Justification for Adoption of Administrative Rules

JUSTIFICATION FOR EMERGENCY RULES ADOPTION

Speech-Language Pathologists and Audiologists

16 Texas Administrative Code, Chapter 111

Emergency amendments to existing rules at Subchapter A, §111.2; Subchapter E, §111.41; Subchapter F, §111.50 and §111.51; Subchapter J, §111.91 and §111.92; Subchapter V, §§111.210-111.212 and §111.215; and Subchapter X, §§111.230-111.232; and the emergency repeal of existing rules at Subchapter V, §111.213 and §111.216

The Texas Commission of Licensing and Regulation (Commission) adopts the emergency amendments to existing rules at 16 Texas Administrative Code (TAC), Chapter 111, Subchapter A, §111.2; Subchapter E, §111.41; Subchapter F, §111.50 and §111.51; Subchapter J, §111.91 and §111.92; Subchapter V, §§111.210-111.212 and §111.215; and Subchapter X, §§111.230-111.232; and the emergency repeal of existing rules at Subchapter V, §111.213 and §111.216, regarding the Speech-Language Pathologists and Audiologists program. The effective date for these emergency amendments and repeals (emergency rules) is September 1, 2021.

EXPLANATION, JUSTIFICATION, AND FINDINGS FOR THE EMERGENCY RULE

The rules under 16 TAC Chapter 111 implement Texas Occupations Code, Chapter 401, Speech-Language Pathologists and Audiologists, and Chapter 51, the enabling statute of the Commission and the Texas Department of Licensing and Regulation (Department).

Background and Findings

On March 13, 2020, the Governor of Texas issued a disaster proclamation under Texas Government Code §418.014 certifying that COVID-19 poses an imminent threat of disaster for all counties in the State of Texas, and this proclamation has been renewed continuously since that date.

On March 22, 2020, the Texas Department of Licensing and Regulation (Department) submitted a request to waive certain rules under 16 TAC Chapter 111 in order to remove restrictions and to expand the provision of services to clients and supervision of certain licensees through telehealth. These waivers allowed additional licensees to provide telehealth services to clients; allowed for the use of additional technologies to provide telehealth services; allowed for the expanded use of facilitators; allowed for direct and indirect supervision of certain licensees to be performed through telehealth; removed in-person supervision requirements; removed caps and restrictions on the amount of supervision that could be conducted through telehealth; and removed the in-person initial client contact requirement.

On April 8, 2020, the Governor granted the telehealth waiver request, and the Department implemented these waivers on April 9, 2020. The providers under 16 TAC Chapter 111 have been providing services to clients and supervising certain licensees in accordance with those waivers since April 2020.

On June 3, 2021, the Governor signed S.B. 40, 87th Legislature, Regular Session, 2021, which became effective immediately. This bill amended Texas Occupations Code, Chapter 51, to add new telehealth provisions and rulemaking authority, and amended Texas Occupations Code, Chapters 401 and 402, to repeal existing provisions regarding joint rules for fitting and dispensing hearing instruments by telepractice.

On July 20, 2021, the Department requested that the telehealth waivers granted for 16 TAC Chapter 111, in part, be rescinded effective September 1, 2021. The Governor granted the waiver rescission request on July 26, 2021, with termination effective at 12:01 a.m. on September 1, 2021.

The Department will propose telehealth rules for adoption by the Texas Commission of Licensing and Regulation on a permanent basis, pursuant to Texas Occupations Code, Chapters 51 and 401, as amended by S.B. 40, 87th Legislature, Regular Session, 2021. The new permanent rules are anticipated to be adopted by early 2022. To prevent a gap in services before that date, the Commission has adopted emergency rules to ensure that services to clients and supervision of certain licensees may continue to be provided through telehealth as was allowed under the waivers that were granted by the Governor during the COVID-19 pandemic.

It is found that without emergency rules to fill the gap, there will be a disruption in the services that have been provided to clients since the waivers were granted, resulting in imminent peril to the public health, safety, and welfare. There will be a reduction in the number of providers who may provide telehealth services; a reduction in the number of clients a provider may serve in a given time period; and a negative impact on clients’ timely access to services. It also would require a return to in-person services and supervision at a time when COVID-19 is still active and when at least one population of clients served by the licensees are not eligible for a COVID-19 vaccination (children under the age of 12).

It is found that this emergency rulemaking is necessary to ensure that services to clients and supervision of certain licensees may continue to be provided through telehealth as was allowed under the waivers that were granted by the Governor during the COVID-19 pandemic. This emergency rulemaking also reflects the change in the statutory authority regarding telehealth. This emergency rulemaking is necessary to protect the public health, safety, and welfare.

Continuing Telehealth Services and Supervision through Emergency Rules

The emergency rules reflect the waivers that were granted by the Governor during the COVID-19 pandemic until permanent rules are adopted. The emergency rules make the following changes:

S.B. 40, 87th Legislature, Regular Session, 2021, added new telehealth provisions and rulemaking authority to Texas Occupations Code, Chapter 51, and repealed the provisions regarding joint rules for fitting and dispensing hearing instruments by telepractice in Texas Occupations Code, Chapters 401 and 402. The joint rules were with the Hearing Instrument Fitters and Dispensers program. These changes became effective immediately.

SECTION BY SECTION SUMMARY

Subchapter A

The emergency rules amend Subchapter A, §111.2, Definitions. The emergency rules amend the definitions under paragraphs (14), (15), (23), (24), and (25) to allow supervision—both direct and indirect--to be performed through telehealth and not require in-person supervision. References to “telepractice/telehealth” have been replaced with the term “telehealth.”

Subchapter E

The emergency rules amend Subchapter E, §111.41, Intern in Speech-Language Pathology License--Internship and Supervision Requirements. Subsection (d) is amended to allow interns to receive direct supervision through telehealth and not require in-person supervision.

Subchapter F

The emergency rules amend Subchapter F, §111.50, Assistant in Speech-Language Pathology License--Licensing Requirements--Education and Clinical Observation and Experience. Subsection (e) is amended to allow supervision to be performed through telehealth and not require in-person supervision.

The emergency rules amend Subchapter F, §111.51, Assistant in Speech-Language Pathology License--Supervision Requirements. Subsection (e) is amended to allow supervision to be performed through telehealth and not require in-person supervision. Subsection (g) is amended to eliminate any caps or limits on the number of hours that can be supervised through telehealth and to allow direct and indirect supervision to be provided through telehealth.

Subchapter J

The emergency rules amend Subchapter J, §111.91, Assistant in Audiology License--Supervision Requirements. Subsection (f) is amended to eliminate any caps or limits on the number of hours that can be supervised through telehealth, to eliminate restrictions on the duties that can be supervised by telehealth, and to allow direct and indirect supervision to be provided through telehealth.

The emergency rules amend Subchapter J, §111.92, Assistant in Audiology License--Practice and Duties of Assistants. Subsection (c) is amended to allow all assigned duties to be supervised through telehealth and not require in-person supervision.

Subchapter V

The emergency rules amend Subchapter V, §111.210, Definitions Relating to Telehealth. The definition of “provider” under paragraph (5) has been expanded to include speech-language pathology interns and speech-language pathology assistants, which will allow these licensees to provide telehealth services under this subchapter. The definitions of “facilitator” under paragraph (4) and “provider site” under paragraph (6) have been updated to reference “provider” since the term has been expanded. The definition of “telecommunications technology” under paragraph (8) has been updated to include a smart phone, or any audio-visual, real-time, or two-way interactive communication system. The definitions of “telepractice” and “telepractice services” under paragraphs (11) and (12) are repealed. They are unnecessary and duplicative with the terms “telehealth” and “telehealth services.”

