Hi, welcome everybody to today's IHS webinar, State Activities and Engagement, Your Inside Track to Influence. I'm your moderator, Sierra Sharp, IHS's Director of Professional Development. Thank you for joining us. And now on to our presenter. To share her valuable insights about state activities and engagement is IHS's Manager of Government Affairs, Christine Seitz. In her role at IHS, Christine manages IHS's State and Provincial Legislative and Regulatory Affairs, as well as providing support to advocacy and fundraising efforts. As you can see, Christine has a lot to cover today. Now let's get to our main presentation. Take it away, Christine. Thank you so much, Sierra. And I hope you all are doing well. And thank you for taking the time out of your busy days to be with us today. As the sole U.S. organization that advocates for hearing aid specialists' scope of practice at the state level, your IHS Government Affairs team plays a crucial role in supporting hearing aid specialists through various advocacy and policy initiatives. Here are some key ways we help you. We develop position statements and draft bills for introduction, such as when a chapter wants to update their hearing aid laws to clarify that cerumen removal is within their scope. We also draft amendments to fix oversights, such as when an insurance mandate is extended to adults, we worked to add you to the list of providers, as we did in Montana. Additionally, we draft comment letters expressing support or opposition, like the letter of concern we wrote for West Virginia in 2023, when their board proposed regulations that prohibited them from removing cerumen. As a result of our combined efforts, this regulation was pulled. Our work is done in consultation with chapter leaders, active IHS members, IHS Federal and State Advocacy Committee, and IHS Board of Governors. We also collaborate with other stakeholders to form coalitions that strengthen our advocacy efforts. We offer training and resources, such as today's webinar and the IHS Advocacy Toolkit, and we are developing additional materials to help hearing aid specialists yourselves effectively advocate for your profession. Please watch for these resources and do not hesitate to contact us for assistance. However, I can't stress this enough, elected officials need and want to hear from you, the individual directly affected by legislation, regulations, and outdated laws. Most elected officials are not hearing health care professionals, which is why advocating for your profession and building a relationship with them is crucial to your practice. Why? You provide them with needed insight into how their bill will impact patients, their constituents, or how a regulatory body's proposed regulation will harm your business, and you can refrain the opposition's argument to your efforts to clarify your scope of practice or their attempts to prohibit certain services. So, let's begin your journey learning how to protect your profession. Let's start with an overview of the state legislative and regulatory process. State laws and regulations have a direct impact on your scope of practice. The states determine licensing requirements, patient care standards, and continuing education mandates. Understanding your state's legislative and regulatory process allows for you to effectively communicate with your state representative or senator to advocate for maintaining high standards and protecting your profession, influence public policy, and ultimately provide better care for your patients. Without this awareness, you risk having legislation or regulations introduced or proposed that could deregulate your profession or impose prohibition from the services you can provide. Today's information will be helpful to defeat harmful bills and proposed regulations, and more positively, to enact meaningful legislation and final regulations. Steps in the state legislative process. Now, while state legislative processes may vary slightly from state to state, it generally follows a similar pattern. A bill is introduced in either the House or the Senate, it's assigned a committee number, and referred to committee for review. The committee examines the bill, holds hearings, and may adopt amendments based on comments from the public and from those hearings. If the committee approves the bill, it moves to the floor of the House or the Senate for further consideration. The bill is debated on the full chamber floor where the bill was introduced. Legislators may propose further amendments for consideration or adoption. If the bill passes that chamber, it's sent to the other chamber for consideration. The bill then goes through the similar process in the second chamber. If both chambers pass the same bill, I'm sorry, if they both pass a bill with different language, it may go to a conference committee to resolve any differences between the versions. If differences are resolved, it's sent back to both chambers for a final vote. However, the majority of the time, both chambers agree on the final version and the bill is sent to the governor. The governor then can either sign the bill into law, veto it, or allow it to become law without a signature. If signed or allowed to become law, it will be implemented and regulatory bodies may issue regulations to help enforce it and help you all be compliant. Check your state's legislative website for your specific legislative process and chamber rules or ask us for assistance. Generally speaking, regulatory bodies, for example, your state department of health or licensing board are