What Does The AUD Model Licensing Bill Mean To You?
Organized Audiology Targeting State Legislation
The movement to achieve "gatekeeper" status for audiologists has resurfaced-this time on the many states level throughout the US. It is not (yet) an issue in Alabama, but may surface in the future. You should, as a practicing dispenser, have a good working knowledge about this effort in other states. For that reason, this information is provided for your information.
Having failed in their initiative on the federal level, organized audiology has taken action to achieve their ultimate goal as the sole entry point to hearing healthcare state-by-state. The doctoral degree in audiology (AuD) is their platform.
The advent of the AuD has led to the assertion that this be the entry-level degree for the practice of audiology. To that end a joint committee from the American Academy of Audiology, the Academy of Dispensing Audiologists and the Audiology Foundation of America created a model bill for the regulation of the profession of audiology (AuD Model Bill).
It has long been IHS's position to support legislation that:
· maximizes access to hearing healthcare services
· provides for healthy competitive business practices
· recognizes the roles of all licensed and qualified hearing healthcare providers
· does not increase cost
While IHS does not oppose recognizing audiologists who attain a doctoral degree and incorporating such into existing state statutes, the AuD Model Bill contains provisions that are not in the consumer's best interest and could restrict practice by other hearing health professions. Enactment of this model legislation would dramatically restructure the nation's hearing healthcare delivery system; it would recognize audiologists as autonomous providers of hearing health services and could require all non-audiologists to work under the supervision of and all patients to be managed by an AuD audiologist.
As written, the AuD Model Bill could:
· redefine the practice of audiology to include every conceivable aspect of hearing healthcare; the sweeping language leaves considerable room for interpretation through the rulemaking process;
· restrict the use of the title Audioprosthologist by non-audiologists;
· restrict the practice of fitting and dispensing of hearing aids to audiologists;
· endanger the consumer by allowing service without face-to-face contact; and
· relegate non-AuD audiologists entering the profession to practice only under the supervision of a licensed audiologist.
The AuD Model Bill is not in the best interest of the hearing impaired. It will impede access and raise costs. This initiative is on a fast track. It will eventually come up in our state. IHS will continue to monitor state legislative developments and will work directly with affiliate chapters facing legislative initiatives that would restrict consumer access to all hearing healthcare professionals. We were successful in preserving your right to practice during the federal FDA rulemaking. The battlefield has now shifted to the states.
IHS Analysis of Key Issues in the AuD Model Bill
Sec. 1 Statement of Purpose
Audiology is hereby declared to be a learned profession, affecting public safety and welfare and charged with the public interest, and therefore subject to protection and regulation by the State. It is the policy of the State to assure the availability of the highest possible quality of audiology services to the people of this State. It is furthermore the policy of the State to serve the public by further expanded education and training requirements for providers of audiology services, through transition to doctorate status for all such providers.
ISSUE
Public safety and welfare are currently being met by existing requirements. Transition to doctorate status as a minimum entry-level requirement will limit access to all qualified hearing healthcare providers and raise costs.
Sec. 2.4 Audiologist, any person that engages in the practice of audiology. A person represents oneself to be an audiologist if that person holds out to the public that the person practices audiology, by any means, or by any service or function performed, directly or indirectly, or by using the terms audiological, audiologist, audiology, audiometrics, audiometrist, aural rehabilitationist, balance center, hearing aid audiologist, hearing and balance center, hearing and balance specialist, vestibular specialist, hearing center, hearing clinic, hearing clinician, hearing conservation, hearing conservationist, hearing therapist, hearing therapy, or any variation or synonym which expresses, employs, or implies these terms or functions.
ISSUE
This definition has been crafted to include any/every practice term related to hearing and communication disorders. This definition leaves considerable room for interpretation through the rulemaking process by including such sweeping terms as directly or indirectly and any variation or synonym which expresses, employs, or implies these terms or functions. These statements restrict other professionals from using terms reserved for use by an audiologist only.