The emergency rules amend Subchapter V, §111.211, Service Delivery Models for Speech-Language Pathology. The title of the section has been changed to reflect the expanded scope of providers and references to “telepractice” have been replaced with “telehealth service.”

The emergency rules amend Subchapter V, §111.212, Requirements for the Use of Telehealth in Speech-Language Pathology. The title of the section has been changed to reflect the expanded scope of speech-language pathology providers. Subsection (a) is amended to state that the section applies to a speech-language pathologist, speech-language pathology intern, or a speech-language pathology assistant. Subsection (a) also clarifies the telehealth services that may be provided by speech-language pathology assistants. Subsection (b) is amended to apply to a speech-language pathologist or speech-language pathology intern, but not to a speech-language pathology assistant. References within the section to “telepractice” and “telehealth/telepractice” have been replaced with “telehealth.”

The emergency rules repeal Subchapter V, §111.213, Limitations on the Use of Telecommunications Technology by Speech-Language Pathologists.

The emergency rules amend Subchapter V §111.215, Requirements for Providing Telehealth Services in Audiology. The title of the section has been changed to remove references to “telepractice.” Subsection (b) has been amended to clarify the modes of communication that do not utilize telecommunications technology. Subsections (e) and (f)(1) have been amended to allow for expanded use of facilitators by removing training requirements. bsection (i) has been amended to replace the reference to “the provider’s telepractice” with “telehealth.” References within the section to “telepractice” have been replaced with “telehealth.”

The emergency rules repeal Subchapter V, §111.216, Limitations on the Use Telecommunications Technology by Audiologists.

Subchapter X

The emergency rules amend the title of Subchapter X to reflect the change in the statutory authority and the change in terminology.

RECOMMENDATIONS AND COMMISSION ACTION

The Speech-Language Pathologists and Audiologists Advisory Board met August 6, 2021, and recommended that the Commission adopt the emergency rules. At its meeting on August 10, 2021, the Commission adopted the emergency rules as recommended by the Advisory Board and the Department.

FUTURE RULEMAKING

Under Texas Government Code §2001.034, the emergency rule may be effective for 120 days, and may be renewed once for an additional 60 days. The Department may propose this or a similar rule under the standard rulemaking process and will consider any additional action necessary in the event unforeseen issues arise with the adopted emergency rule.

STATUTORY AUTHORITY

The emergency rules are adopted with abbreviated or no notice and with an expedited effective date under Texas Government Code §2001.034(a) and §2001.036(a)(2).

The emergency rules are adopted under Texas Occupations Code, Chapters 51 and 401, which authorize the Texas Commission of Licensing and Regulation, the Department's governing body, to adopt rules as necessary to implement those chapters. The emergency rules are also adopted under Texas Occupations Code, Chapter 51, §51.501, Telehealth, as added by S.B. 40, and Texas Occupations Code, Chapter 111, Telemedicine and Telehealth.

The statutory provisions affected by the emergency rules are those set forth in Texas Occupations Code, Chapters 51, 111, 401, and 402. No other statutes, articles, or codes are affected by the emergency rules.

SUBCHAPTER A. GENERAL PROVISIONS.

  • 111.2. Definitions.

Unless the context clearly indicates otherwise, the following words and terms shall have the following meanings.

(1) ABA--The American Board of Audiology.

(2) Act--Texas Occupations Code, Chapter 401, relating to Speech-Language Pathologists and Audiologists.

(3) Acts--Texas Occupations Code, Chapter 401, relating to Speech-Language Pathologists and Audiologists; and Texas Occupations Code, Chapter 402, relating to Hearing Instrument Fitters and Dispensers.

(4) Advisory board--The Speech-Language Pathologists and Audiologists Advisory Board.

(5) ASHA--The American Speech-Language-Hearing Association.

(6) Assistant in audiology--An individual licensed under Texas Occupations Code §401.312 and §111.90 of this chapter and who provides audiological support services to clinical programs under the supervision of an audiologist licensed under the Act.

(7) Assistant in speech-language pathology--An individual licensed under Texas Occupations Code §401.312 and §111.60 of this chapter and who provides speech-language pathology support services under the supervision of a speech-language pathologist licensed under the Act.

(8) Audiologist--An individual who holds a license under Texas Occupations Code §401.302 and §401.304 to practice audiology.

(9) Audiology--The application of nonmedical principles, methods, and procedures for measurement, testing, appraisal, prediction, consultation, counseling, habilitation, rehabilitation, or instruction related to disorders of the auditory or vestibular systems for the purpose of providing or offering to provide services modifying communication disorders involving speech, language, or auditory or vestibular function or other aberrant behavior relating to hearing loss.

(10) Caseload--The number of clients served by the licensed speech-language pathologist or licensed speech-language pathology intern.

(11) Client--A consumer or proposed consumer of audiology or speech-language pathology services.

(12) Commission--The Texas Commission of Licensing and Regulation.

(13) Department--The Texas Department of Licensing and Regulation.

(14) Direct Supervision related to Assistants (Speech-Language Pathology and Audiology)--Real-time observation and guidance by the supervisor while a client contact or clinical activity or service is performed by the assistant. Direct supervision may [shall] be performed in person or via telehealth [telepractice/telehealth] as authorized and prescribed by this chapter.

(15) Direct supervision related to Interns (Speech-Language Pathology)--Real-time observation and guidance by the supervisor while a client contact or clinical activity or service is performed by the intern. Telehealth [Telepractice/telehealth] may [not] be used for direct supervision of Speech-Language Pathology Interns.

(16) Ear specialist--A licensed physician who specializes in diseases of the ear and is medically trained to identify the symptoms of deafness in the context of the total health of the client, and is qualified by special training to diagnose and treat hearing loss. Such physicians are also known as otolaryngologists, otologists, neurotologists, otorhinolaryngologists, and ear, nose, and throat specialists.

(17) Executive director--The executive director of the department.

(18) Extended absence--More than two consecutive working days for any single continuing education experience.

(19) Extended recheck--Starting at 40 dB and going down by 10 dB until no response is obtained or until 20 dB is reached and then up by 5 dB until a response is obtained. The frequencies to be evaluated are 1,000, 2,000, and 4,000 hertz (Hz).

(20) Fitting and dispensing hearing instruments--The measurement of human hearing by the use of an audiometer or other means to make selections, adaptations, or sales of hearing instruments. The term includes the making of impressions for earmolds to be used as a part of the hearing instruments and any necessary postfitting counseling for the purpose of fitting and dispensing hearing instruments.

(21) Hearing instrument--Any wearable instrument or device designed for, or represented as, aiding, improving or correcting defective human hearing. This includes the instrument's parts and any attachment, including an earmold, or accessory to the instrument. The term does not include a battery or cord.

(22) Hearing screening--A test administered with pass/fail results for the purpose of rapidly identifying those persons with possible hearing impairment which has the potential of interfering with communication.

(23) In-person--The licensee is physically present with the client while a client contact or clinical activity or service is performed. In the case of supervision, the supervisor is physically present with the assistant or intern while a client contact or clinical activity or service is performed. [The supervisor must be physically present, observing the assistant’s or the intern’s client contact or clinical activity or service. Telepractice/telehealth is not considered in-person.]