authorized by the state legislature and are tasked with promulgating rules or regulations to help hearing aid specialists understand and comply with the corresponding state law. The regulatory process begins with a directive from the state legislature being enacted law or the regulatory body identifies the need for a new regulation or an amendment to an existing one. The next step is for the regulatory body to publish a notice of proposed rulemaking, which outlines the proposed regulation and invites public comment. This notice is typically published in the state register. Excuse me for a moment. During the public comment period, stakeholders, including you, manufacturers, general public, and legislators can submit feedback on the proposed regulation. A regulatory body could also hold public hearings to receive public comment. The regulatory body reviews the public comments and may revise the proposed regulations based on the feedback received. If revisions are made, a new notice and public comment period will commence. After completion of those steps, final regulations is then adopted by the governing body and published in the state register. It is then implemented and enforced by the regulatory body. Check your state's regulatory website for their specific regulation and process or ask IHS for assistance. Why should you be an advocate for your profession? Let's discuss why advocacy is crucial and how it helps protect your profession. Legislators may introduce a bill to reduce government or cut cost. Unknowingly, they are introducing a deregulation bill. Alternatively, a department could issue a report recommending that the legislature review the need for your license. Unknowingly, this recommendation could also result in deregulating your profession, which then decreases consumer access to 50% of the marketplace, preventing you from ordering and fitting prescription hearing aids, as well as preventing you from participating in managed care. We've seen these examples occur this year in Indiana and Georgia and Michigan. Many legislators may not fully grasp your specialized training, skills, and knowledge. This lack of understanding can lead to those types of misguided, unintended legislative efforts that don't reflect the realities of your profession. In addition, legislative policy statements may misunderstand the difference between the terms ordered the use of and prescribed. The FDA views these terms as equivalent, but legislators and their staff might misconstrue them, as we've seen in Maryland. By advocating for your profession, you ensure that laws and regulations do not impede on your scope of practice, and more importantly, your ability to effectively and efficiently serve the citizens of your state with hearing loss. Without your active involvement, opposing voices will dominate the conversation. They'll continue to push for practice prohibitions, such as prohibiting you from removing cerumen, which again impedes your practice, limits access to services, and could increase patient costs. Staying engaged and advocating for your interests is crucial to shaping the narrative and influencing outcome. This work is crucial to ensuring hearing specialists remain at the table and a prominent partner on the hearing care team. As I previously stated, elected officials need and want to hear from you, the individuals directly affected by legislation, regulations, and outdated laws. Most elected officials are not hearing health care professionals or experts, which is why advocating for your profession and building relationships is paramount. You provide them with insight into how their bill will impact your patients, their constituents, or how a regulatory body's proposed regulation will harm your business or patients. By actively participating in advocacy, you help protect your profession, you ensure high standards of care, and influence policy decisions that benefit both practitioners and patients. How to be an advocate. Being an effective advocate involves building relationships with decision makers and staying engaged. Here's how to get involved and make a difference. Reach out to the governor, secretary of health, legislators, and their staff. Schedule meetings with them, attend their public events, get to know them. Building these relationships is crucial because your insight helps them understand the real-world impacts of their decision. Monitor legislative and regulatory activity, attend public meetings, and participate in public hearings. Your input can influence decisions by providing valuable perspectives that legislators might not otherwise consider. Staying informed ensures you can respond quickly to any threats or opportunities. Collective action, such as attending fly-ins or annual advocacy day, amplifies your voice and demonstrates the widespread support for your cause. This demonstrates to legislators that the issue is important to many constituents, increasing their likelihood of positive outcomes. Keeping up with legislative changes and policy updates and participating in IHS advocacy campaigns ensures that you are well-informed and prepared to act. These resources provide the latest information and strategies to advocate for your profession effectively. A lobbyist can also help your chapter navigate the political landscape and amplify your message. Their expertise and connections with your state legislators and stakeholders can be invaluable in overcoming opposition and ensuring your voice is heard and achieving your goals. By following these steps, you can be an effective advocate