten percent (10%) of all clinical services provided by the assistant." This rule was amended effective August 14, 2026. (Ala. Admin. Code r. 870-X-2-.06(e) (opens in a new tab))
• Pennsylvania. The SLP must provide "direct onsite supervision of the assistant," which the rules define as "The physical presence of a licensed audiologist or speech-language pathologist in the facility or location where the assistant is working who is immediately available to exercise supervision, direction and control." On a home visit, that location is the patient's home. (49 Pa. Code §§ 45.301, 45.306 (opens in a new tab))
• District of Columbia. Direct supervision includes "Remaining in the speech-language pathology office or treatment facility while the procedures are being performed by the supervisee," but it "may include the supervisor viewing and communicating with the supervisee via telecommunication technology as the supervisee performs clinical services provided that the supervisor can directly observe and give ongoing, immediate feedback." (17 DCMR § 10207.3 to .4 (opens in a new tab))
• Florida. "Direct supervision requires the physical presence of the licensee in the same facility when the assistant is carrying out assigned responsibilities, unless acting pursuant to Board of Speech Language Pathology and Audiology approved protocols." (Fla. Admin. Code r. 64B20-4.004(3) (opens in a new tab)) The protocol rule covers SLPAs "providing services in a location distant to the supervising licensee": both sign a written collaborative practice agreement, and the SLP "must be available via synchronous telecommunication." (Fla. Admin. Code r. 64B20-4.0045 (opens in a new tab))
• Indiana. The percentages leave most of an assistant's time without the SLP in the room, but one line matters for home visits: "The supervisor must be present when the SLP support personnel provide direct client treatment outside the designated practice setting." (880 IAC 1-2.1-9(e) (opens in a new tab))

Wisconsin points the same way for its unlicensed assistants: treatment is allowed by "adhering to the treatment plans established by the speech-language pathologist who is available on site for consultation, as needed," and the assistant may not be "Working with clients without direct supervision by the speech-language pathologist." (Wis. Admin. Code HAS 6.14 (opens in a new tab)) California's first-90-day supervision must be on-site observation; after that, its definition of direct supervision includes "synchronous audiovisual observation and guidance." (16 CCR § 1399.170 (opens in a new tab))

Eleven jurisdictions let live video count as direct supervision: Alaska, Arizona, California (after the first 90 days), Delaware, DC, Maryland, Minnesota, Missouri, Oklahoma, Texas and Wyoming. Arizona's definition includes "the supervising licensed speech-language pathologist viewing and communicating with the speech-language pathology assistant via telecommunication technology." (A.R.S. § 36-1901(8) (opens in a new tab)) Minnesota's covers supervision "either on-site and in-view or through the use of real-time, two-way interactive audio and visual communication." (Minn. Stat. § 148.5192, subd. 3(d) (opens in a new tab)) Illinois goes the other way: direct supervision "means on-site, in-view observation and guidance." (68 Ill. Adm. Code 1465.35(c)(3) (opens in a new tab)) Indiana, Iowa, Kansas, Nebraska, South Carolina, Virginia and Washington also define direct supervision as on site or in person.

The First 90 Days

Eleven states front-load supervision while the assistant is new.

• Alaska: "A plan for supervision must provide for direct supervision of the speech-language pathologist assistant for at least 50 percent of the speech-language pathologist assistant services during the first 90 days of employment of the speech-language pathologist assistant and, after the first 90 days of employment, for at least 20 percent of the speech-language pathologist assistant services." (AS 08.11.045(a) (opens in a new tab))
• Wisconsin: "at least 50% of client contact time during the first 90 days of employment and no less than 10% thereafter." (Wis. Admin. Code HAS 6.14(3)(a) (opens in a new tab))
• Connecticut: direct observation and conferencing "for not less than thirty per cent of client contact time for the support personnel's first ninety workdays and for not less than twenty per cent of client contact time thereafter." (Conn. Gen. Stat. § 20-413(5) (opens in a new tab))
• Wyoming: "First ninety (90) days from initial certification – minimum of thirty (30) percent weekly supervision shall be provided with at least twenty (20) percent being direct contact supervision." Then "a minimum of one hour of direct supervision each week." (Wyo. Rules ch. 12, § 6 (opens in a new tab))
• Arizona: 20% direct plus 10% indirect for 90 days, then "at least one hour of direct supervision weekly," and "The supervising speech-language pathologist shall require direct supervision of a speech-language pathology assistant when services are provided to a medically fragile individual." (A.R.S. § 36-1940.04(F) (opens in a new tab))
• Oklahoma: "For the first 90 workdays following the first day of employment, a speech-language pathology assistant shall practice under a minimum of 20% direct supervision with a minimum of 8 indirect supervising activities per month." After that, full-time assistants get "a minimum of four hours of direct supervision per month," and "Realtime telesupervision is acceptable." (OAC 690:10-7-3(c) (opens in a new tab))
• Arkansas counts 45 work days, not 90, and adds that "all patients/clients receive direct contact with the speech-language pathologist at least once every two (2) weeks." (17 CAR § 180-1312 (opens in a new tab))
• California, Illinois, Indiana and New Hampshire are in the table above.