(24) Indirect supervision related to Assistants (Speech-Language Pathology and Audiology)--The supervisor performs monitoring activities or provides guidance to the assistant, either of which does not occur during actual client contact by the assistant or while the assistant is providing a clinical activity or service. Telehealth [Telepractice/telehealth] may be used for indirect supervision as authorized and prescribed under this chapter.

(25) Indirect supervision related to Interns (Speech-Language Pathology)--The supervisor performs monitoring activities or provides guidance to the intern, either of which does not occur during actual client contact by the intern or while the intern is providing a clinical activity or service. Telehealth [Telepractice/telehealth] may be used for indirect supervision as authorized and prescribed under this chapter.

(26) Intern in audiology--An individual licensed under Texas Occupations Code §401.311 and §111.80 of this chapter and who is supervised by an individual who holds an audiology license under Texas Occupations Code §401.302 and §401.304.

(27) Intern in speech-language pathology--An individual licensed under Texas Occupations Code §401.311 and §111.40 of this chapter and who is supervised by an individual who holds a speech-language pathology license under Texas Occupations Code §401.302 and §401.304.

(28) Intern Plan and Agreement of Supervision Form (for Interns in Speech-Language Pathology and Audiology)--An agreement between a supervisor and an intern in which the parties enter into a supervisory relationship and the supervisor agrees to assume responsibility for all services provided by the intern.

(29) Provisional Licensee--An individual granted a provisional license under Texas Occupations Code §401.308.

(30) Sale or purchase--Includes the sale, lease or rental of a hearing instrument or augmentative communication device to a member of the consuming public who is a user or prospective user of a hearing instrument or augmentative communication device.

(31) Speech-language pathologist--An individual who holds a license under Texas Occupations Code §401.302 and §401.304, to practice speech-language pathology.

(32) Speech-language pathology--The application of nonmedical principles, methods, and procedures for measurement, testing, evaluation, prediction, counseling, habilitation, rehabilitation, or instruction related to the development and disorders of communication, including speech, voice, language, oral pharyngeal function, or cognitive processes, for the purpose of evaluating, preventing, or modifying or offering to evaluate, prevent, or modify those disorders and conditions in an individual or a group.

(33) Supervisor--An individual who holds a license under Texas Occupations Code §401.302 and §401.304 and whom the department has approved to oversee the services provided by the assigned assistant and/or intern. The term “supervisor” and “department-approved supervisor” have the same meaning as used throughout this chapter.

(34) Supervisory Responsibility Statement (SRS) Form (for Assistants in Audiology or Speech-Language Pathology)--An agreement between a supervisor and an assistant in which the parties enter into a supervisory relationship, the supervisor agrees to assume responsibility for the assistant’s activities, and the assistant agrees to perform only those activities assigned by the supervisor that are not prohibited under this chapter.

(35) Telehealth--See definition(s) in Subchapter V, Telehealth.

SUBCHAPTER E. REQUIREMENTS FOR INTERN IN SPEECH-LANGUAGE PATHOLOGY LICENSE.

  • 111.41. Intern in Speech-Language Pathology License--Internship and Supervision Requirements.

(a) A licensed intern in speech-language pathology (intern) must be supervised by a licensed speech-language pathologist who has been approved by the department to serve as the intern's supervisor (supervisor).

(b) A supervisor must agree to assume responsibility for all services provided by the intern. The supervisor must comply with the requirements set out in the Act and §111.154.

(c) Intern Plan and Agreement of Supervision Form. A Speech-Language Pathology Intern Plan and Agreement of Supervision Form shall be submitted in a manner prescribed by the department and completed by both the applicant and the proposed supervisor. The proposed supervisor must meet the requirements set out in the Act and §111.154.

(1) Approval from the department shall be required prior to practice by the intern. The Speech-Language Pathology Intern Plan and Agreement of Supervision Form shall be submitted upon:

(A) application for an intern license;

(B) any changes in supervision; and

(C) the addition of other supervisors.

(2) If more than one speech-language pathologist agrees to supervise the intern, each proposed supervisor must submit a Speech-Language Pathology Intern Plan and Agreement of Supervision Form.

(3) The intern may not practice without an approved Speech-Language Pathology Intern Plan and Agreement of Supervision Form. The supervisor may not allow an intern to practice before a Speech-Language Pathology Intern Plan and Agreement of Supervision Form is approved.

(4) If the supervisor ceases supervision of the intern, the supervisor shall notify the department, in a manner prescribed by the department, and shall inform the intern to stop practicing immediately. The supervisor is responsible for the practice of the intern until notification has been received by the department.

(5) If the intern's supervisor ceases supervision, the intern shall stop practicing immediately. The intern may not practice until a new Speech-Language Pathology Intern Plan and Agreement of Supervision Form has been submitted to and approved by the department.

(d) Internship Requirements. The internship shall:

(1) be completed within a maximum period of forty-eight (48) months once initiated;

(2) be successfully completed after no more than two attempts;

(3) consist of thirty-six (36) weeks of full-time supervised professional experience (thirty-five (35) hours per week) totaling a minimum of 1,260 hours, or its part-time equivalent, of supervised professional experience in which clinical work has been accomplished in speech-language pathology. Professional experience of less than five hours per week cannot be used to meet the minimum 1,260 hours, but the professional experience still must be supervised by a licensed speech-language pathologist.

(4) involve primarily clinical activities such as assessment, diagnosis, evaluation, screening, treatment, report writing, family/client consultation, and/or counseling related to the management process of individuals who exhibit communication disabilities;

(5) be divided into three (3) segments with no fewer than thirty-six (36) clock hours of supervisory activities to include:

(A) six (6) hours of [in-person] direct supervision per segment by the supervisor(s) of the intern's [direct] client contact [at the worksite] in which the intern provides screening, evaluation, assessment, habilitation, and rehabilitation; and

(B) six (6) hours of indirect supervision per segment with the supervisor(s) which may include correspondence, review of videos, evaluation of written reports, phone conferences with the intern, evaluations by professional colleagues; or

(C) an alternative plan as approved by the department.

(e) Extension Request. An applicant who does not meet the time frames defined in subsection (d)(1), shall request an extension, in writing, explaining the reason for the request. The request must be signed by both the intern and the supervisor in a manner prescribed by the department. Evaluation of the intern's progress of performance from all supervisors must accompany the request. Intern plans and supervisory evaluations for any completed segments must be submitted in a manner prescribed by the department. The department shall determine if the internship:

(1) should be revised or extended; and

(2) whether additional course work, continuing professional education hours, or passing the examination referenced in §111.21 is required.

(f) Evaluations. During each segment of the internship, each supervisor shall conduct a formal evaluation of the intern's progress in the development of professional skills. Documentation of this evaluation shall be maintained by both parties for three years or until the speech-language pathology license is granted. A copy of this documentation shall be submitted to the department upon request.

(g) Changes in Internship. Prior to implementing changes in the internship, approval from the department is required.

(1) If the intern changes the intern’s supervisor or adds additional supervisors, a current Speech-Language Pathology Intern Plan and Agreement of Supervision Form shall be submitted by the new proposed supervisor and approved by the department before the intern may resume practice as prescribed under subsection (c).

(2) If the intern changes the intern’s supervisor, the Speech-Language Pathology Report of Completed Internship Form shall be completed by the former supervisor and the intern and submitted to the department upon completion of that portion of the internship. It is the decision of the former supervisor to determine whether the internship is acceptable. The department shall review the form and inform the intern of the results.

(3) Each supervisor who ceases supervising an intern shall submit a Speech-Language Pathology Report of Completed Internship Form for the portion of the internship completed under the supervisor's supervision. This must be submitted within thirty (30) days of the date the supervision ended.

