Comment--The Department received another comment from an individual related to §111.50(g)(3), Assistant in Speech-Language Pathology License--License Requirements. The commenter was glad to see rule changes that positively affect the practice of speech-language pathology, and in particular, the changes that provide more flexibility for supervising assistants. The commenter stated that the changes, which allow for the supervision time to occur in monthly units, will allow very rural patients to receive services.

Department Response-- The Department appreciates the comment on the proposed changes. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received another comment from an individual regarding §111.50(g)(3), Assistant in Speech-Language Pathology License--License Requirements. The commenter had a question about months such as December, when school is only in session for three weeks. The commenter asked whether licensees will be able to do six hours in that month or will they still be required to supervise eight hours in a three week time period.

Department Response-- The licensee will still be required to supervise a minimum of eight hours per month. The proposed rule creates flexibility by allowing supervision hours to be conducted and counted on a monthly basis rather than on a weekly basis; however, the proposed rule does not change the minimum number of eight hours that must be supervised per month. The current DSHS rule at 22 TAC §741.64(h)(4) requires at least two hours of supervision per week, which means at least eight hours per month. The Department has retained the same total number of hours of supervision per month. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received comments from the TSHA and an individual regarding §111.214, Requirements for Providing Telehealth Services in Speech-Language Pathology. The commenters support and agree with the licensing requirement for providers of telehealth services who practice in Texas.

Department Response-- The Department appreciates the comment on the proposed rule. The proposed rule reflects and carries over the current DSHS rule at 22 TAC §741.215, with updates to the appropriate licensing entity. The Department did not make any changes to the proposed rule in response to this comment.

Comment--The Department received comments from the TSHA and an individual regarding §111.212, Requirements for the Use of Telehealth by Speech-Language Pathologists. The commenters support the requirement for initial contact between a licensed speech-language pathologist and client to be at the same physical location to adequately assess the client's candidacy for telehealth services prior to the client receiving telehealth services.

Department Response-- The Department appreciates the comment on the proposed rule. The proposed rule reflects and carries over the current DSHS rule at 22 TAC §741.213. The Department did not make any changes to the proposed rule in response to this comment.

Comment--The Department received comments from the TSHA and an individual regarding §111.90, Assistant in Audiology License--Licensing Requirements. The commenters identified a conflict between §111.90(e)(4)(A) and §111.90(f)(5)(A) and (D). In §111.90(e)(4)(A), the licensed assistant may conduct assessments for documenting progress in aural rehabilitation therapy; however, under §111.90(f)(5)(A) and (D), the licensed assistant shall not conduct aural rehabilitation activities or therapy or administer assessments during aural rehabilitation therapy. The individual commenter also stated that the assistant would not have training to perform these activities based on the proposed licensing requirements and training. Both commenters suggested the elimination of §111.90(e)(4)(A).

Department Response-- Based on these public comments and the Advisory Board discussions and recommendations, the Department has removed §111.90(e)(4)(A). In addition, the Department has removed §111.90(e)(4)(B) based on the Advisory Board recommendation. The Advisory Board at its November 17, 2015, meeting discussed moving activities from the list of activities that an audiology assistant could do to the list of activities that the audiology assistant could not do as reflected in the Department proposed rules as published under §111.90(f)(4) and (f)(5). Section 111.90(e)(4) as published had another provision regarding aural rehabilitation that was not deleted or moved to the list of activities that the assistant could not do. The Department has deleted §111.90(e)(4)(A) to eliminate the conflict between §111.90(e)(4)(A) and §111.90(f)(5)(A) and (D) and to reflect the Advisory Board's discussion and intent that activities related to aural rehabilitation are to be included in the list of activities that an audiology assistant cannot perform. In addition, the Advisory Board also recommended deleting §111.90(e)(4)(B), which includes evaluations that the assistant cannot perform. This change would be consistent with the recently adopted DSHS rules that removed this provision.