and ensure your voice is heard. Advocacy is not just about reacting to threats, it's also about proactively shaping the narrative and influencing outcomes to protect and advance your profession. As always, IHS, government, and our staff are ready to assist you. You're not alone in this. You can build a relationship with your state senator or state representative by reaching and, I'm sorry, researching and understanding their background priorities and interests. Knowing their stance on relevant issues helps you tailor your advocacy efforts effectively. This understanding allows you to connect your profession's needs with their legislative goals, making your advocacy more persuasive. For example, if you know the member's primary concern is a health care shortage, you can help them understand how you help fill that void, especially in rural areas. Maintaining regular contact with legislators and their staff by sharing updates, providing insight, and keeping them informed about developments in your field. Consistent communication builds trust and keeps your issues on their radar. Regular interactions ensure that your profession remains a priority to them. Highlight how legislative decisions impact their constituents, your patients. Personal stories and examples without violating HIPAA can help make your case more compelling. Legislators are more likely to support initiatives that clearly benefit their constituents, so illustrating the direct impact on patients can be very persuasive. Legislators and their staff appreciate well-researched information that helps them make informed decisions. Providing data-driven evidence strengthens your position and demonstrates the importance of your profession in a concrete way. Offering your expertise helps legislators understand complex issues and positions you as a trusted advisor, like someone that they would call from the House floor if a bill or an amendment is being discussed that affects you. They might call you. After meeting or events, follow up with a thank you note or email. Expressing gratitude and maintaining communication reinforces your relationship and keeps the dialogue open. Why do these actions matter? Building relationships with legislators is crucial because it ensures that your profession's needs and concerns are understood and considered in the legislative process. Without these relationships, there is a risk that decisions will be made without fully understanding the impacts on your profession and your patients, such as the Georgia Deregulation Bill. Once our Georgia members educated the legislator, he removed the hearing aid specialist-related language from the bill. By being proactive and engaged, you can influence policy decisions, protect your scope of practice, and ensure that high standards of care are maintained. A major element of building relationships is a fly-in or advocacy day. So I'd like to share one of the key elements to building relationships. Organizing an annual advocacy day with your chapter or colleagues in the absence of a chapter. This is a major way to protect your profession at the state level. Advocacy day is crucial because it provides your profession the opportunity to educate legislators and their staff about the importance of your profession, your license, and the role you play in hearing health care, thus ensuring that your voice is heard in the legislative process. This also demonstrates the collective strength and unity of your profession. For a successful annual advocacy day, like the effective Georgia Society's annual day, you need to identify the topics you want to discuss and the outcomes you aim to achieve, such as getting a yes vote on a bill or co-sponsoring a chapter piece of legislation. Involved members who are passionate about your profession, they support and participate, can amplify your message and demonstrate widespread backing of your cause. Use your chapter website, social media platforms, and email campaigns to promote your advocacy day, ensuring maximum participation. Schedule meetings with legislators, preferably during a session day, and sometimes it's best in small groups of two or three to maximize your access to representatives and senators and ensure personalized and impactful decisions. Large group meetings are also fine. This approach allows for more detailed conversations and helps build stronger relationships. Communicate your goals and the importance of your profession to legislators and their staff members. Their communication ensures that your message is understood and taken seriously. Legislative staff, who I once was one, play a crucial role in shaping policy decisions. Don't take offense if you meet with staff only. They can provide valuable insights and help you navigate the legislative process more effectively. They also have more direct contact on a regular basis with the member or even the chairperson. Document the outcomes, commitments, and any need for follow-ups from your meetings. This is essential for accountability and tracking progress. Remember to express your gratitude and remind legislators of the action items. Keeping the dialogue open is crucial to ongoing engagement. Organizing the annual advocacy day creates a powerful opportunity to advocate for your profession, build and maintain relationships with legislators and their staff, and influence policy decisions that protect and advance best practices for your profession. What not to do in advocacy. To ensure effective and professional advocacy, you should know and understand your issue or goal. For instance, educating