(4) If no hours were earned under an approved supervisor, the licensed intern or the approved supervisor must submit a signed, written statement that no hours were earned and provide the reason.

(5) If the intern changes the intern’s employer but the supervisor and the number of hours employed per week remain the same, the supervisor shall notify the department in a manner prescribed by the department of the new location. This must be submitted within thirty (30) days of the date the change occurred.

(h) Notwithstanding the supervision provisions in this section, the department may establish procedures, processes, and mechanisms for the monitoring and reporting of the supervision requirements.

SUBCHAPTER F. REQUIREMENTS FOR ASSISTANT IN SPEECH-LANGUAGE PATHOLOGY LICENSE.

  • 111.50. Assistant in Speech-Language Pathology License--Licensing Requirements--Education and Clinical Observation and Experience.

(a) An individual shall not practice as an assistant in speech-language pathology without a current license issued by the department. An applicant for an assistant in speech-language pathology license must meet the requirement under the Act and this section. The applicant must meet the following requirements:

(1) possess a baccalaureate degree with an emphasis in communicative sciences or disorders;

(2) have acquired at least twenty-four (24) semester credit hours in speech-language pathology and/or audiology with a grade of "C" or above with the following conditions:

(A) at least 18 of the 24 semester credit hours must be in speech-language pathology;

(B) at least three (3) of the 24 semester credit hours must be in language disorders;

(C) at least three (3) of the 24 semester credit hours must be in speech disorders;

(D) the 24 semester credit hours excludes course work such as special education, deaf education, or sign language; and

(E) the 24 semester credit hours must be academic course work and excludes any clinical experience; and

(3) have earned no fewer than twenty-five (25) hours of clinical observation in the area of speech-language pathology and twenty-five (25) hours of clinical assisting experience in the area of speech-language pathology obtained within an educational institution or in one of its cooperating programs. If these hours are not completed, the applicant must complete the Clinical Deficiency Plan under subsection (e).

(b) The baccalaureate degree shall be completed at a college or university which has a program accredited by the ASHA Council on Academic Accreditation or holds accreditation or candidacy status from a recognized regional accrediting agency.

(1) Original or certified copy of the transcripts showing the conferred degree shall be submitted and reviewed as follows:

(A) only course work earned within the past ten (10) years with a grade of "C" or above is acceptable;

(B) a quarter hour of academic credit shall be considered as two-thirds of a semester credit hour; and

(C) academic courses, the titles of which are not self-explanatory, shall be substantiated through course descriptions in official school catalogs or bulletins or by other official means.

(2) In the event the course work and clinical experience set out in subsection (a), were earned more than ten (10) years before the date of application for the assistant license, the applicant shall submit proof of current knowledge of the practice of speech-language pathology to be evaluated by the department. Proof of current knowledge may include: recently completing continuing education or other courses; or holding a current license in another state.

(c) An applicant who possesses a baccalaureate degree with a major that is not in communicative sciences or disorders may qualify for the assistant license. The department shall evaluate transcripts on a case-by-case basis to ensure equivalent academic preparation, and shall determine if the applicant satisfactorily completed twenty-four (24) semester credit hours in communicative sciences or disorders and meets the requirements of §111.50(b)(2), which may include some leveling hours.

(d) Degrees and/or course work received at foreign universities shall be acceptable only if such course work and clinical practicum hours may be verified as meeting the requirements of subsection (a). The applicant must bear all expenses incurred during the procedure. The department shall evaluate the documentation, which shall include an original transcript and an original report from a credential evaluation services agency acceptable to the department.

(e) An applicant who has not acquired the twenty-five (25) hours of clinical observation and twenty-five (25) hours of clinical experience referenced in subsection (a)(3), shall not meet the minimum qualifications for the assistant license. These hours must be obtained through an accredited college or university, or through a Clinical Deficiency Plan. All hours must be completed under [in-person,] direct supervision. In order to acquire these hours, the applicant shall first obtain the assistant license by submitting the forms, fees, and documentation referenced in §111.55 and include the prescribed Clinical Deficiency Plan to acquire the clinical observation and clinical assisting experience hours lacking.

(1) The licensed speech-language pathologist who will provide the applicant with the training to acquire these hours must meet the requirements set out in the Act and §111.154 and shall submit:

(A) the Supervisory Responsibility Statement Form prescribed under §111.51; and

(B) the prescribed Clinical Deficiency Plan.

(2) The department shall evaluate the documentation and fees submitted to determine if the assistant license shall be issued. Additional information or revisions may be required before approval is granted.

(3) The Clinical Deficiency Plan shall be completed within sixty (60) days of the issue date of the assistant's license or the licensed assistant must submit a new plan.

(4) Immediately upon completion of the Clinical Deficiency Plan, the licensed speech-language pathologist identified in the plan shall submit a statement or information that the licensed assistant successfully completed the clinical observation and clinical assisting experience and that all hours worked by the licensed assistant were under the in-person, direct supervision of the licensed speech-language pathologist. This statement shall specify the number of hours completed and verify completion of the training identified in the Clinical Deficiency Plan.

(5) Department staff shall evaluate the documentation required in paragraph (4) and inform the licensed assistant and licensed speech-language pathologist who provided the training if acceptable.

(6) A licensed assistant may continue to practice under the in-person, direct supervision of the licensed speech-language pathologist who provided the licensed assistant with the training while the department evaluates the documentation identified in paragraph (4). All hours worked by the licensed assistant must be under the in-person, direct supervision of the licensed speech-language pathologist.

(7) In the event another licensed speech-language pathologist shall supervise the licensed assistant after completion of the Clinical Deficiency Plan, a Supervisory Responsibility Statement Form shall be submitted to the department seeking approval for the change in supervision. If the documentation required by paragraph (4), has not been received and approved by the department, approval for the change in supervision shall not be granted.

  • 111.51. Assistant in Speech-Language Pathology License--Supervision Requirements.

(a) A licensed assistant in speech-language pathology (assistant) must be supervised by a licensed speech-language pathologist who has been approved by the department to serve as the assistant’s supervisor (supervisor).

(b) A supervisor must agree to assume responsibility for all services provided by the assistant. The supervisor must comply with the requirements set out in the Act and §111.154.

(c) Supervisory Responsibility Statement Form. A Supervisory Responsibility Statement Form shall be submitted in a manner prescribed by the department by both the applicant and the proposed supervisor. The proposed supervisor must meet with the requirements set out in the Act and §111.154.

(1) Approval from the department shall be required prior to practice by the assistant. The Supervisor Responsibility Statement Form shall be submitted upon:

(A) application for an assistant license;

(B) any changes in supervision; and

(C) the addition of other supervisors.

(2) If more than one speech-language pathologist agrees to supervise the assistant, each proposed supervisor must submit a separate Supervisor Responsibility Statement Form in manner prescribed by the department.

(3) The assistant may not practice without an approved Supervisor Responsibility Statement Form. The supervisor may not allow an assistant to practice before a Supervisor Responsibility Statement Form is approved.

(4) The assistant shall only provide services for the caseload of the assistant’s supervisors who have current Supervisor Responsibility Statement Forms on file with the department.

(5) If the supervisor ceases supervision of the assistant, the supervisor shall notify the department, in a manner prescribed by the department, and shall inform the assistant to stop practicing immediately. The supervisor is responsible for the practice of the assistant until notification has been received by the department.

(6) If the assistant’s supervisor ceases supervision, the assistant shall stop practicing immediately. The assistant may not practice until a new Supervisor Responsibility Statement Form has been submitted to and approved by the department.