Several states count a fixed number of first hours instead: Georgia's aides (10 hours), Mississippi's aides (5), Rhode Island (10), Tennessee (10), West Virginia (3 per patient), Maryland (2 per client) and Nebraska (2 sessions per patient).

Contact With Every Patient

Another group sets no percentage but requires the SLP to see each patient on a schedule. This is the version that fits home health best, and it is easy to track per patient.

• Every 30 days, Virginia: the SLP "personally delivers treatment or services to a client who is receiving some services from an assistant" at a frequency "up to the professional judgment of the speech-language pathologist" that "shall occur at least every 30 days," plus "onsite supervision of at least two client sessions for each assistant being supervised every 30 days." (18VAC30-21-140 (opens in a new tab))
• Every 60 days, Minnesota and Oregon: "Once every 60 days, the supervising speech-language pathologist must treat or cotreat with the speech-language pathology assistant each client on the speech-language pathology assistant's caseload." (Minn. Stat. § 148.5192, subd. 3(c) (opens in a new tab)) Oregon: "Every 60 days the speech-language pathologist must treat, or co-treat with the SLPA, every patient/client/student on the SLP’s caseload," and "Speech-language pathology assistants may not have a caseload." (OAR 335-095-0050 (opens in a new tab))
• Every 60 days, Missouri and South Dakota: Missouri's SLP "shall have the first initial contact with all patients/clients/students on the assistant’s caseload," then direct supervision at least every 60 days, which "may be either in-person or through appropriate remote methods." (20 CSR 2150-4.201(4) (opens in a new tab)) South Dakota adds that "A speech-language pathology assistant may not practice when a supervising speech-language pathologist is not available in-person or by telecommunication technology." (ARSD 20:79:04:03 (opens in a new tab))
• Every 90 days, Delaware: "Supervision of the SLPA may be indirect, at the discretion of the supervising SLP, except that 100% direct supervision of SLPAs for medically fragile students, patients, or clients is required." (24 Del. Admin. Code 3700-14.6 (opens in a new tab))
• Maryland ties contact to visit frequency: "Not less than one session every 2 weeks of in-person contact per client if the client is being seen three times per week or more." (COMAR 10.41.11.07 (opens in a new tab))
• South Carolina counts sessions: "a minimum of one of every seven therapy sessions per patient of direct, visual supervision," which "must be on-site, in person, and documented in writing." (S.C. Code Regs. 115-2(G) (opens in a new tab))
• Texas counts hours: "Each supervisor must provide a minimum of eight hours per calendar month of supervision to the assistant," "At least four hours must be direct supervision," and "Tele-supervision may be used for direct and indirect supervision." Also: "Initial contacts directly with the client must be conducted by the supervisor." (16 TAC § 111.51 (opens in a new tab))

States Without an SLPA Credential

Nineteen states don't credential SLPAs for health care settings, counting Kentucky's schools-only license and New Jersey, which I couldn't verify. They split three ways.

Assistants or aides allowed under rules. Connecticut's act allows "The use of supervised support personnel to assist licensed speech and language pathologists with tasks that are (A) designed by the licensed speech and language pathologists being assisted, (B) routine." (Conn. Gen. Stat. § 20-413(5) (opens in a new tab)) Wisconsin's act doesn't require a license "to assist in the practice of speech-language pathology or audiology under the direct supervision of the speech-language pathologist or audiologist." (Wis. Stat. § 459.22(2)(e) (opens in a new tab)) Iowa, Kansas, Pennsylvania, Rhode Island and Virginia set qualifications and supervision by rule without issuing a credential. Iowa's rules say an "Assistant" means "an unlicensed person who works under the supervision of an Iowa-licensed speech pathologist or audiologist." (Iowa Admin. Code r. 481—740.1 (opens in a new tab)) Georgia, Mississippi and Ohio credential aides with a high school education, which is a lower level than an SLPA. New Mexico licenses an "apprentice in speech-language" who must be "enrolled in a master's degree program in speech-language pathology or communication disorders." (16.26.2.18 NMAC (opens in a new tab))

School-only. Colorado's act reaches only a school SLPA "authorized by the department of education." (C.R.S. § 12-305-104(2) (opens in a new tab)) Kentucky does license SLPAs, but its statute says "The practice shall be limited to the public schools." (KRS 334A.033(1)(a) (opens in a new tab))