legislators on the importance of your license, which ensures that you can speak confidently and accurately about the implications of deregulations. Like, for example, a deregulation bill will result in limited access to hearing health care. 50% of the marketplace, you won't be able to provide prescription hearing aids or participate in, I'm sorry, managed care or any other state-related programs. This preparation helps you address questions and counter arguments effectively, demonstrating your expertise and commitment. Maintaining a calm and respectful demeanor is crucial for building positive relationships with policymakers. Professionalism fosters trust and credibility, making legislators more likely to take your concerns seriously. Clear and concise communication ensures that your message is understood and remembered, making your advocacy more impactful and efficient. Data and real-world examples help legislators understand the practical implications of their decision. This evidence-based approach makes your argument more compelling and harder to dismiss. Understanding their concerns and perspective allows you to address them directly and find common ground. This empathy and insight can lead to more productive discussions and better outcomes. Follow-ups show that you are committed to ongoing dialogue and collaboration. They reinforce your message and keep your issue on the policymaker's radar, increasing the likelihood of a possible positive action. Avoiding the common mistakes outlined on your screen is crucial because they can undermine your advocacy efforts. How to address opposition. During the legislative process, you may encounter opposition. I'd like to discuss some strategies that you can use to counter. Understand their belief, background, and positions of your opponents. Knowing their strategies and motivations can help you articulate your rebuttal. Use personal stories. Again, be mindful of HIPAA and facts to counter negative claims. Focus on your strengths and the key points you want to address. How it will benefit and continue to provide the public with safe healing healthcare. Don't wait for the opposition to dictate the terms of the debate. Take the initiative to bring up important issues and steer the conversation. Form coalitions with other organizations and stakeholders who share your goals. The united front is more powerful and can be effective at countering opposition. By empowering these strategies, hearing aid specialists can effectively counter opposition to and strengthen, I'm sorry, can effectively counter opposition and strengthen their advocacy efforts. Remember, one of the goals of advocacy is to build a positive and persuasive case for your profession while addressing and mitigating the concerns of your opponents. How to get a bill introduced. Getting a hearing aid specialist focused bill introduced requires clear planning, strategic alliances, and ongoing advocacy to ensure the law addresses your profession's needs. Outline the issue your bill addresses and how it provides an effective solution. Research and find a legislator who shares your vision and is likely to champion your cause. Sometimes all it takes is asking a freshman representative or senator. Schedule a meeting with your chosen legislator to present your proposal. Be ready to explain the significance and impact of your bill and answer any questions they may have. Work with the legislator, their staff, and IHS staff to draft the bill that ensures its accuracy and that reflects your goals and remains free from unwanted amendments introduced by the opposition. Rally support from colleagues, coalition partners, and the public. A broad base of support strengthens your case. Track its journey through committees and floor votes, attend public hearings, and be prepared to provide testimony. Stay actively involved throughout the process. Contact your legislators and the governor's office to secure additional support. As always, IHS staff is available to assist you with this process as we have in other states like Nebraska and Pennsylvania. I'm going to tie everything that you've learned together today by talking about what we've recently been working on. With our Miracle Ear partner, as well as our Starkey partner, and through IHS members advocacy, we successfully defeated deregulation bills in Indiana and Georgia. Indiana House Bill 1520, the IHS, Indiana Hearing Alliance, and our partners sprang into action. We submitted opposition testimony and issued a call to action as soon as we became aware of the bill. The Committee on Employment, Labor, and Pension heard the concerns of numerous hearing aid specialists and therefore tabled the bill, meaning it was never considered further. Basically, a dead bill. In Georgia, House Bill 579, in an attempt to streamline government, a bill was introduced that would have unintentionally deregulated hearing aid dealers. Like in Indiana, we all sprang into action. IHS and the Georgia Society of Hearing Professionals issued a call to action, and due to numerous calls and emails, the bill sponsor amended the bill to remove all references to hearing aid dealers, thus maintaining their licensure. In Maryland, House Bill 1355 and Senate Bill 641, our very active advocates in Maryland proactively worked to fix an oversight. Last session, the General Assembly passed an insurance mandate bill that did not include hearing aid specialists. Through our efforts, and their testifying before the committee and their diligence, and support from our Miracle Air partners, a bill is