Comment--The Department received comments from the Texas Academy of Audiology related to §111.90, Assistant in Audiology License--Licensing Requirements. The Texas Academy of Audiology submitted comments in support of the proposed rules changes, specifically regarding audiology assistants. The commenter stated that the current licensing requirements needed to be updated. The commenter stated that it was fully supportive of the proposed rule changes for the education requirements to include a high school diploma or equivalent and that the change is entirely consistent with the position statements offered by both the American Academy of Audiology and the American Speech-Language-Hearing Association on this issue. The commenter also stated that the proposed rule changes for what duties the audiology assistant can and cannot perform have been appropriately addressed. The commenter does foresee future discussions about the specific training courses used, but stated that for now the Council for Accreditation of Occupational Hearing Conservation (CAOHC) training course is appropriate given the lack of alternatives.

Department Response-- The Department appreciates the comments in support of the proposed changes. Regarding the training courses used, this may be an issue to be addressed by a work group in the future. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received a comment from the TSHA regarding §111.90, Assistant in Audiology License--Licensing Requirements. TSHA expressed its cautious support of the proposed rules to change the education requirement for a licensed assistant in audiology from a bachelor's degree to a high school diploma or GED. TSHA stated that the current education requirement for licensed assistants may be excessively restrictive, since there are very few licensed audiology assistants in Texas. TSHA also stated it was in support of a limit on the number of licensed assistants one licensed audiologist can supervise along with the specific requirements for on-site and in-person supervision. TSHA encouraged longitudinal tracking of this proposed rule change to insure consumer/client protection as well as to track an increase in the number of licensed assistants.

Department Response-- The Department appreciates the comment on the proposed changes. The issues regarding tracking changes may be appropriate for future discussions by a work group. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received comments from the TSHA regarding §111.154, Requirements, Duties and Responsibilities of Supervisors. TSHA stated that it supports the clear description of the supervision requirements based on whether the assistant holds a baccalaureate degree or a high school diploma or equivalent. TSHA requested the elimination of the word "interns" as it relates to audiology assistants with a high school diploma or equivalent.

Department Response-- The Department appreciates the comment regarding the clear description of the supervision requirements. The Department did not make the suggested change to remove the word "intern" from §111.154(e)(4)(C). The proposed rules address the total number of interns and/or assistants that can be supervised by a single supervisor and were modeled after the DSHS rules at 22 TAC §741.44(d)(4). The Department proposed rules do not address the total number of interns and the total number of assistants separately. The supervisor can supervise any combination of interns and assistants as long as the total number is not exceeded. At its November 17, 2015, meeting, the Advisory Board discussed that if the education requirements were changed for an audiology assistant from a bachelor's degree to a high school diploma or equivalent, the supervisor would not be able to supervise as many individuals. The proposed rules reflect the total number of interns and/or assistants that can be supervised if the audiology assistant holds a bachelor's degree or holds a high school diploma or equivalent. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received a comment from an individual regarding §111.154, Requirements, Duties and Responsibilities of Supervisors. The commenter agreed that an audiologist should not be allowed to supervise as many individuals if the assistants have a high school diploma or equivalent. The commenter requested that the Department keep the proposed rules under §111.154 regarding a supervisor supervising no more than a total of two (2) audiology interns and/or assistants, if an assistant holds a high school diploma or equivalent. The commenter stated that this is a strong change to make as compared to previous rules and stated that it is important to monitor patient services to determine the impact of this change.

Department Response-- The Department appreciates the comment in support of the proposed changes. The issue regarding monitoring the impact of the changes may be appropriate for future discussions by a work group. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received a comment from an individual regarding §111.75(d)(2), Audiology License--Application and Eligibility Requirements. The commenter stated that a person who is requesting a waiver and has ASHA or ABA certification could have received certification prior to 2011, which means they could be a certified audiologist with a master's degree. The commenter recommended adding language as found in §111.80(e) (master's degree if the audiologists applied for the certification before September 1, 2011, or a doctoral degree if the audiologists applied for certification after September 1, 2011).

Department Response-- Pursuant to Senate Bill 613, 82nd Legislature, Regular Session (2011), audiology license applicants must have at least a doctoral degree in audiology or a related hearing science for license applications filed on or after September 1, 2011. The ASHA or ABA certification only waives the clinical experience and examination requirements; it does not waive the education/degree requirements to obtain a license from the State. While an applicant may have obtained the ASHA or ABA certification before September 1, 2011, that date is relevant for purposes of the applicant filing the license application with the State. Texas Occupations Code Chapter 401 does not include reciprocity authority except as provided under §401.308 related to provisional licenses. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received comments from an individual regarding §111.80(f)(1), Intern in Audiology License--Licensing and Internship Requirements. The commenter discussed the 1600 hours of supervised clinical work. The comment noted that while it is not a new requirement, it assumes the individual with an audiology intern license will work 40 hours a week for 40 weeks. The commenter discussed other internship arrangements and placements and the potential impact of the 1600 hours on interns and schools. The commenter recommended considering a reduction in hours, and stated that even a reduction to 1500 hours would be beneficial to the licensees.