No provision. New York's act is the strictest: "Only a person licensed or otherwise authorized under this article shall practice speech-language pathology," and "Any person or firm offering the services of a speech-language pathologist or audiologist shall employ only persons licensed or exempt under this article and a violation of this provision shall be a Class A misdemeanor." (N.Y. Educ. Law §§ 8202, 8208 (opens in a new tab)) Hawaii, Utah and Vermont have licensure acts with no assistant exemption. Vermont's only exemption is for students under "the direct supervision of a speech-language pathologist licensed in this State." (26 V.S.A. § 4453 (opens in a new tab)) Michigan has no SLP-specific rule, but its health code lets any licensee delegate to "a licensed or unlicensed individual who is otherwise qualified by education, training, or experience," with one limit: "A licensee shall not delegate an act, task, or function under this section if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the licensee under this article." (MCL 333.16215(1) (opens in a new tab))

I couldn't open New Jersey's rules or statute; its consumer affairs site blocked every request. Ask the Audiology and Speech-Language Pathology Advisory Committee before using an assistant there.

What an SLPA Can't Do

The lists differ in length, but almost every state that writes one bans the same core tasks: evaluating, interpreting, writing or changing the plan, and discharging. Most also bar swallowing screening and representing yourself as an SLP. A few examples:

• Arizona: a speech-language pathology assistant shall not "Conduct swallowing screening, assessment and intervention protocols, including modified barium swallow studies," "Administer standardized or nonstandardized diagnostic tests or formal or informal evaluations or interpret test results," "Write, develop or modify a patient's, client's or student's treatment plan, individual support plan or individualized education program in any way," or "Discharge patients, clients or students from services." (A.R.S. § 36-1940.04(D) (opens in a new tab))
• Illinois: may not "screen or diagnose patients or clients for feeding or swallowing disorders," "provide patient or client or family counseling," or "demonstrate swallowing strategies or precautions to patients, family, or staff." (225 ILCS 110/8.7(b) (opens in a new tab))
• Alabama keeps it short: assistants will not "evaluate speech, language, or hearing," "interpret measurements of speech, language, or hearing," "make recommendations regarding treatment or provide counseling," or "sign test reports and other documents regarding the practice of speech-language pathology and/or audiology." (Ala. Admin. Code r. 870-X-2-.06(c) (opens in a new tab))
• Arkansas adds one most states don't: no "intervention tasks associated with skill acquisition," because the SLP is "solely responsible for" directly implementing plans "through the acquisition stage of intervention." (17 CAR § 180-1315 (opens in a new tab))
• Medically fragile patients: California requires immediate supervision, meaning the SLP "is physically present." (16 CCR § 1399.170 (opens in a new tab)) South Carolina bars an SLPA from treating "a person who is medically fragile as defined by the ASHA Speech-Language Pathology Assistant Scope of Practice." (S.C. Code Regs. 115-2(K) (opens in a new tab)) Many home health patients would meet those definitions.
• Alaska draws the line on feeding and swallowing by level of supervision: an assistant "under the immediate supervision of a person licensed as a speech-language pathologist in the state may perform treatment of a person who is medically fragile," and may not "perform screening of feeding or swallowing functions." (AS 08.11.042 (opens in a new tab))

Medicare and SLPAs

This part is federal, not state, and it is the same everywhere.

CMS's Medicare Benefit Policy Manual, chapter 15, section 230.3, says it in so many words:

Services of speech-language pathology assistants are not recognized for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services.

It adds that "Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare." (Medicare Benefit Policy Manual, ch. 15, § 230.3(C) (opens in a new tab))

The home health rules point the same way without naming SLPAs. Medicare's home health coverage rule says skilled therapy must be services that "can safely and effectively be performed only by a qualified physical therapist or by a qualified physical therapy assistant under the supervision of a qualified physical therapist, by a qualified speech-language pathologist, or by a qualified occupational therapist or a qualified occupational therapy assistant under the supervision of a qualified occupational therapist." There is an assistant for PT and OT, and none for speech. (42 CFR 409.44(c)(2)(ii) (opens in a new tab))

The home health personnel rule has standards for a physical therapist assistant and an occupational therapy assistant, but none for an SLPA. Its speech standard is "A person who has a master's or doctoral degree in speech-language pathology, and who meets either of the following requirements: (1) Is licensed as a speech-language pathologist by the state in which the individual furnishes such services." (42 CFR 484.115 (opens in a new tab)) The home health chapter of the manual says skilled speech services are covered when "the specialized judgment, knowledge, and skills of a qualified speech-language pathologist are necessary." (Medicare Benefit Policy Manual, ch. 7, § 40.2.3 (opens in a new tab))

Medicaid and commercial plans are different. ASHA notes that "States and third-party payers (e.g., insurance, Medicaid) vary in their policies regarding recognition of SLPAs as approved service providers." (ASHA, SLPA Scope of Practice (opens in a new tab)) Check each payer before an SLPA sees its members.