going to the governor's office soon to correct that unintended oversight. We are now included in the law. However, and with all due respect, if there had been an active chapter, hearing aid specialists wouldn't have been excluded from the bill and acted law. This and other examples from today are why having active chapters and advocates in each state is so important. Nebraska, LB 154. In Nebraska, through the Nebraska Hearing Society's determination and dedication, as well as their attendance at numerous meetings and committee hearings, we've gained support from the state health and human services department for clarifying cerumen removal and tinnitus care are within their scope of practice. The society's bill was recently amended into LB 332. Scope of practice regulations. Our New Mexico members brought a harmful regulation to our attention. As a result of numerous IHS advocates voicing their concerns, the hearing aid professional governing board in New Mexico tabled a harmful regulatory proposal that would have prohibited hearing aid specialists from providing tinnitus care and cerumen removal and from servicing children. This is why hearing aid specialists licensing board representation is so important and also attending the meetings and being proactive and voicing your concerns. The board is tasked with protecting the public from unsafe practices and from occupational practices that tend to reduce competition in the profession and under its purview. The prohibitions on cerumen and tinnitus care and fitting children with hearing aids were anti-competitive and limited competition between the licensees and the board they oversee. Our last example is in Michigan where we're also working with the Michigan Society, which just this month hired a lobbyist to proactively prevent a deregulation bill from being introduced based on the department's red tape report. The Michigan Department of Licensing and Regulatory Affairs recently released the cutting red tape report, which includes a recommendation that the legislature should review whether hearing aid dealers license is still needed. Deregulation will significantly impact your profession. Without a license hearing aid specialists cannot order and fit prescription hearing aids or participate in marriage care as most require a licensed professional and there are some state programs too that you'd probably be prohibited from participating in. Thanks to their monitoring of the regulatory body, the Michigan Society, IHS, and our partners at Miracle Ear and Starkey can be proactive, not reactive, and advocating for hearing aid dispensing practices. Now if you come across a bill or proposed regulation that would impact your practice, we suggest that you carefully review and understand the bill or proposed regulation. Identify the key points, potential impacts, and any areas of concern. Contact the bill's sponsor to understand their perspective and ask why the bill was introduced and what problems it aims to solve. This information is crucial for formulating your response. Please share this information with IHS staff and seek our guidance. We are happy to provide expert advice, develop a strategy, and support your advocacy efforts. I sincerely hope you found today's webinar helpful and I'm happy to answer any questions. Christine, that was great. Thank you so much for sharing all of your expertise and this valuable information. Folks, before we get into our Q&A session, we'd like to first invite Terry Ozog, who's president of the IHS Affiliate Chapter in Michigan, to share some of his insights on some current advocacy work advocating on behalf of Michigan Hearing Aid Specialists and Michigan's recent legislature issues. So, Terry, if you'd like to go ahead and come off mute and share any remarks that you'd like to and then we'll move into our formal Q&A session. All right. Am I open? Yes. Okay. First of all, foremost, it shows the importance of having an advocacy group at the state level. We, the history of Michigan was that it had a very strong, it had quite a few members in the past several years, but then pre-pandemic kind of faded off. We lost the board for what reasons? I don't think we were even told. And so the ability to monitor what was going on at the state level was, we didn't know. And this just shows when you're active as, this is kind of a double edged sword, so to speak, in that it's getting us to get totally organized and to be able to fight and with the support of the manufacturers like has occurred in the other states. But again, the significance and importance that you need for everybody to be involved, whether you are on this site here as a manufacturer's person, as a big box, or as an independent, we all have to pull together and form this advocacy day, the advocacy to go out and to educate these legislators. Because as they said, if we lose this, and just because it's happened in other states, but they fought it. And unless it's fought here and in other states where probably it's going to come up because of the OTC verbiage that is going on and had occurred across the nation, that we need the full support and your membership here at IHS to be able to fight this. Or here in Michigan, what we realized over the years is that Laura, which is the licensing and regulation board, recognized the hearing instrument specialists as retailers because of the big box, you know, of the Sam's and the Costco's. And we have to differentiate that term with clinicians and patients. A lot of times, being in medical for over 40 years, they came and they