State Advocacy Front Lines: What Otolaryngologists Need to Know for 2026
Responding to state proposals that threaten patient safety, physician-led care, or access to specialty services.
Aaron Castelo, Senior Advisor, AAO-HNS State Advocacy
AAO-HNS collaborates closely with state otolaryngology-head and neck surgery societies, individual physicians, and coalition partners to track legislation and respond when proposals threaten patient safety, physician-led care, or access to specialty services. This year, two issues are expected to dominate our attention: inappropriate expansions of the audiology scope of practice and ongoing efforts to advance newborn screening for congenital cytomegalovirus (cCMV).
The Legislative Climate
Legislative priorities differ widely across states. Many early-session agendas are focusing on issues outside healthcare, including budgets and tax policy. When healthcare proposals emerge, lawmakers often view them through the lens of cost, workforce availability, or access, rather than clinical outcomes.
Physician engagement is crucial under these conditions. Policy ideas can move quickly, and without physician input, legislators may not fully grasp their practical implications. Testimony from practicing otolaryngologists is essential to provide perspective and credibility, which are consistently valued in these brief, often unpredictable sessions.
Scope of Practice: A Persistent Challenge
Inappropriate expansions of nonphysician scope of practice remain the Academy’s top state advocacy priority. Across the country, some audiologists are seeking authority to diagnose, treat, and order tests or procedures.
While audiologists are essential to hearing healthcare, their training does not prepare them to make independent medical decisions. Otolaryngologists complete medical school, a minimum of five years of residency, and thousands of hours of supervised clinical training to manage complex otologic and systemic conditions. Overlapping these boundaries can jeopardize patient safety.
AAO-HNS members consistently report concerns about misdiagnosis, delayed treatment, unnecessary testing, fragmented care, and increased costs when scope expansions occur.
Recent experience underscores why physician involvement matters. In 2025, the Academy worked with state societies to amend or stop problematic scope bills in Arkansas, Louisiana, and Oregon. In Arkansas, a bill modeled on expansive Maryland legislation was narrowed after physician testimony and member engagement. In Oregon, similar legislation failed to advance out of committee following our coordinated opposition efforts.
In 2026, additional proposals are already emerging, including bills under consideration in Wisconsin and Kentucky. To help members navigate these issues, the Academy provides talking points, physician testimonials, and state-specific advocacy resources.
Advancing Newborn cCMV Screening
AAO-HNS also continues to prioritize early identification of cCMV, the most common non-genetic cause of pediatric sensorineural hearing loss. Many infants with cCMV appear healthy at birth and pass routine newborn hearing screening, yet later develop permanent hearing loss. Early identification allows timely monitoring and intervention, improving long-term outcomes. For these reasons, the Academy strongly supports universal newborn screening for cCMV.
State approaches to screening vary. Connecticut and Minnesota require universal testing, while several states implement hearing-targeted screening. Others have enacted education or awareness laws only, and more than half of the U.S. states have no formal policy.
The Academy supports advocacy efforts by offering draft legislation, messaging guidance, and assistance for physician-led campaigns. Oregon’s new hearing-targeted screening law demonstrates the impact of coordinated advocacy. Momentum is building in other states, including Michigan, Massachusetts, and New York. In 2026, Wisconsin and Florida present additional opportunities for progress.
Other State Advocacy Issues
AAO-HNS also monitors policies that influence daily practice. Issues such as hearing aid coverage, dispensing laws, prior authorization, and medical liability can all affect patient access, administrative burden, and the delivery of care.
The Importance of Physician Engagement
Direct involvement from practicing otolaryngologists is essential for successful advocacy. Lawmakers respond to testimony, constituent meetings, and timely action alerts from members more than any other input.
At the heart of the Academy’s state-level work is the State Legislative Tracker Program. Trackers serve as the primary link between the Academy and state otolaryngology communities, monitoring legislation, identifying emerging issues, coordinating with staff, and mobilizing physician engagement. Trackers receive legislative updates, policy analysis, training, and ongoing support from AAO-HNS staff.
Members are encouraged to volunteer as State Legislative Trackers. Those unable to serve directly can identify colleagues who are engaged and responsive. State societies benefit from small government relations committees to share responsibilities and maintain continuity. Even modest participation, from responding to action alerts, attending testimony sessions, or staying informed, has a meaningful impact on state healthcare decisions.
AAO-HNS Staff Support
Advocacy staff provide guidance, strategic support, and practical resources throughout the legislative process. We assist with bill review, messaging, coordination with coalition partners, and engagement with legislators. Staff are available at every stage to help members and societies navigate the complexities of state policy.
The primary contact for state advocacy is Aaron Castelo, Senior Advisor of State Advocacy, at acastelo@entnet.org
The State-mENT is an “at a glance” resource outlining the Academy’s state legislative activity from the previous month. Sign up as a State Tracker and become part of the discussion! And don’t miss our new AAO-HNS Fact Sheet: Audiology Scope of Practice and Patient Safety.
