PURPOSE: This rule details the supervision requirements for speech-language pathology assistants.

1. (1) All applications for registration to practice as a speechlanguage pathology assistant must include a statement from a speech-language pathologist holding current, unrestricted licensure to practice in the state of Missouri pursuant to section 345.015(10), RSMo, acknowledging acceptance of the legal and ethical responsibilities for supervising the assistant. A speechlanguage pathologist practicing with a provisional license pursuant to section 345.021, RSMo, shall not be the supervisor for a speech-language pathology assistant.
2. (2) The supervising speech-language pathologist is responsible for the clinical activities of the assistant.
3. (3) The supervising speech-language pathologist has the responsibility of ensuring and protecting the interests of all patients and/or clients and/or students at all times during which the assistant is practicing and/or interacting with patients and/or clients and/or students; this responsibility includes the supervisor’s and the assistant’s compliance with the ethical standards of practice as specified in rule 20 CSR 2150-4.080.
4. (4) The supervising speech-language pathologist shall have the first initial contact with all patients/clients/students on the assistant’s caseload. Prior to the speech-language pathologist assistant initiating services or therapy, the supervising speechlanguage pathologist shall gather baseline data and establish an appropriate plan of care for the patient/client/student. The supervising speech-language pathologist shall provide ongoing direct supervision to each assistant a minimum of once every sixty (60) days for each patient/client/student. Direct supervision is defined as real-time observing and viewing the assistant and patient/client/student when the treatment is being provided; direct supervision may be either in-person or through appropriate remote methods. If an alternative arrangement is necessary, the supervising speech-language pathologist must submit a proposed plan of supervision for the review of the advisory commission and board to determine if the supervision plan is acceptable. Supervision shall be distributed across the patient/client/student caseload as appropriate to ensure adequate oversight.
5. (5) The supervising speech-language pathologist must be available for the purpose of providing guidance and support to the assistant at all times, which can include but is not limited to telephone, facsimile, or other electronic communication; face-to-face communication; or other appropriate communication means. If the supervising speech-language pathologist is temporarily unavailable, a qualified speech-language pathologist alternate may be designated to meet this requirement. Written communication shall be provided by the supervising speech-language pathologist to the assistant that identifies the alternate and the period of temporary supervision.
6. (6) The supervising speech-language pathologist shall review and sign all patient/client/student documented progress notes written by the speech-language pathology assistant.
7. (7) The supervising speech-language pathologist shall assign and the assistant shall accept only those duties and responsibilities for which the assistant has been specifically trained and is qualified to perform, pursuant to the judgment of the supervising speech-language pathologist, and in compliance with the provisions of Chapter 345, RSMo.
8. (8) The speech-language pathology assistant shall maintain supervisory logs and the speech-language pathologist shall sign verifying the hours of supervision per month; such logs shall be made available to the board within thirty (30) days upon receipt of a request for such logs from the board.
9. (9) The maximum number of speech-language pathology assistants supervised by one (1) speech-language pathologist shall not exceed three (3) at one (1) time.

AUTHORITY: sections 345.015 and 345.021, RSMo Supp. 2024, and section 345.030, RSMo 2016.* This rule originally filed as 4 CSR 150-4.201. Original rule filed July 31, 2000, effective Feb. 28, 2001. Moved to 20 CSR 2150-4.201, effective Aug. 28, 2006. Amended: Filed Dec. 14, 2007, effective June 30, 2008. Amended: Filed Jan. 3, 2012, effective Aug. 30, 2012. Amended: Filed Dec. 19, 2024, effective July 30, 2025. *Original authority: 345.015, RSMo 1973, amended 1986, 1995, 1998, 2004, 2005, 2007, 2015, 2020, 2022; 345.021, RSMo 2022; and 345.030, RSMo 1973, amended 1981, 1995, 1998, 2007.