said, Terry, they're not patients. And I said, like hell if they aren't, you know, they're not customers, they're patients. Follow them from independent to assisted to hospice. We take care of patients when we build the insurance company and the codes, they're patients. So we had to educate the legislators to these terms, as I guess you had said occurred in one of the other states. So that's being formulated. We have a lobbyist to let us know what's going on and to keep abreast and to give us some instruction. Again, this red tape that had come out just recently, we found out that there was a 16,000 or that there was a questionnaire put out that 16,000 citizens and manufacturers and businesses had responded to. We didn't know anything about that. So again, the importance of having an active and supportive advocacy group in your state is extremely important. Everybody who's listening, I guess and myself, so to speak, we kind of can see what can happen if it doesn't occur. So don't let it happen to you and we have all the instruments and the knowledge or we'll find out where to get it to be able to help not only hear what's going on in the state of Michigan, but to keep you on guard in your states. Okay, enough of that biblical, but it is extremely important, extremely important. We kind of learned a hard way and hopefully we don't pay for it. Terry, thank you so much for sharing your experience and kind of how quickly, you know, if you're, if it's not nurtured or there's an outside event like the pandemic, you know, the chapter can kind of fall apart and then we can see, you know, the possibility for negative impacts from that. So it is so important to keep those groups together and cohesive. Thank you for sharing your perspective with our attendees today. So Christine, we'll go ahead and move into some questions. We've got a couple coming in. Folks, go ahead and throw your questions in the Q&A box. We do have a fair amount of time left. So we're happy to sit with you today and answer any questions that you might have about specific issues that you may be facing in your state, you know, how to get more involved, et cetera. So Christine, first question here is from Desiree. How would you recommend approaching a conversation with a congressional representative if your personal politics are in opposition to that representative's politics? How would you handle that conversation? Yeah, thank you, Desiree. That's a fantastic question, especially in the environment right now. I think you, I might highly recommend that you just stay focused on the issue. Your issue is protecting your industry and promoting it and ensuring that what piece of legislation that you're working on gets enacted. Don't engage in any conversation outside of that scope. If the member does bring up their own personal or their political ideologies that you don't agree with, just don't engage and move on and continue. Bring it back again to Zeroom and your licensure or just generally speaking about what you do and how you help and how you're an effective, great part of the healing healthcare system. Great, thank you. Yeah, such a critical topic for the times that we're in today. Next question here is from Chris. Chris wants to know if you've heard about a potential upcoming bill in Oregon labeled the Senate Bill 943, looks like maybe being introduced by Senator Cedric Hayden. And I'm just gonna give you this context that Chris shared with us and then let you respond if you're aware of this and what the steps might be. If enacted as written, hearing aid specialists would not be authorized to provide their patients with prescription hearing aids, tinnitus treatment devices, or remove Zeroom in from the ear, which prevents proper hearing testing or hearing aids from functioning correctly. Yeah, thank you. Thank you, Chris, for that question. My understanding and from coalitions that we have that that bill is not going anywhere anytime soon. I will say though, hearing aid specialists were granted the FDA authority to order the use of prescription hearing aids previously. So you're fine on that front. Apparently audiologists didn't get that through the other way. Now, in regards to the tinnitus treatment devices and removing Zeroom in, we did submit a letter to the sponsor expressing our concerns. If they wanna do tinnitus, fine, they wanna do Zeroom in, fine, but you cannot pick one profession over the other. So we kindly said, with all due respect, Zeroom in is part of our scope. You should clarify it too. There's major concerns if there's Zeroom in the ear, you might not be able to get a proper ear testing, ear mold, and you might not be able to, I think, yeah. But anyway, you're not gonna be able to do your job. It's going to be impeded if you don't. So if you're going to give it to them, please give it to us. And then tinnitus too. I understand tinnitus is a big, broad picture. It requires sometimes psychiatrists as well as the physician, or ENT as well. But precluding us from having even a conversation about tinnitus is not in the best interest. So we express those concerns. There is also a gentleman named Vladimir Gutierrez. Sorry. He is in the early stages of reconstituting that society. So I'm happy to connect you with him if you would like. Good, thanks, Christina. If you want to send a chat specifically to the panelists, I think you have that option in your chat box, or you could put it in the Q&A, your contact information, if you'd like, Christine, to get you connected with the folks who are working on these issues in Oregon. I'm sure