Sec. 2.5 Audiology
(a) The application of principles, methods, and procedures related to the development and disorders of the human auditory-vestibular system, which disorders shall include any and all conditions whether of organic or functional origin, including, but not limited to, disorders of hearing, balance, tinnitus, auditory processing and other neural functions, as those principles, methods and procedures are taught in doctoral programs in audiology in accredited programs.
(b) Such principles, methods or procedures include, without limitation, those of diagnosis, assessment, measurement, testing, appraisal, evaluation, rehabilitation, treatment, prevention, conservation, identification, consultation, counseling, intervention, management, interpretation, instruction or research related to hearing, vestibular function, balance and fall prevention, and associated neural systems, or any abnormal condition related to tinnitus, auditory sensitivity, acuity, function or processing, speech, language or other aberrant behavior resulting from hearing loss, for the purpose of diagnosing, designing, and implementing audiological management and treatment or other programs for the amelioration of such disorders and conditions. Management and treatment shall include but not be limited to the activities described in subsection 2.5(c) below.
(c) Engaging in the practice of prescribing, selecting, specifying, evaluating, assisting in the adjustment to, and dispensing of prosthetic devices for hearing loss, including hearing aids, and hearing assistive devices by means of specialized audiometric equipment or by any other means accepted by the board.
ISSUE
By including hearing aids, hearing aid screening and hearing aid sales, this all-encompassing description could expand the audiologist's scope of practice and establish a legal basis limiting the provision of these services by others. Further, terminology such as any and all conditions, and including, but not limited to and without limitation leaves room for interpretation through the rulemaking process.
Sec. 2.6 Audiology assistant, an unlicensed individual who provides specified services under the supervision of a licensee.
ISSUE
See Sections 5 and 5.1.
Sec. 2.12 Hearing aid, any wearable, implantable or partially implantable instrument or device, including an assistive hearing device, designed for or offered or represented as aiding or compensating for impaired human hearing and any attachments, or accessories to the instrument or device, including ear molds, but excluding batteries and cords or accessories thereto, or equipment, devices, and attachments used in conjunction with services provided by a public utility company.
Sec. 2.13 Hearing screening, a binary puretone screening at a preset intensity level for the purpose of determining if the screened individuals are in need of further medical or audiological evaluation. Measurements of auditory thresholds are not included in hearing screening procedures.
Sec. 2.20 Rental or selling of hearing aids, the selection, adaptation, and sale or rental of hearing aids. Also included is the making of impressions for ear molds and instruction pertaining to the use of hearing aids, as well as the repair of hearing aids.
ISSUE
These definitions, by their inclusion, now become covered skills/competencies of the AuD licensee.
Sec. 2.23 Telehealth communications, the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiologic care to an individual at a distance from the provider through hardwire or internet connections.
ISSUE
It is not in the consumer's best interest to receive services via "hardwire or internet connections."
Sec. 4 License required for practice
(a) No person may engage in the practice of audiology, or display a sign, or in any other way advertise or hold oneself out as a person who practices audiology, unless the person holds a current license issued by the board, an affiliated person holds such a license, or the person comes under the provisions of subsection (c) of this section.
(b) Such advertisement or holding out referred to in subsection (a) of this section includes, without limitation, use of the title "audiologist," "clinical audiologist," "certified hearing aid audiologist," "audioprosthologist," "licensed hearing aid audiologist," or any similar title, or use, without limitation, of any of the following words to represent oneself: "audiological," "audiology," "audiometrics," "audiometrist," "audiometry," "aural rehabilitationist," "balance center," "balance specialist" "hearing aid audiologist," "hearing and balance center," "hearing center," "hearing clinic," "hearing clinician," "hearing conservation," "hearing conservationist," "hearing therapy," "hearing therapist," "vestibular specialist," or any other title that expresses, employs, or implies similar terms or functions.
(c) A person that is not an individual that engaged in activities within the scope of subsection (a) of this section at least one year prior to the effective date of this chapter, without an affiliated person that holds a license, may continue to do so only so long as it employs or contracts for the services of at least one individual who is a licensee and only such licensee provides audiology services or supervises audiology assistants.
