1. (a) An individual shall not practice as an assistant in audiology without a current license issued by the department. An applicant for an assistant in audiology license shall meet the requirements set out in the Act and this section.

2. (b) An assistant in audiology shall meet the following requirements:

   1. (1) reach the minimum age of 18 years old and possess a high school diploma or equivalent;
   2. (2) complete the approved 20-hour certification course from the Council for Accreditation of Occupational Hearing Conservation (CAOHC) and earn a passing score on the examination; and

   3. (3) submit the department-prescribed Supervisory Responsibility Statement for an Assistant in Audiology Form, that shall include:

      1. (A) an agreement signed by both the licensed proposed department-approved supervisor (who must meet the requirements set out in the Act and §111.154) and the applicant, to enter into a supervisory relationship, in which the proposed department-approved supervisor agrees to assume responsibility for the applicant's activities, and the applicant agrees to perform only those activities assigned by the department-approved supervisor that are not prohibited under this section; and
      2. (B) a plan for a minimum of twenty-five (25) hours of job-specific competency-based training to be carried out by the department-approved supervisor. Until this training is complete, the licensed assistant in audiology may practice only under direct supervision by the department-approved supervisor.
3. (c) Upon satisfactory completion of job-specific competency-based training, the department-approved supervisor shall submit the Report of Completed Training for an Assistant in Audiology Form on behalf of the licensed assistant in audiology. After the department approves the report, the licensed assistant may practice only in compliance with the supervision requirements under subsection (e)(3).

4. (d) The Supervisory Responsibility Statement for an Assistant in Audiology Form must be completed and signed by both the applicant and the licensed audiologist who agrees to assume responsibility for all services provided by the licensed assistant in audiology. The department-approved supervisor must meet the requirements set out in the Act and §111.154.

   1. (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:

      1. (A) application for a license;
      2. (B) license renewal;
      3. (C) changes in supervision; and
      4. (D) addition of other department-approved supervisors.
   2. (2) In the event more than one licensed audiologist agrees to supervise the licensed assistant in audiology, each licensed audiologist shall be identified and a separate Supervisory Responsibility Statement for an Assistant in Audiology Form be submitted by each department-approved supervisor in a manner prescribed by the department.
   3. (3) A licensed assistant in audiology may renew the license but may not practice until a new Supervisory Responsibility Statement for an Assistant in Audiology Form is approved.
   4. (4) In the event the department-approved supervisor ceases supervision of the licensed assistant in audiology, the licensed assistant in audiology shall stop practicing immediately.
   5. (5) Should the licensed assistant in audiology practice without approval from the department, disciplinary action shall be initiated against the licensed assistant in audiology. If the department-approved supervisor had knowledge of this violation, disciplinary action against the department-approved supervisor shall also be initiated.

5. (e) A licensed audiologist department-approved supervisor shall assign duties and provide appropriate supervision to the licensed assistant in audiology.

   1. (1) All diagnostic contacts shall be conducted by the licensed audiologist department-approved supervisor.
   2. (2) Following the initial diagnostic contact, the licensed audiologist department-approved supervisor shall determine whether the licensed assistant in audiology has the competence to perform specific non-diagnostic and non-prohibited duties before delegating tasks (as referenced in subsection (f)(4)).
   3. (3) The licensed audiologist department-approved supervisor shall be on-site at the licensed assistant in audiology's employment location for at least ten (10) hours per week, or forty (40) hours per month, and provide at least one (1) hour per week or four (4) hours per month of direct supervision, at the location where the assistant is employed. However, the licensed audiologist department-approved supervisor shall be on-site and provide direct supervision for the duties described under subsections (f)(4)(A) - (D). This paragraph applies whether the licensed assistant in audiology is employed full- or part-time. For the purposes of this paragraph, the telehealth and telepractice provisions described under §111.215 may be used except for duties described under subsections (f)(4)(A) - (D) where the department-approved supervisor must be on-site and provide direct supervision. When determining the amount and type of supervision, the department-approved supervisor must consider the skill and experience of the licensed assistant as well as the services to be provided. The supervision hours established in this paragraph may be exceeded as determined by the department-approved supervisor.
   4. (4) Supervisory records shall be maintained by the licensed audiologist department-approved supervisor for a period of three years which verify regularly scheduled monitoring, assessment, and evaluation of the licensed assistant in audiology's and client's performance. Such documentation may be requested by the department.

6. (f) Although the licensed audiologist department-approved supervisor may delegate specific clinical tasks to a licensed assistant, the responsibility to the client for all services provided cannot be delegated. The licensed audiologist department-approved supervisor shall ensure that all services provided are in compliance with this chapter.