that they would love to have your voice added into the fray as they're working with their legislators and licensing agencies to try to combat some of these perspective issues. Next question is from Wendy. And Wendy is asking if you have any updates on the bill in Nebraska, LB 154, allowing hearing aid specialists to remove cerumen. Yeah, I have pretty good news. I don't want to jinx anything, but the society has worked on that very diligently and very, they put all, anyway, LB 154 has been amended into another bill that's called like a vehicle bill. I forget the number. It might be LB 322, but it was referenced in the slide. So we can look back in a few minutes maybe. But anyway, that bill was amended into another bill that is a high priority bill that's being considered. And hopefully that bill will go to the governor's desk before the end of legislature, which I think is next month, that would authorize cerumen and require some education beforehand. Great, thank you. Good news. All right, next question here is from Greg. The question from Greg is how can we be effective in introducing the Model Licensing Act in our state? That is perfect. Sorry, just writing down Chris's email address. So an individual is asking about introducing the Model Licensure Act in their state. Correct. Yeah, and it would go back with a bill. That's your intent. So now you know what you want to do. So now you're going to try to find a sponsor who is either in the House and the Senate, sometimes both depending upon the rules over there, and find them that's a champion. And then you would create talking points and help them out understanding what part. Do you want all of the Model Licensure Act or are you talking about just education, cerumen, tinnitus? Figure out that plan and then meet with them, ask them for their support, answer any questions they have, work with them on drafting it. The Model Licensure is already in bill draft format. So you could easily just send that to them. But if you want to make any changes or need any other guidance from us, let us know. We can also help with the talking points and any of the background research that you would need. And then continuously communicate with them and kind of, I don't want to say literally be on call, but just kind of be on call when they have questions about your bill. Your bill could be brought up in another committee meeting or they could have had lunch with someone that brought it up. You would be their point of contact that they would reach out to you and ask any questions. Perfect, thank you. Next question here is from Richard. So there's a little bit of context here. So Richard says, our state organization recently merged into a multi-state group. So an IHS chapter that's representing multiple states. Aside from IHS, is there such a thing as a multi-state lobbyist that would be able to advocate for issues in more than one state versus having to hire a lobbyist in each state, which might be unaffordable? So can you hire a multi-state lobbyist? Possibly, we would have to have conversations with, there's a little bit of research on that. I am not aware of lobby firms, but sometimes it's more corporate, but that doesn't mean it's not available. It just means I don't know off the top of my head. So we'd have to have conversations and let's continue this conversation about finding someone that could lobby or have multiple offices in multiple states, a co-lobbying firm that would be able to help you out. Perfect, thank you. So Richard, you could drop your email address in the Q&A box for us, or you could send Christine an email at advocacy at IHSinfo.org to flesh that out a little bit more. We'll show that email address at the end of our talk here as well. Yeah, that's a great question, Richard, and I look forward to helping you with that. Yeah, the next, and it looks like, okay, perfect, thank you, Richard. He shared his email address in the chat room, so we'll grab that so that you guys can connect after. Okay, the next question here is from Nathan, and it's, you and I can maybe answer this one a little bit together, Christine. Okay. Nathan is asking if other states are having difficulty with TPA, like third-party administrators and managed care. He said, in Missouri, we are approaching 40% TPA purchase rates in some areas. Further, he says, for my practice, this is a big problem, but do you think that this may be more welcomed by some practices that survive off TPA referrals? Or do you think, in general, the TPA competition is generally viewed as harmful to dispensers? So what I would say, from my perspective, is certainly you are not the only person with these concerns, Nathan. Consistently, when we're talking to members, when we're at chapter events and things of that nature, managed care really is the biggest challenge that is facing business owners in the hearing aid space. People, if they want to participate, they need to know how to be compliant, how to be legal, how to still profit. If they don't want to participate, they need to know, like, what are the, how can I keep my patients, right? Like, people do have a fear of, I might lose patients if I don't participate with third-party, but then they feel like, but if I do participate with third-party, I might not be able to make money. So we do have a lot of resources for folks engaging with managed care, and we have a lot more coming, actually, in 2025. In June, we're gonna be making a big announcement about additional managed care information that is coming out from IHS, but we do know that is one of the