(d) The supervisor shall assign duties and provide appropriate supervision to the assistant.

(e) Direct supervision of the assistant may only occur when [at the worksite in which] the assistant provides services to existing clients or while the assistant provides services to cases previously delegated to the assistant. The supervisor may not make temporary, short-term assignments from the supervisor’s caseload to the assistant in order to fulfill direct supervision requirements.

(f) Client Contacts.

(1) Initial contacts directly with the client shall be conducted by the supervisor.

(2) Following the initial contact, the supervisor shall determine whether the assistant has the competence to perform specific duties before delegating tasks.

(g) Amount and Type of Supervision. Each supervisor shall provide a minimum of eight (8) hours per calendar month of supervision to the assistant. This subsection applies whether the assistant is employed full-time or part-time.

(1) At least four (4) hours must be direct supervision. [At least two (2) of the direct supervision hours must be in-person. The other two (2) hours may be in-person or by telehealth/telepractice.]

(2) The remaining hours may be performed using indirect supervision.

(3) If fewer than four (4) weeks are worked in a calendar month, then the number of hours of supervision provided will be based on the number of weeks worked. Two (2) hours of supervision must be provided for each week worked, including one (1) hour of direct supervision and one (1) hour of indirect supervision.

(4) Direct and indirect supervision may be provided through telehealth in accordance with Subchapter V. [For the purposes of this subsection the telehealth/telepractice provisions allowed by Subchapter V may be used for up to six (6) hours of supervision (two (2) hours of direct supervision and four (4) hours of indirect supervision).]

(5) When determining the amount and type of supervision, the supervisor must consider the skill and experience of the assistant as well as the services to be provided. The supervision hours established in this subsection may be exceeded as determined by the supervisor.

(h) Delegating Clinical Tasks.

(1) The supervisor may delegate specific clinical tasks to an assistant; however, the responsibility to the client for all services provided cannot be delegated.

(2) The supervisor shall ensure that all services are documented and provided in compliance with the Act and this chapter.

(3) The supervisor shall:

(A) in writing, determine the skills and assigned tasks the assistant is able to carry out under §111.52. This document must be agreed upon by the assistant and the supervisor;

(B) notify the client or client’s legal guardian(s) that services will be provided by a licensed assistant;

(C) develop the client’s treatment program in all settings and review it with the assistant who will provide the service; and

(D) maintain responsibility for the services provided by the assistant.

(i) Admission, Review, and Dismissal Meetings. The supervisor, prior to an Admission, Review and Dismissal (ARD) meeting, shall:

(1) notify the parents of students with speech impairments that services will be provided by the assistant and that the assistant will represent Speech Pathology at the ARD;

(2) develop the student’s new Individual Education Program (IEP) goals and objectives and review them with the assistant; and

(3) maintain undiminished responsibility for the services provided and the actions of the assistant.

(j) Records. The supervisor shall maintain the following records.

(1) The supervisor shall maintain for a period of three years supervisory records that verify regularly scheduled monitoring, assessment, and evaluation of the assistant’s and client’s performance. Such documentation may be requested by the department.

(2) The supervisor shall keep job descriptions and performance records of the assistant. Records shall be current and made available upon request to the department.

(k) Supervision Audits. The department may audit a random sampling of assistants for compliance with this section and §111.154.

(1) The department shall notify the assistant and the supervisor in a manner prescribed by the department that the assistant has been selected for an audit.

(2) Upon receipt of an audit notification, the assistant and the supervisor shall provide in a manner prescribed by the department the requested proof of compliance to the department.

(3) The assistant and the supervisor shall comply with the department’s request for documentation and information concerning compliance with the audit.

(l) Notwithstanding the supervision provisions in this section, the department may establish procedures, processes, and mechanisms for the monitoring and reporting of the supervision requirements.

SUBCHAPTER J. REQUIREMENTS FOR ASSISTANT IN AUDIOLOGY LICENSE.

  • 111.91. Assistant in Audiology License--Supervision Requirements.

(a) A licensed assistant in audiology (assistant) must be supervised by a licensed audiologist who has been approved by the department to serve as the assistant’s supervisor (supervisor).

(b) A supervisor must agree to assume responsibility for all services provided by the assistant. The supervisor must comply with the requirements set out in the Act and §111.154.

(c) Supervisory Responsibility Statement Form. A Supervisory Responsibility Statement Form shall be submitted in a manner prescribed by the department by both the applicant and the proposed supervisor. The proposed supervisor must meet the requirements set out in the Act and §111.154.

(1) Approval from the department shall be required prior to practice by the licensed assistant in audiology. The Supervisory Responsibility Statement for an Assistant in Audiology Form shall be submitted upon:

(A) application for a license;

(B) any changes in supervision; and

(C) addition of other supervisors.

(2) If more than one audiologist agrees to supervise the assistant, each proposed supervisor must submit a separate Supervisory Responsibility Statement Form in a manner prescribed by the department.

(3) The assistant may not practice without an approved Supervisor Responsibility Statement Form. The supervisor may not allow an assistant to practice before a Supervisor Responsibility Statement Form is approved.

(4) The assistant shall only provide services for the caseload of the assistant’s supervisors who have current Supervisor Responsibility Statement Forms on file with the department.

(5) If the supervisor ceases supervision of the assistant, the supervisor shall notify the department, in a manner prescribed by the department, and shall inform the assistant to stop practicing immediately. The supervisor is responsible for the practice of the assistant until notification has been received by the department.

(6) If the assistant’s supervisor ceases supervision, the assistant shall stop practicing immediately. The assistant may not practice until a new Supervisor Responsibility Statement Form has been submitted to and approved by the department.

(d) A supervisor shall assign duties and provide appropriate supervision to the assistant.

(e) Client Contacts.

(1) All diagnostic contacts shall be conducted by the supervisor.

(2) Following the initial diagnostic contact, the supervisor shall determine whether the assistant has the competence to perform specific non-diagnostic and non-prohibited duties before delegating tasks as referenced in §111.92(c).

(f) Amount and Type of Supervision. Each supervisor must provide a minimum of ten (10) hours per week, or forty (40) hours per calendar month, of supervision to the assistant. This subsection applies whether the assistant is employed full-time or part-time.

(1) At least one (1) hour per week, or four (4) hours per calendar month, must be direct supervision.

(2) The remaining hours may be performed using indirect supervision.

(3) If fewer than four (4) weeks are worked in a calendar month, then the number of hours of supervision provided will be based on the number of weeks worked. Ten (10) hours of supervision must be provided for each week worked, including one (1) hour of direct supervision.

[(4) The supervisor shall provide in-person, direct supervision for the duties described under §111.92(c)(1) - (4).]

(4)[(5)] Direct and indirect supervision may be provided through telehealth in accordance with Subchapter V. [For the purposes of this subsection, the telehealth and telepractice provisions described under §111.215 may be used except for duties described under §111.92(c)(1) - (4) where the supervisor must provide in-person, direct supervision.]

(5)[(6)] When determining the amount and type of supervision, the supervisor must consider the skill and experience of the assistant as well as the services to be provided. The supervision hours established in this paragraph may be exceeded as determined by the supervisor.

(g) Delegating Clinical Tasks.

(1) Although the supervisor may delegate specific clinical tasks to an assistant, the responsibility to the client for all services provided cannot be delegated.

(2) The supervisor shall ensure that all services are documented and provided in compliance with the Act and this chapter.