   1. (1) The licensed audiologist department-approved supervisor need not be in direct supervision when the licensed assistant is completing the assigned tasks; however, the licensed audiologist department-approved supervisor shall document all services provided and the supervision of the licensed assistant.
   2. (2) The licensed audiologist department-approved supervisor shall keep job descriptions and performance records. Records shall be current and be made available upon request to the department.
   3. (3) The licensed assistant may execute specific components of the clinical hearing program if the licensed audiologist department-approved supervisor determines that the licensed assistant has received the training and has the skill to accomplish that task, and the licensed audiologist department-approved supervisor provides sufficient supervision to ensure appropriate completion of the task assigned to the licensed assistant.

   4. (4) Examples of duties that a licensed audiologist department-approved supervisor may assign to a licensed assistant who has received appropriate training include the following:

      1. (A) conduct or participate in, with the department-approved supervisor on-site, 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. (B) assist the audiologist, who must be on-site, with play audiometry, visual reinforcement audiometry, and tasks such as picture-pointing speech audiometry;
      3. (C) assist the audiologist, who must be on-site, in the evaluation of difficult-to-test patients;
      4. (D) assist the audiologist, who must be on-site, with technical tasks for diagnostic evaluation such as preparing test rooms, attaching electrodes, and preparing patients prior to procedures;
      5. (E) maintain clinical records;
      6. (F) prepare clinical materials;
      7. (G) participate with the department-approved supervisor in research projects, staff development, public relations programs, or similar activities as designated and supervised by the department approved supervisor;
      8. (H) maintain equipment by conducting biologic and electroacoustic calibration of audiometric equipment, perform preventative maintenance checks and safety checks of equipment;
      9. (I) explain the proper care of hearing instruments and assistive listening devices to patients;
      10. (J) 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. (K) provide case history and/or self-assessment forms and clarify questions on the forms to patients as needed;
      12. (L) conduct basic record keeping and prepare paperwork for signature by the audiologist;
      13. (M) coordinate ear mold and hearing instrument records or repairs and other orders;
      14. (N) attach hearing aids to computers and use software to verify internal electroacoustic settings; and
      15. (O) perform other non-diagnostic duties not prohibited in paragraph (5), for which the assistant has been trained and demonstrates appropriate skills, as assigned by the licensed audiologist department-approved supervisor.

   5. (5) The licensed assistant shall not:

      1. (A) conduct aural habilitation or rehabilitation activities or therapy;
      2. (B) 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. (C) collect data during aural rehabilitation therapy documenting progress and results of therapy;
      4. (D) administer assessments during aural rehabilitation therapy to assess therapeutic progress;
      5. (E) conduct any audiological procedure that requires decision-making or leads to a diagnosis, even under direct supervision;
      6. (F) interpret results of procedures and evaluations, except for screening tests;
      7. (G) make diagnostic statements, or propose or develop clinical management strategies;
      8. (H) make ear impressions;
      9. (I) 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. (J) make any changes to the internal settings of a hearing instrument manually or using computer software;
      11. (K) represent audiology at staff meetings or on an admission, review and dismissal (ARD) committee;
      12. (L) attend staffing meetings or ARD committee meetings without the department-approved supervisor being present;
      13. (M) design a treatment program;
      14. (N) determine case selection;
      15. (O) present written or oral reports of client information, except to his or her department-approved supervisor;
      16. (P) refer a client to other professionals or other agencies;
      17. (Q) use any title which connotes the competency of a licensed audiologist; or
      18. (R) practice as a licensed assistant in audiology without a valid Supervisory Responsibility Statement for an Audiology Assistant Form or information on file with the department.
7. (g) In any professional context the licensee must indicate the licensee's status as a licensed audiology assistant.
8. (h) A licensed assistant in audiology may not engage in the fitting, dispensing or sale of a hearing instrument; 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 his or her assistant in audiology license when performing those activities.

9. (i) The department may audit a random sampling of licensed assistants in audiology for compliance with this section and §111.154.

   1. (1) The department shall notify a licensed assistant in audiology and the licensed audiologist department-approved supervisor in a manner prescribed by the department that the licensee has been selected for an audit.
   2. (2) Upon receipt of an audit notification, the licensed assistant in audiology and the licensed audiologist department-approved supervisor, who agreed to accept responsibility for the services provided by the licensed assistant in audiology, shall provide the requested proof of compliance to the department in a manner prescribed by the department.
   3. (3) The licensed assistant in audiology and the licensed audiologist department-approved supervisor shall comply with the department's request for documentation and information concerning compliance with the audit.
10. (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.

Source Note:The provisions of this §111.90 adopted to be effective October 1, 2016, 41 TexReg 4441.