What This Means in Home Health

1. Medicare home health visits need the SLP. An SLPA can't make a billable Medicare speech visit, so don't schedule one as if they could. Our guide to which order a PTA, COTA or LPN visit falls under covers the assistants Medicare home health does recognize.
2. For other payers, start with the state. If your state requires the SLP in the same facility or location (Alabama, Pennsylvania, and Florida without a signed protocol), an SLPA can't run home visits alone. In DC the SLP has to be there or watching by live video.
3. Build the supervision schedule into the calendar. Where the rule is per patient (every 30, 60 or 90 days), schedule the SLP's own visit or co-treat as part of the plan, the same way you'd track a PTA or OTA supervisory visit.
4. Count the ratio across every employer. Most ratios are per SLP, not per agency, and some count interns and clinical fellows in the same cap.
5. Practicing across state lines is a separate question. The audiology and speech-language pathology compact is for audiologists and SLPs; an SLPA needs each state's own credential.

Key Takeaways

• SLPAs are real, and 31 states and DC credential them. Kentucky adds a schools-only license.
• Eleven more states allow assistants or aides under rules without an SLPA credential. Six have no provision, and I couldn't verify New Jersey.
• Supervision rules come in three shapes: percentages (often heavier in the first 90 days), hours per month, or SLP contact with each patient on a schedule.
• Alabama and Pennsylvania require the SLP in the same facility or location. Florida does unless a board protocol is signed, and DC unless the SLP watches by live video.
• Most states cap an SLP at two or three assistants.
• Medicare doesn't recognize SLPA services, even when the state licenses the assistant.
• This isn't legal advice. I checked these rules on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Is there such a thing as an SLPA?

Yes. A speech-language pathology assistant (SLPA) carries out treatment that a speech-language pathologist has planned and supervises. 31 states and DC issue a license, registration or certificate for the role, and Kentucky licenses SLPAs for public schools only. ASHA has certified SLPAs (the C-SLPA) since December 2020. An SLPA does not evaluate, diagnose, write or change the plan of care, or discharge patients.

Does Medicare pay for services by a speech-language pathology assistant?

No. CMS's Medicare Benefit Policy Manual says SLPA services are not recognized for Medicare coverage, even where the state licenses the assistant, and are denied if billed as therapy. The home health and outpatient rules name a qualified speech-language pathologist and have no SLPA standard, unlike PTAs and OTAs. Medicaid and private payers set their own policies.

How much supervision does an SLPA need?

It depends on the state. Where the rule sets an amount, a common pattern is 20 to 30 percent direct supervision for the first 90 days, then 10 to 20 percent, or a set number of hours a month. Other states count contacts instead: the SLP must see each patient every 30, 60 or 90 days. Alabama and Pennsylvania require the SLP to be on site whenever the assistant works, and Florida does unless a signed board protocol is in place.

How many SLPAs can one SLP supervise?

Usually two or three. Delaware and Rhode Island allow one. Most states with a ratio allow two full-time assistants, and several allow three. Texas caps an SLP at four interns and assistants combined, and California at three full-time equivalents and six support personnel in all. Idaho, Kansas, Montana, Nevada, North Dakota and Washington set no ratio in the rules I read.

Can an SLPA see home health patients on their own?

In some states, yes. Where direct supervision can be done by live video, or the rule only requires the SLP to be reachable, an SLPA can treat in the home with the SLP elsewhere. Alabama and Pennsylvania require the SLP in the same facility or location, the District of Columbia requires it unless the SLP watches by live video, Florida does unless a signed board protocol is in place, and Indiana requires the supervisor present when support personnel treat outside the designated practice setting. And Medicare home health will not pay for the visit either way.

Sources

Every state's rule is linked in the table, to the state's legislature, its official administrative code publisher or its SLP board. All were read on November 9, 2026.

• CMS, Medicare Benefit Policy Manual, chapter 15 (opens in a new tab), § 230.3(B) and (C).
• CMS, Medicare Benefit Policy Manual, chapter 7 (opens in a new tab), § 40.2.3.
• eCFR, 42 CFR 409.44 (opens in a new tab) (home health skilled services) and 42 CFR 484.115 (opens in a new tab) (home health personnel qualifications).
• ASHA, Speech-Language Pathology Assistant Scope of Practice (opens in a new tab), Apply for C-SLPA (opens in a new tab) and Education Pathways to C-SLPA (opens in a new tab).
• State rules quoted in the sections above but not in the table: A.R.S. § 36-1901 (opens in a new tab), 225 ILCS 110/8.7 (opens in a new tab), 16 CCR § 1399.170 (opens in a new tab), 17 CAR § 180-1315 (opens in a new tab) and Wis. Stat. § 459.22 (opens in a new tab).