(3) The supervisor shall:

(A) in writing, determine the skills and assigned tasks the assistant is able to carry out under §111.92. This document must be agreed upon by the assistant and the supervisor;

(B) notify the client or client’s legal guardian(s) that services will be provided by a licensed assistant; and

(C) maintain responsibility for the services provided by the assistant.

(h) Records. The supervisor shall maintain the following records.

(1) Supervisory records shall be maintained by the supervisor for a period of three years which verify regularly scheduled monitoring, assessment, and evaluation of the assistant’s and client’s performance. Such documentation may be requested by the department.

(2) The supervisor shall keep job descriptions and performance records. Records shall be current and be made available upon request to the department.

(i) Supervision Audits. The department may audit a random sampling of assistants for compliance with this section and §111.154.

(1) The department shall notify an assistant and the supervisor in a manner prescribed by the department that the assistant has been selected for an audit.

(2) Upon receipt of an audit notification, the assistant and the supervisor, who agreed to accept responsibility for the services provided by the assistant, shall provide the requested proof of compliance to the department in a manner prescribed by the department.

(3) The assistant and the supervisor shall comply with the department’s request for documentation and information concerning compliance with the audit.

(j) Notwithstanding the supervision provisions in this section, the department may establish procedures, processes, and mechanisms for the monitoring and reporting of the supervision requirements.

  • 111.92. Assistant in Audiology License--Practice and Duties of Assistants.

(a) A licensed assistant in audiology (assistant) must perform assigned duties under the supervision of a licensed audiologist who has been approved by the department to serve as the assistant's supervisor (supervisor).

(b) The assistant may execute specific components of the clinical hearing program if the supervisor:

(1) determines that the assistant has received the training and has the skill to accomplish that task; and

(2) provides sufficient supervision to ensure appropriate completion of the task assigned to the assistant.

(c) Duties that a supervisor may assign to an assistant, who has received appropriate training, include the following:

(1) under [in-person,] direct supervision, conduct or participate in, hearing screening including screening otoscopy, tympanometry, otoacoustic emissions procedures and pure tone air conduction procedures, but may not diagnose hearing loss or disorders of the auditory system, or make statements of severity or implication;

(2) under [in-person,] direct supervision, assist the audiologist with play audiometry, visual reinforcement audiometry, and tasks such as picture-pointing speech audiometry;

(3) under [in-person,] direct supervision, assist the audiologist in the evaluation of difficult-to-test patients;

(4) under [in-person,] direct supervision, assist the audiologist with technical tasks for diagnostic evaluation such as preparing test rooms, attaching electrodes, and preparing patients prior to procedures;

(5) maintain clinical records;

(6) prepare clinical materials;

(7) participate with the supervisor in research projects, staff development, public relations programs, or similar activities as designated and supervised by the supervisor;

(8) maintain equipment by conducting biologic and electroacoustic calibration of audiometric equipment, perform preventative maintenance checks and safety checks of equipment;

(9) explain the proper care of hearing instruments and assistive listening devices to patients;

(10) maintain hearing instruments including cleaning, replacing ear mold tubing, minor hearing instrument repairs, determining need for repair, and performing biologic and electroacoustic checks of hearing instruments;

(11) provide case history and/or self-assessment forms and clarify questions on the forms to patients as needed;

(12) conduct basic record keeping and prepare paperwork for signature by the audiologist;

(13) coordinate ear mold and hearing instrument records or repairs and other orders;

(14) attach hearing aids to computers and use software to verify internal electroacoustic settings; and

(15) perform other non-diagnostic duties not prohibited in subsection (d), for which the assistant has been trained and demonstrates appropriate skills, as assigned by the supervisor.

(d) The assistant shall not:

(1) conduct aural habilitation or rehabilitation activities or therapy;

(2) provide carry-over activities (therapeutically designed transfer of a newly acquired communication ability to other contexts and situations) for patients in aural rehabilitation therapy;

(3) collect data during aural rehabilitation therapy documenting progress and results of therapy;

(4) administer assessments during aural rehabilitation therapy to assess therapeutic progress;

(5) conduct any audiological procedure that requires decision-making or leads to a diagnosis;

(6) interpret results of procedures and evaluations, except for screening tests;

(7) make diagnostic statements, or propose or develop clinical management strategies;

(8) make ear impressions;

(9) cause any substance to enter the ear canal or place any instrument or object in the ear canal for the purpose of removing cerumen or debris;

(10) make any changes to the internal settings of a hearing instrument manually or using computer software;

(11) represent audiology at staffing meetings or on an admission, review and dismissal (ARD) committee;

(12) attend staffing meetings or ARD committee meetings without the supervisor being present;

(13) design a treatment program;

(14) determine case selection;

(15) present written or oral reports of client information, except to the assistant’s supervisor;

(16) refer a client to other professionals or other agencies;

(17) use any title which connotes the competency of a licensed audiologist; or

(18) practice as an assistant without a valid Supervisory Responsibility Statement for an Audiology Assistant Form on file with the department.

(e) In any professional context the assistant must indicate the assistant's status as a licensed audiology assistant.

(f) A licensed assistant in audiology may not engage in the fitting, dispensing or sale of a hearing instrument under this chapter; however, a licensed assistant in audiology who is licensed under the Texas Occupations Code, Chapter 402 may engage in activities as allowed by that law and is not considered to be functioning under the person’s assistant in audiology license when performing those activities.

SUBCHAPTER V. TELEHEALTH.

  • 111.210. Definitions Relating to Telehealth.

Unless the context clearly indicates otherwise, the following words and terms, when used in this subchapter, shall have the following meanings.

(1) Client--A consumer or proposed consumer of speech-language pathology or audiology services.

(2) Client site--The physical location of the client at the time the services are being furnished via telecommunications.

(3) Consultant--Any professional who collaborates with a provider of telehealth services to provide services to clients.

(4) Facilitator--The individual at the client site who assists with the delivery of the telehealth services at the direction of the provider [audiologist or speech-language pathologist].

(5) Provider--An individual who holds a current, renewable, unrestricted speech-language pathology or audiology license under Texas Occupations Code §401.302 and §401.304; [or] an individual who holds a speech-language pathology intern or an audiology intern license under Texas Occupations Code §401.311; or an individual who holds a speech-language pathology assistant license under Texas Occupations Code §401.312.

(6) Provider site--The physical location at which the provider [speech-language pathologist or audiologist] delivering the services is located at the time the services are provided via telecommunications which is distant or remote from the client site.

(7) Telecommunications--Interactive communication at a distance by concurrent two-way transmission, using telecommunications technology, of information, including, without limitation, sound, visual images, and/or computer data, between the client site and the provider site, and required to occur without a change in the form or content of the information, as sent and received, other than through encoding or encryption of the transmission itself for purposes of and to protect the transmission.

(8) Telecommunications technology—Computers, smart phones, and equipment, other than analog telephone, email or facsimile technology and equipment, used or capable of use for purposes of telecommunications. For purposes of this subchapter, the term includes, without limitation:

(A) compressed digital interactive video, audio, or data transmission;

(B) clinical data transmission using computer imaging by way of still-image capture and storage and forward; [and]

(C) smart phones, or any audio-visual, real-time, or two-way interactive communication system; and

(D)[(C)] other technology that facilitates the delivery of telehealth [telepractice] services.

(9) Telehealth--The use of telecommunications and information technologies for the exchange of information from one site to another for the provision of speech-language pathology or audiology services to a client from a provider.

(10) Telehealth services--The application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention, and/or consultation.

