The Texas Department of Licensing and Regulation (Department) proposes new rules at 16 Texas Administrative Code (TAC) Chapter 111, Subchapter A, §111.1 and §111.2; Subchapter B, §§111.10, 111.11, 111.12, 111.13, and 111.14; Subchapter C, §§111.20, 111.21, 111.22 and 111.23; Subchapter D, §§111.30, 111.35, 111.36 and 111.37; Subchapter E, §§111.40, 111.45, 111.46 and 111.47; Subchapter F, §§111.50, 111.55, 111.56 and 111.57; Subchapter G, §§111.60, 111.65 and 111.66; Subchapter H, §§111.70, 111.75, 111.76 and 111.77; Subchapter I, §§111.80, 111.85, 111.86 and 111.87; Subchapter J, §§111.90, 111.95, 111.96 and 111.97; Subchapter K, §§111.100, 111.105 and 111.106; Subchapter L, §§111.110, 111.115, 111.116 and 111.117; Subchapter N, §§111.130, 111.131 and 111.132; Subchapter O, §111.140; Subchapter P, §§111.150, 111.151, 111.152, 111.153, 111.154 and 111.155; Subchapter Q, §111.160; Subchapter R, §111.170 and §111.171; Subchapter S, §§111.180, 111.181, 111.182 and 111.183; Subchapter T, §§111.190, 111.191 and 111.192; Subchapter U, §§111.200, 111.201 and 111.202; Subchapter V, §§111.210, 111.211, 111.212, 111.213, 111.214 and 111.215; Subchapter W, §111.220; Subchapter X, §§111.230, 111.231 and 111.232, regarding the Speech-Language Pathologists and Audiologists program.

The Texas Legislature enacted Senate Bill 202 (S.B. 202), 84th Legislature, Regular Session (2015), which, in part, transferred 13 occupational licensing programs in two phases from the Department of State Health Services (DSHS) to the Texas Commission of Licensing and Regulation (Commission) and the Department. Under Phase 1, the following seven programs are being transferred from DSHS to the Commission and the Department: (1) Midwives, Texas Occupations Code, Chapter 203; (2) Speech-Language Pathologists and Audiologists, Chapter 401; (3) Hearing Instrument Fitters and Dispensers, Chapter 402; (4) Licensed Dyslexia Practitioners and Licensed Dyslexia Therapists, Chapter 403; (5) Athletic Trainers, Chapter 451; (6) Orthotists and Prosthetists, Chapter 605; and (7) Dietitians, Chapter 701. The statutory amendments transferring regulation of these seven Phase 1 programs from DSHS to the Commission and the Department took effect on September 1, 2015.

The Texas Legislature also enacted Senate Bill 219 (S.B. 219), 84th Legislature, Regular Session (2015), which, in part, amended the enabling acts of the health-related programs regulated by DSHS before those programs were transferred by S.B. 202. S.B. 219 was effective April 2, 2015.

The new rules are proposed to enable the Commission and the Department to regulate the seven Phase 1 programs listed above. The proposed new rules provide for the Department to perform the various functions, including licensing, compliance, and enforcement, necessary to regulate these transferred programs. At the time of adoption, the Commission will designate the effective date of the new rules. The effective date will coincide with the completion of the transfer of the programs to the Commission and Department. The Commission will provide sufficient notice to the regulated community in order for it to comply with the new rules.

The proposed new rules under 16 TAC Chapter 111 are necessary to implement S.B. 202 and to regulate the Speech-Language Pathologists and Audiologists program under the authority of the Commission and the Department. The rules also incorporate the changes made by S.B. 219 as applicable. These proposed new rules are separate from and are not to be confused with the DSHS rules located at 22 TAC Chapter 741, regarding Speech-Language Pathologists and Audiologists, which are still in effect.

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

As part of the discussions on November 17, 2015, the Advisory Board recommended changing references from "communicative sciences or disorders" to "communication sciences and disorders." However, the proposed rules as published do not include that recommendation. The proposed rules as published retain the references to "communicative sciences or disorders" to reflect the statutory language under Texas Occupations Code §401.304(a)(1)(A), which requires an applicant for a speech-language pathology license to "possess at least a master's degree with a major in at least one of the areas of communicative sciences or disorders."

The Advisory Board also recommended updating the educational degree requirements for audiology licenses in several of the licensing provisions, but recommended retaining references in other audiology licensing provisions and in the supervision provisions to "a master's degree with a major in at least one of the areas of communicative sciences or disorders." With the exception of the out-of-state internship supervision provisions under proposed new §111.75 and §111.105, the proposed rules as published, as they relate to audiology licenses, either do not include the master's degree references or include those references but with date restrictions. S.B. 613, 82nd Legislature, Regular Session (2011), changed the educational degree requirements for audiology licenses from "at least a master's degree with a major in at least one of the areas of communicative sciences or disorders" to "at least a doctoral degree in audiology or a related hearing science." This change was effective September 1, 2011, and it applied to applications filed on or after the effective date. The proposed rules as published reflect the statutory language under Texas Occupations Code §401.304(a)(1)(B) and reflect the changes in the degree and the subject area requirements that were effective September 1, 2011, for audiology licenses. The Department seeks public comments on the degree and subject area requirements necessary to obtain an audiology license in other states in order to address the out-of-state internship supervision requirements under proposed new §111.75 and §111.105.