biggest challenges, and it's, they're such a cross the board. Like, some people, you know, I know a business owner in Florida who says, like, I participate with all managed care because I think that's the right thing to do, and I figured out how to make money in other ways. And then there are some practices who say, I don't touch it with a 10-foot pole, and, you know, they're very successful as well. So it's about making the decisions that are gonna be right for your individual business. And I see your additional comment here. I'll just read out loud, and then, Christine, if you have any thoughts you wanna share. What Nathan has said, which I'm not familiar with this, but he said, I think anyone concerned about TPA competition maybe could take a look at the Robinson-Patman Act on the FTC website. So if there's a concern about maybe unfair business practices or something like that, there might be something to investigate there. So that's kind of my two cents on the managed care piece. Do you have anything you would add? Not as thorough as you. To be honest, the managed care that I've been experiencing with my time here has been about mandating insurance providers to cover hearing aids, and the price amount and the frequency, getting into the weeds of TPAs and what have you, I've not experienced. But we do have, as Sierra said, we have resources like the Managed Care Guide, Managed Care Mondays. It also wouldn't hurt to potentially think about having a conversation with your insurance commissioner to get a feel of what is on the book, so to speak, statute about that. How is this pro or anti-consumerism? Yeah, great points. Thank you. There's another comment here from Clell, Clell Hammond, North Carolina, which is going back to the previous question about introducing the Model Licensing Act and how to go about that effectively. And Clell is a great resource for that because in North Carolina, he championed a huge success in clarifying scope of practice there using the IHS Model Licensing Act. And so he just added a comment, by introducing the Model Licensing Act and the scope language within it, what you're doing is clarifying your already broadly defined scope. So introducing it as a clarification as opposed to maybe having somebody view it as an expansion of scope, which there's a lot of sensitivity to. When you're introducing that Model Licensing Act, you're clarifying your scope is how I interpret your comment there, Clell. If I'm wrong, definitely feel free to correct me. Totally, totally. That's totally correct. And every time I have a conversation with any of our chapter leaders or members that are interested in making any changes to their statute, we always say it's clarifying because removing cerumen is part of your job. If it's there and you can't remove it, it impedes you from being able to do your job. It impedes you from being able to provide health, prepare the services to your citizens of your state. Yeah, and like same thing with turning up a dentist's mask, right? Like this is an groundbreaking activity. This is something that you're already doing and that you should be doing in service of your patients, right? Like if they have bad masking in their hearing aids, then they need it. And then it reminds me of some of the opposition comments that have been brought up. Well, this means that you wanna go deeper, further into the ear and that's absolutely not. You're talking about the first third where the primary location of it is. And again, we're clarifying. This is not a scope expansion. You're not interested in doing anything like impacted wax. So yeah, we're very sensitive and very cognizant of using the word clarifying. Yeah, and those are the kinds of expertise that I just can bring to these processes, right? Because we've been through this in so many states. And so, we're able to share our expertise in terms of that language and things like that, understanding for example, the clarification versus expansion is a really important point that could make or break your case. And we can keep you updated on what other states are doing like the Nebraska bill or potentially PA. And we can also put you in contact with individuals like Wilhelm is very active. We've connected him when Nebraska, while they were working on that bill. Yeah, very good. Thank you. And then I'll just read this out loud. Terry Ozog, who we just heard from made a comment here in the chat. I'll read out loud. And then I'm not seeing any additional questions. If you have an additional question, speak now or forever hold your peace and we'll wrap up after this. What Terry shared is that in Michigan, we're having a meeting on April 25th at 6 p.m. at the IHS headquarters office in Farmington Hills, Michigan and a Zoom call regarding the recent report of hearing aid dealers and sales people licensing in the state of Michigan. If that is of interest to you, whether you're in Michigan or outside of Michigan, you can send us an email to Christine, probably advocacy at IHSinfo.org to be added to that meeting. Thank you, Terry, for informing folks of that. So thank you guys for your engagement today. And thank you so much, Christine, for your valuable presentation, State Activities and Engagement, Your Inside Track to Influence. Folks, if you have any additional questions following today's webinar, as I've said a couple of times, you can email Christine at advocacy at IHSinfo.org. Thank you for spending an hour with us today and have a great night. Thanks everybody. Thank you.

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