[(11) Telepractice--The use of telecommunications technology by a license holder for an assessment, intervention, or consultation regarding a speech-language pathology or audiology client.]

[(12) Telepractice services--The rendering of audiology and/or speech-language pathology services through telepractice to a client who is physically located at a site other than the site where the provider is located.]

  • 111.211. Service Delivery Models for Speech-Language Pathology [of Speech-Language Pathologists].

(a) Telehealth may be delivered in a variety of ways, including, but not limited to those set out in this section.

(1) Store-and-forward model/electronic transmission is an asynchronous electronic transmission of stored clinical data from one location to another.

(2) Clinician interactive model is a synchronous, real time interaction between the provider and client or consultant that may occur via telecommunication links.

(b) Self-monitoring/testing model refers to when the client or consultant receiving the services provides data to the provider without a facilitator present at the site of the client or consultant.

(c) Live versus stored data refers to the actual data transmitted during the telehealth service [telepractice]. Both live, real-time and stored clinical data may be included during the telehealth service [telepractice].

  • 111.212. Requirements for the Use of Telehealth in Speech-Language Pathology [by Speech-Language Pathologists].

(a) The requirements of this section apply to the use of telehealth by a provider who is a speech-language pathologist, speech-language pathology intern, or a speech-language pathology assistant as defined in this subchapter [by speech-language pathologists]. Speech-language pathology assistants may provide services through telehealth, as directed by their supervisor, according to the speech-language pathology assistant practice and duties under 16 TAC §111.52.

(b) A provider shall comply with the commission's Code of Ethics and Scope of Practice requirements when providing telehealth services.

(c) The scope, nature, and quality of services provided via telehealth are the same as that provided during in-person sessions by the provider.

(d) The quality of electronic transmissions shall be equally appropriate for the provision of telehealth services as if those services were provided in person.

(e) A provider shall only utilize technology that the provider is competent to use as part of the provider’s telehealth services.

(f) Equipment used for telehealth services at the clinician site shall be maintained in appropriate operational status to provide appropriate quality of services.

(g) Equipment used at the client/patient site at which the client or consultant is present shall be in appropriate working condition and deemed appropriate by the provider.

(h) The initial contact between a licensed speech-language pathologist or speech-language pathology intern and a client may be at the same physical location or through telehealth [telehealth/telepractice], as determined appropriate by the licensed speech-language pathologist or speech-language pathology intern.

(i) A provider shall consider relevant factors including the client's behavioral, physical, and cognitive abilities in determining the appropriateness of providing services via telehealth [telehealth/telepractice].

(j) A provider shall be aware of the client’s or consultant’s level of comfort with the technology being used as part of the telehealth services. The provider shall adjust the provider’s practice to maximize the client’s or consultant’s level of comfort.

(k) When a provider collaborates with a consultant from another state in which the telehealth [telepractice] services are delivered, the consultant in the state in which the client receives services shall be the primary care provider for the client.

(l) As pertaining to liability and malpractice issues, a provider shall be held to the same standards of practice as if the telehealth services were provided in person.

(m) A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.

(n) Upon request, a provider shall submit to the department data which evaluates effectiveness of services provided via telehealth including, but not limited to, outcome measures.

(o) Telehealth providers shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements, regardless of the state where the records of any client within this state are maintained.

(p) Notification of telehealth services shall be provided to the client, the guardian, the caregiver, and the multi-disciplinary team, if appropriate. The notification shall include, but not be limited to: the right to refuse telehealth services, options for service delivery, and instructions on filing and resolving complaints.

[111.213. Limitations on the Use of Telecommunications Technology by Speech-Language Pathologists.

(a) The limitations of this section apply to the use of telecommunications technology by speech-language pathologists.

(b) Supervision of a licensed assistant in speech-language pathology may be undertaken through the use of telecommunications technology as described under §111.51 and as follows:

(1) no more than two (2) hours of direct supervision per month shall be undertaken through the use of telecommunications technology; and

(2) no more than six (6) total hours of supervision per month shall be undertaken through the use of telecommunications technology.

(c) Direct supervision of a licensed intern in speech-language pathology shall not be undertaken through the use of telecommunications technology.

(d) Telehealth services may not be provided by correspondence only, e.g., mail, email, faxes, although they may be adjuncts to telepractice.]

  • 111.214. Requirements for Providing Telehealth Services in Speech-Language Pathology.

(a) A provider of telehealth services who practices in the State of Texas shall be licensed by the department.

(b) A provider of telehealth services shall be competent in both the type of services provided and the methodology and equipment used to provide the service.

  • 111.215. Requirements for Providing Telehealth [Telepractice] Services in Audiology.

(a) Unless otherwise legally authorized to do so, an individual shall not render telehealth [telepractice] services in audiology from the State of Texas or to a client in the State of Texas, unless the individual qualifies as a provider as that term is defined in this subchapter and renders only those telehealth [telepractice] services that are within the course and scope of the provider's licensure and competence, and delivered in accordance with the requirements of that licensure and pursuant to the terms and conditions set forth in this section.

(b) The provider shall use only telecommunications technology that meets the definition of that term, as defined in this subchapter, to render telehealth [telepractice] services. Modes of communication that do not utilize such telecommunications technology, including analog telephone, facsimile and email, may be used only as adjuncts.

(c) Subject to the requirements and limitations of this section, a provider may utilize a facilitator at the client site to assist the provider in rendering telehealth [telepractice] services.

(d) The provider shall be present at the provider site and shall be visible and audible to, and able to see and hear the client and the facilitator via telecommunications technology in synchronous, real-time interactions, even when receiving or sending data and other telecommunication transmissions in carrying out the telehealth [telepractice] services. The provider is responsible for the actions of the facilitator and shall monitor the client and oversee and direct the facilitator at all times during the telehealth [telepractice] session.

(e) The provider of telehealth [telepractice] services, prior to allowing a facilitator to assist the provider in rendering telehealth [telepractice] services, shall verify and document the facilitator’s qualifications, training, and competence, if applicable, in each task the provider directs the facilitator to perform at the client site, and in the methodology and equipment the facilitator is to use at the client site.

(f) The facilitator may perform at the client site only the following tasks:

(1) those physical, administrative, and other tasks [for which the provider has trained the facilitator] in connection with the rendering of audiology services for which no form of license, permit, authorization or exemption under the Texas Occupations Code is required; and

(2) a task for which the facilitator holds and acts in accordance with any license, permit, authorization or exemption required under the Texas Occupations Code to perform the task.

(g) A provider shall not render telehealth [telepractice] services to a client in those situations in which the presence of a facilitator is required for safe and effective service to the client and no qualified facilitator is available to the client during the telehealth [telepractice] session.

(h) The scope, nature, and quality of the telehealth [telepractice] services provided, including the assistance provided by the facilitator, shall be commensurate with the services the provider renders in person at the same physical location as the client.

(i) The provider shall not render telehealth [telepractice] services unless the telecommunications technology and equipment located at the client site and at the provider site are appropriate to the telehealth [telepractice] services to be rendered; are properly calibrated and in good working order; and are of sufficient quality to allow the provider to deliver equivalent audiology service and quality to the client as if those services were provided in person at the same physical location. The provider shall only utilize telecommunications technology and other equipment for telehealth [the provider’s telepractice] which the provider is competent to use.

(j) Providers and facilitators involved in the provider’s delivery of telehealth [telepractice] services shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements. Documentation of telehealth [telepractice] services shall include documentation of the date and nature of services performed by the provider by telehealth [telepractice] and of the assistive tasks of the facilitator.