Department Response-- The Department appreciates the comment on the proposed changes. The issue regarding the 1600 hours was discussed by the Advisory Board at its November 17, 2015, meeting, but it decided to leave the currently required 1600 hours in the proposed rules as published. As part of the Department's and Advisory Board's discussion of the public comments, the issue regarding the 1600 hours was assigned to a work group of the Advisory Board for further study. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received comments by email and by mail from an individual regarding §111.30(a), Speech-Language Pathology License--Licensing Requirements. The commenter holds a Life-time Certification in Speech-Language-Hearing Therapy issued by the Texas Education Agency (TEA). The commenter is concerned that she and others who hold the TEA-issued certification, which allows them to practice within the public schools, will be prevented from doing so if they do not hold a license issued by the Department. The commenter stated that she completed all the necessary requirements at the time and obtained a valid life-time certification. The commenter suggested that proposed §111.30(a) be amended to add language referencing the "Life-time TEA Certification in the area of Speech-Language Pathology (restricted to the public schools)." The commenter requested that the Department consider "grandfathering in" the commenter and other therapists like her so they could continue in their profession.

Department Response-- Section 111.30(a) implements Texas Occupations Code §401.301, License Required. The statute also provides exemptions from holding a license under Chapter 401, and one of these exemptions is §401.054, Persons Certified by Texas Education Agency. Chapter 401 only includes exemptions; it does not include any grandfathering authority or provisions. The Advisory Board discussed that the last time TEA issued one of the lifetime certifications was in 1995 and that there are approximately 400 people that currently hold this TEA certification. The Advisory Board discussed that there were two previous opportunities for persons holding the TEA certifications to grandfather into the speech-language pathology license if they had been practicing, but those opportunities have passed and are no longer available. The statute and the proposed rules do not affect persons practicing with the Life-time TEA Certification as long as they are practicing under the scope of that certification and under the authority of TEA. The Department did not make any changes to the proposed rules in response to this comment. The Department will consider making this issue part of its frequently asked questions and customer service documents.

Comment--The Department received a comment from an individual requesting technical assistance in accessing a copy of the proposed rules.

Department Response-- The Department provided assistance with a website link to the proposed rules. The Department did not make any changes to the proposed rules in response to this comment.

Comment--The Department received a comment from an individual asking how to submit comments about specific rules. The commenter wanted to know if there is a specific format or website that provides guidance in formulating a proposal or comments.

Department Response-- The preamble of the proposed rules includes information about how and when to submit comments on the proposed rules to the Department. The preamble is included with the proposed rules published in the Texas Register and posted on the Department's website. An interested party may submit comments by mail, email, or fax, and there is no specific format that is required for the comments. The Department did not make any changes to the proposed rules in response to this comment.

The Speech-Language Pathologists and Audiologists Advisory Board (Advisory Board) met on November 17, 2015, to consider a draft of the proposed rules. The Advisory Board amended the draft rules and recommended proposing them in the Texas Register for public comment.

The Department staff met with DSHS staff to seek their technical expertise prior to the February 24, 2016, advisory board meeting.

The Advisory Board met on February 24, 2016, to discuss the proposed rules with Department staff and DSHS staff and to review the rule publication and the public comments received. The Department and the Advisory Board recommended changes to the proposed rules based on the public comments received and the Advisory Board discussion. The Advisory Board voted and unanimously recommended that the Commission adopt the proposed rules as published in the Texas Register with changes. At its meeting on April 13, 2016, the Commission adopted the proposed rules with changes as recommended by the Advisory Board and the Department.

The new rules are adopted under Texas Occupations Code, Chapters 51 and 401, and Chapter 402 as applicable, which authorize the Commission, the Department's governing body, to adopt rules as necessary to implement these chapters and any other law establishing a program regulated by the Department.

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