ISSUE
This definition has been crafted to include any/every practice title related to hearing and communications disorders. This definition leaves considerable room for interpretation through the rules process by including such sweeping terms as without limitation and any other title that expresses, employs, or implies similar terms or functions. These statements could prohibit other professionals from using titles restricted to use by an audiologist only.
Important: Should you encounter any provision to restrict the use of the title audioprosthologist contact IHS immediately. IHS has successfully protected the use of this title in every instance it has been challenged.
Sec. 4.3 Qualifying examinations for audiologists
(a) The board may conduct examinations for audiologist licensure, or adopt an examination conducted by a national examination agency. The examinations shall be in writing and consist of tests that require applicants to demonstrate at least the minimum knowledge of services and subject matter related to the practice of audiology that will enable the applicant to practice audiology effectively.
(b) As the volume of applications may make appropriate, the board shall administer the qualifying examinations throughout the year. The board shall provide public notice of each examination at least 60 days before it is held.
ISSUE
Proficiency is not guaranteed by virtue of education alone. A consumer is best served by requiring demonstration of proficiency in all areas of hearing instrument dispensing through a written and practical examination process.
Sec. 4.5 Effect of statute
(a) Nothing in this chapter may be construed as preventing or restricting:
(1) A person licensed or registered by this state in another profession from practicing the profession for which licensed, registered, certified or credentialed.
(2)-(6)
(b) This statute does not do any of the following:
(1) Authorize an individual licensed under this statute to engage in any practice for which a license is required by any other licensing board.
(2) Authorize a speech-language pathologist or other practitioner licensed or registered in this state to provide audiology services as defined in sections 2.4 (a), (b), and (c) of this statute.
ISSUE
The only way hearing instrument specialists can be assured their right to practice is protected is to include language that specifically identifies them as excluded professionals.
Sec. 4.7 Reciprocity
(c) The board may grant a license to an audiologist who practices audiology solely by means of telehealth communications from outside this state on an individual who is located in this state. The license shall only be granted to an individual who does all of the following:
(1) Submits an application for the license to the board on a form provided by the board.
(2) Pays the fee specified by applicable rules.
(3) Presents evidence that the individual holds an unrestricted valid license from another state or territory of the United States.
(4) Submits evidence satisfactory to the board that he or she has received a doctor of audiology degree from an accredited program, or has completed education or training that the board determines is substantially equivalent to the completion of that requirement.
(5) Meets such other requirements as the board establishes by rule.
(d) The board shall set forth rules regulating the practice of audiologists who practice by means of telehealth communications.
ISSUE
It is not in the consumer's best interest to receive services via telehealth communications.
Sec. 5 Audiology assistants An audiology assistant shall work under the supervision of a licensee. A licensee supervising an audiology assistant shall account for the performance and all services provided by the assistant, consistent with rules established by the board.
Sec. 5.1 Restriction on audiology assistants
The assistant may not engage in any of the following activities:
(a) Interpreting obtained observations or data into diagnostic statements of clinical management strategies or procedures.
(b) Determining case selection.
(c) Transmitting clinical information including data or impressions relative to client performance, behavior, or progress either verbally or in writing to anyone other than the professional.
(d) Independently composing clinical reports except for progress notes to be held in the client's file.
(e) Referring a client to other agencies.
(f) Using any title either verbally or in writing other than that determined by the licensee.
ISSUE
This language appears to be fairly innocuous on the surface, but has the potential for interpretation in the future in light of AAA's vision of the audiology assistant as portrayed in the January/February 2006 issue of Audiology Today. Editor Jerry Northern, in his article "Look Around: The Audiology Assistants are Here," states:
"The need for hearing aids by our rapidly growing senior citizen population may require an expanded use of audiology assistants as the estimated manpower requirements needed far exceed our best estimates of the numbers of audiologists that will be available to meet these services."
It is clear that the intent is to hire "assistants" to sell hearing aids, thereby skirting all regulatory and competency requirements by virtue of an AuD audiologist's supervision, thus diminishing the quality of service to the consumer.