(k) Except to the extent it imposes additional or more stringent requirements, this section does not affect the applicability of any other requirement or provision of law to which an individual is otherwise subject under this chapter or other law.

[111.216. Limitations on the Use of Telecommunications Technology by Audiologists.

(a) The limitations of this section apply to the use of telecommunications technology by audiologists.

(b) Supervision of a licensed assistant in audiology may be undertaken through the use of telecommunications technology as described under §111.91, except for duties described under §§111.92(c)(1) - (4) where the supervisor must provide in-person, direct supervision.

(c) Telehealth services may not be provided by correspondence only, e.g., mail, email, faxes, although they may be adjuncts to telepractice.]

SUBCHAPTER X. [JOINT RULES FOR] FITTING AND DISPENSING OF HEARING INSTRUMENTS BY TELEHEALTH [TELEPRACTICE].

  • 111.230. Purpose.

[Pursuant to Texas Occupations Code §401.2022 and §402.1023, the commission, with the assistance of the Speech-Language Pathologists and Audiologists Advisory Board and the Hearing Instrument Fitters and Dispensers Advisory Board, shall adopt rules to establish requirements for the fitting and dispensing of hearing instruments through the use of telepractice.] This subchapter contains rules that set forth the requirements for the fitting and dispensing of hearing instruments through the use of telehealth [telepractice].

  • 111.231. Definitions.

Unless the context clearly indicates otherwise, the following words and terms, when used in this subchapter, shall have the following meanings:

(1) Acts--Texas Occupations Code, Chapter 401, relating to Speech-Language Pathologists and Audiologists, and Texas Occupations Code, Chapter 402, relating to Hearing Instrument Fitters and Dispensers.

(2) Client--A consumer or proposed consumer of services.

(3) Client site--The site at which the client is physically located.

(4) Facilitator--The individual at the client site who assists with the delivery of telehealth services.

(5) Fitting and dispensing hearing instruments--The measurement of human hearing by the use of an audiometer or other means to make selections, adaptations, or sales of hearing instruments. The term includes the making of impressions for earmolds to be used as a part of the hearing instruments and any necessary post fitting counseling for the purpose of fitting and dispensing hearing instruments.

(6) Hearing instrument--Any wearable instrument or device designed for, or represented as, aiding, improving or correcting defective human hearing. This includes the instrument's parts and any attachment, including an earmold, or accessory to the instrument. The term does not include a battery or cord.

(7) Provider--An individual who holds a current, renewable, unrestricted audiology license under Texas Occupations Code, §401.302 and §401.304; an individual who holds an audiology intern license under Texas Occupations Code, §401.311; or an individual who holds a current, renewable, unrestricted license under Texas Occupations Code, Chapter 402, that authorizes the individual to fit and dispense hearing instruments without supervision.

(8) Provider site--The physical location of the provider of telehealth services which is distant or remote from the client site.

(9) Telecommunications--Interactive communication at a distance by concurrent two-way transmission, using telecommunications technology, of information, including, without limitation, sound, visual images, and/or computer data, between the client site and the provider site, and required to occur without a change in the form or content of the information, as sent and received, other than through encoding or encryption of the transmission itself for purposes of and to protect the transmission.

(10) Telecommunications technology—Computers, smart phones, and equipment, other than analog telephone, email or facsimile technology and equipment, used or capable of use for purposes of telecommunications. For purposes of this subchapter, the term includes, without limitation:

(A) compressed digital interactive video, audio, or data transmission;

(B) clinical data transmission using computer imaging by way of still-image capture and storage and forward; [and]

(C) smart phones, or any audio-visual, real-time, or two-way interactive communication system; and

(D)[(C)] other technology that facilitates the delivery of telehealth services.

(11) Telehealth services--The fitting and dispensing of hearing instruments through telehealth [telepractice] to a client who is physically located at a site other than the site where the provider is located.

(12) Telehealth [Telepractice]--The use of telecommunications technology for the fitting and dispensing of hearing instruments.

  • 111.232. Requirements for Providing Telehealth Services for the Fitting and Dispensing of Hearing Instruments.

(a) Unless otherwise legally authorized to do so, an individual shall not render telehealth services from the State of Texas or to a client in the State of Texas, unless the individual qualifies as a provider as that term is defined in this subchapter and renders only those telehealth services that are within the course and scope of the provider's licensure and competence, and delivered in accordance with the requirements of that licensure and pursuant to the terms and conditions set forth in this section.

(b) The provider shall use only telecommunications technology that meets the definition of that term, as defined in this subchapter, to render telehealth services. Modes of communication that do not utilize such telecommunications technology, including analog telephone, facsimile, and email, may be used only as adjuncts.

(c) Subject to the requirements and limitations of this section, a provider may utilize a facilitator at the client site to assist the provider in rendering telehealth services.

(d) The provider shall be present at the provider site and shall be visible and audible to, and able to see and hear the client and the facilitator via telecommunications technology in synchronous, real-time interactions, even when receiving or sending data and other telecommunication transmissions in carrying out the telehealth services. The provider is responsible for the actions of the facilitator and shall monitor the client and oversee and direct the facilitator at all times during the telehealth session.

(e) The provider of telehealth services, prior to allowing a facilitator to assist the provider in rendering telehealth services, shall verify and document the facilitator's qualifications, training, and competence, if applicable, in each task the provider directs the facilitator to perform at the client site, and in the methodology and equipment the facilitator is to use at the client site.

(f) The facilitator may perform at the client site only the following tasks:

(1) those physical, administrative, and other tasks [for which the provider has trained the facilitator] in connection with the fitting or dispensing of hearing instruments for which no form of license, permit, authorization or exemption is required by law; and

(2) those tasks for which the individual who is acting as a facilitator otherwise holds and acts in accordance with any license, permit, or other form of authorization or exemption required by law to perform the tasks.

(g) A provider shall not render telehealth services to a client in those situations in which the presence of a facilitator is required for safe and effective service to the client and no qualified facilitator is available to the client during the telehealth [telepractice] session.

(h) The scope, nature, and quality of the telehealth services provided, including the assistance provided by the facilitator, shall be commensurate with the services the provider renders in person at the same physical location as the client.

(i) The provider shall not render telehealth services unless the telecommunications technology and equipment located at the client site and at the provider site are appropriate to the telehealth services to be rendered; are properly calibrated and in good working order; and are of sufficient quality to allow the provider to deliver equivalent fitting and dispensing service and quality to the client as if those services were provided in person at the same physical location. The provider shall only utilize telecommunications technology and other equipment for telehealth [the provider’s telepractice] which the provider is competent to use.

(j) The initial contact between a provider and client may be at the same physical location or through telehealth, as determined appropriate by the provider. [A client’s initial professional contact with a provider shall be in person at the same physical location.]

(k) A provider shall consider relevant factors including the client's behavioral, physical, and cognitive abilities in determining the appropriateness of providing services via telehealth.

(l)(k) Providers and facilitators involved in the provider’s delivery of telehealth services shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements. Documentation of telehealth services shall include documentation of the date and nature of services performed by the provider by telehealth [telepractice] and of the assistive tasks of the facilitator.

(m)[(l)] Except to the extent it imposes additional or more stringent requirements, this section does not affect the applicability of any other requirement or provision of law to which an individual is otherwise subject under this chapter or other law.

REVIEW BY AGENCY COUNSEL

The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the agency’s legal authority.

Filed with the Office of the Secretary of State, on August 16, 2021.

Brad Bowman

General Counsel

Texas Department of Licensing and Regulation