(1) Except where noted, this subchapter applies to
hearing instrument fitters and dispensers, apprentice permit holders,
and temporary training permit holders, as authorized under this subchapter.
(2) Except to the extent it imposes additional or more
stringent requirements, this subchapter 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.
(b) Licensure and Scope of Practice.
(1) An individual shall not provide telehealth services
to a client in the State of Texas, unless the individual holds a license
or permit issued by the department and qualifies as a provider as
that term is defined in this subchapter, or is otherwise legally authorized
to do so.
(2) A provider may provide only those telehealth services
that are within the course and scope of the provider's license or
permit and competence, and delivered in accordance with the requirements
of that license or permit and pursuant to the terms and conditions
set forth in this chapter.
(3) A provider who is an apprentice permit holder may
provide telehealth services under their approved supervisor's license
according to the supervision requirements under 16 TAC §112.43.
(4) A provider who is a temporary training permit holder
may provide telehealth services, as directed by their supervisor,
according to the temporary training permit holder requirements under
Texas Occupations Code, Chapter 402, Subchapter F and 16 TAC §112.53.
A provider who is a temporary training permit holder may only provide
telehealth services after the direct supervision training requirements
(c) Competence and Standard of Practice (Code of Ethics).
(1) 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.
(2) A provider shall comply with the code of ethics
and scope of practice requirements in this chapter when providing
(3) The scope, nature, and quality of the services
provided via telehealth shall be the same as the services provided
(4) A provider shall determine whether a particular
service or procedure is appropriate to be provided via telehealth.
A provider shall not provide a service or procedure via telehealth
if it is not appropriate or cannot be provided at the same standard
of care as if it were provided in-person.
(5) As pertaining to liability and malpractice issues,
a provider providing telehealth services shall be held to the same
standards of practice as if the services were provided in person.
(1) Subject to the requirements and limitations of
this subchapter, a provider may utilize a facilitator at the client
site to assist the provider in providing telehealth services.
(2) A provider shall document whether a facilitator
is used in providing telehealth services. If a facilitator is used,
the provider shall document the tasks in which the facilitator provided
(3) Before allowing a facilitator to assist the provider
in providing telehealth services, the provider shall ascertain and
document the facilitator's qualifications, training, and competence,
as appropriate and reasonable, in:
(A) each task the provider directs the facilitator
to perform at the client site; and
(B) the methodology and equipment the facilitator is
to use at the client site.
(4) The facilitator may perform at the client site
only the following tasks:
(A) a task for which the facilitator holds and acts
in accordance with any license, permit, authorization, or exemption
required by law to perform the task; and
(B) those physical, administrative, and other tasks
for which a provider determines a facilitator is competent to perform
in connection with providing telehealth services, for which no form
of license, permit, authorization, or exemption is required by law.
(5) A 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.
(6) A provider shall not provide telehealth services
to a client if the presence of a facilitator is required for safe
and effective service to the client and no qualified facilitator is
(e) Technology and Equipment.
(1) The provider shall use only telecommunications
technology, as defined in this subchapter, to provide telehealth services.
Modes of communication that do not utilize such telecommunications
technology, including analog telephone, facsimile, and email, may
be used only as adjuncts.
(2) A provider shall only utilize telecommunications
technology and other equipment that the provider is competent to use
as part of the provider's telehealth services.
(3) The provider shall not provide telehealth services
unless the telecommunications technology and equipment located at
the client site and at the provider site:
(A) are appropriate to the telehealth services to be
(B) are properly calibrated, if appropriate, and in
good working order; and
(C) are of sufficient quality to allow the provider
to deliver equivalent service and quality to the client as if those
services were provided in person at the same physical location.
(f) Client Contacts and Communications.
(1) The initial contact between a provider and client
may be at the same physical location or through telehealth, as determined
appropriate by the provider.
(2) A provider shall consider relevant factors including
the client's behavioral, physical, and cognitive abilities in determining
the appropriateness of providing services via telehealth.
(3) A provider shall be aware of the client's level
of comfort with the technology being used as part of the telehealth
(4) A provider shall be sensitive to cultural and linguistic
variables that affect the identification, assessment, treatment, and
management of the clients
(5) 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.
(g) Records and Billing.
(1) A provider of telehealth services shall comply
with all laws, rules, and regulations governing the maintenance of
client records, including client confidentiality requirements.
(2) Documentation of telehealth services shall include
documentation of the date and nature of services performed by the
provider through telehealth and the assistive tasks of the facilitator,
(3) A provider is allowed to provide telehealth services
in accordance with this subchapter, but reimbursement of telehealth
services is subject to the reimbursement policies of the entity being
(h) Hearing Instruments. Hearing instruments may be
adjusted digitally through the use of telecommunications technology
by a provider who provides telehealth services under this subchapter.