In addition, the discussions regarding the audiology license application and eligibility requirements under proposed new §111.75 included a recommendation to draft a reciprocity provision that would recognize, on a case-by-case basis, an out-of-state audiology license holder who had a master's degree, was licensed in good standing in the other state, and had held the out-of-state license continuously for at least five years. The provision would allow such a license holder to be eligible to obtain a Texas audiology license. The proposed rules as published do not include the recommended proposed reciprocity provision. Texas Occupations Code Chapter 401 does not include reciprocity authority except as provided under §401.308 related to provisional licenses. The Department will further research this issue for future discussions.

The Advisory Board also discussed changing the supervision ratios for licensed audiologists, licensed interns in audiology, and licensed assistants in audiology under proposed new rule §111.154. The current ratio under the current DSHS rules is that a licensed audiologist may supervise no more than a total of four interns and/or assistants. The DSHS proposed rules published September 25, 2015 (40 TexReg 6554 - 6572) and these Department proposed rules: (1) reduce the education requirements for an assistant in audiology license from a baccalaureate degree to a high school diploma or equivalent; and (2) eliminate the supervision ratio exception. Based in part on the reduction of the educational degree required for an assistant in audiology license, the Advisory Board recommended reducing the total number of audiology interns and/or assistants that can be supervised at one time by a licensed audiologist from a total of four interns and/or assistants to a total of two interns and/or assistants. The supervision ratio for licensed speech-language pathologists, interns, and assistants remains the same at no more than a total of four interns and/or assistants. The Department has included the recommendation in these proposed rules under §111.154 and seeks public comment on this issue.

Finally, the Department renumbered the sections in the proposed new rules for the specific license types under Subchapters D through L. This change from the draft discussed by the Advisory Board will allow room for future rulemakings to further clarify the rules and make the rules more user-friendly.

Proposed new Subchapter A provides the General Provisions for the proposed new rules.

Proposed new §111.1 provides the statutory authority for the Commission and Department to regulate speech-language pathologists and audiologists.

Proposed new §111.2 creates the definitions to be used in the speech-language pathologists and audiologists program.

Proposed new Subchapter B creates the Speech-Language Pathologists and Audiologists Advisory Board.

Proposed new §111.10 provides the composition and membership requirements of the advisory board.

Proposed new §111.11 details the duties of the advisory board.

Proposed new §111.12 sets the terms and vacancies process for advisory board members.

Proposed new §111.13 provides for a presiding officer of the advisory board.

Proposed new §111.14 provides details regarding advisory board meetings.

Proposed new Subchapter C establishes the examination requirements for the program.

Proposed new §111.20 provides general examination requirements.

Proposed new §111.21 explains the written examination requirement.

Proposed new §111.22 explains the waiver of the written examination requirement.

Proposed new §111.23 details the requirements for the Jurisprudence Examination.

Proposed new Subchapter D establishes the requirements to obtain a speech-language pathology license.

Proposed new §111.30 explains the licensing requirements for those seeking a speech-language pathology license.

Proposed new §111.35 details the application and eligibility requirements for the speech-language pathology license.

Proposed new §111.36 explains the process for issuing a speech-language pathology license.

Proposed new §111.37 details the license terms and renewal requirements for the speech-language pathology license.

Proposed new Subchapter E establishes the requirements to obtain an intern in speech-language pathology license.

Proposed new §111.40 explains the licensing and internship requirements for the intern in speech-language pathology license.

Proposed new §111.45 details the application and eligibility requirements for an intern in speech-language pathology license.

Proposed new §111.46 explains the process for issuing an intern in speech-language pathology license.

Proposed new §111.47 details the license terms and renewal requirements for the intern in speech-language pathology license.

Proposed new Subchapter F establishes the requirements to obtain an assistant in speech-language pathology license.

Proposed new §111.50 explains the licensing requirements for the assistant in speech-language pathology license.

Proposed new §111.55 details the application and eligibility requirements for an assistant in speech-language pathology license.

Proposed new §111.56 explains the process for issuing an assistant in speech-language pathology license.

Proposed new §111.57 details the license terms and renewal requirements for the assistant in speech-language pathology license.

Proposed new Subchapter G establishes the requirements to obtain a temporary certificate of registration in speech-language pathology.

Proposed new §111.60 explains the registration requirements for the temporary certificate of registration in speech-language pathology.

Proposed new §111.65 details the application and eligibility requirements for the temporary certificate of registration in speech-language pathology.

Proposed new §111.66 explains the process for issuing a temporary certificate of registration in speech-language pathology.

Proposed new Subchapter H establishes the requirements to obtain an audiology license.

Proposed new §111.70 explains the licensing requirements for the audiology license.

Proposed new §111.75 details the application and eligibility requirements for an audiology license.

Proposed new §111.76 explains the process for issuing an audiology license.

Proposed new §111.77 details the license terms and renewal requirements for the audiology license.

Proposed new Subchapter I establishes the requirements to obtain an intern in audiology license.

Proposed new §111.80 explains the licensing and internship requirements for the intern in audiology license.

Proposed new §111.85 details the application and eligibility requirements for an intern in audiology license.

Proposed new §111.86 explains the process for issuing an intern in audiology license.

Proposed new §111.87 details the license terms and renewal requirements for the intern in audiology license.

Proposed new Subchapter J establishes the requirements to obtain an assistant in audiology license.

Proposed new §111.90 explains the licensing requirements for the assistant in audiology license.

Proposed new §111.95 details the application and eligibility requirements for an assistant in audiology license.

Proposed new §111.96 explains the process for issuing an assistant in audiology license.

Proposed new §111.97 details the license terms and renewal requirements for the assistant in audiology license.

Proposed new Subchapter K establishes the requirements to obtain a temporary certificate of registration in audiology.

Proposed new §111.100 explains the registration requirements for the temporary certificate of registration in audiology.

Proposed new §111.105 details the application and eligibility requirements for the temporary certificate of registration in audiology.

Proposed new §111.106 explains the process for issuing a temporary certificate of registration in audiology.

Proposed new Subchapter L establishes the requirements to obtain a dual license in speech-language pathology and audiology.

Proposed new §111.110 explains the licensing requirements for those seeking a dual license in speech-language pathology and audiology.

Proposed new §111.115 details the application and eligibility requirements for the dual speech-language pathology and audiology license.

Proposed new §111.116 explains the process for issuing a dual speech-language pathology and audiology license.

Proposed new §111.117 details the license terms and renewal requirements for the dual speech-language pathology and audiology license.

Proposed new Subchapter N establishes the continuing professional education requirements for this program.

Proposed new §111.130 provides the continuing professional education requirements and hours for this program.

Proposed new §111.131 details continuing professional education courses and credits.

Proposed new §111.132 explains the continuing professional education audit process and the records that must be kept.

Proposed new Subchapter O establishes the responsibilities of the Commission and the Department.

Proposed new §111.140 requires the Commission to adopt rules necessary to implement the Speech-Language Pathology and Audiology program, including rules governing changes to the standards of practice rules.

Proposed new Subchapter P establishes the responsibilities of the licensee and creates the code of ethics for this program.

Proposed new §111.150 requires a licensee to notify the Department of a change of name, address, or other pertinent information.

Proposed new §111.151 provides requirements for displaying a license and notifying consumers.

Proposed new §111.152 prohibits false, misleading or deceptive advertising.

Proposed new §111.153 establishes record keeping and billing requirements.

Proposed new §111.154 explains the requirements, duties and responsibilities of supervisors.

Proposed new §111.155 creates the standards of ethical practice (code of ethics) for all licensees in this program.

Proposed new Subchapter O establishes fees for the Speech-Language Pathologists and Audiologists program.

Proposed new §111.160 details all fees associated with the Speech-Language Pathologists and Audiologists program as regulated by the Commission and the Department.

Proposed new Subchapter R establishes a subchapter to address complaints.

Proposed new §111.170 requires the Department to provide a toll free number for complaints to be filed.

Proposed new §111.171 provides that the Commission will adopt rules regarding complaints involving standard of care.

Proposed new Subchapter S establishes enforcement provisions.

Proposed new §111.180 allows for administrative penalties and sanctions.

Proposed new §111.181 provides the authority to enforce Texas Occupations Code, Chapter 401 and this chapter.

Proposed new §111.182 provides the authority to order refunds for a hearing instrument.

Proposed new §111.183 requires a license holder or registration holder to surrender the license or registration to the Department on demand.

Proposed new Subchapter T establishes screening procedures.

Proposed new §111.190 provides communication screening requirements.

Proposed new §111.191 details the hearing screening process.

Proposed new §111.192 explains the authority for newborn hearing screening.

Proposed new Subchapter U establishes provisions for fitting and dispensing of hearing instruments.

Proposed new §111.200 explains registration of audiologists and interns in audiology to fit and dispense hearing instruments.

Proposed new §111.201 provides general practice requirements of audiologists and interns in audiology who fit and dispense hearing instruments.

Proposed new §111.202 creates requirements for audiologists and interns in audiology conducting audiometric testing for the purpose of fitting and dispensing hearing instruments.

Proposed new Subchapter V establishes provisions for telehealth.

Proposed new §111.210 establishes definitions relating to telehealth.

Proposed new §111.211 explains the service delivery models for speech-language pathologists.

Proposed new §111.212 creates requirements for the use of telehealth by speech-language pathologists.