WSR 98-08-117

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed April 1, 1998, 11:55 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-15-098

Title of Rule: WAC 246-828-095 and 246-828-105, audiology and speech-language pathology minimum standards of practice

Purpose: Rules are needed to provide guidance to consumers of hearing and speech health care services, members of the public and audiologists and speech-language pathologists regarding the expected and recognized minimum standards of practice

Statutory Authority for Adoption: RCW 18.35.161 (3) and (10)

Statute Being Implemented: RCW 18.35.161(10)

Summary: The proposed new rules adopt standards of practice for the professions of audiology and speech-language pathology that are accepted and defined by the national organizations of these professions

Reasons Supporting Proposal: There is currently no board definition of minimum standards of practice for audiology and speech-language pathology. Minimum standards of practice rules are currently in place for hearing instrument fitting and dispensing

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Diane Young, 1300 Quince Street S.E., Olympia, (360) 586-0205

Name of Proponent: Department of Health, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The rule clearly defines the expected and recognized minimum standards of practice for audiology and speech-language pathology services. The rule is anticipated to provide guidance for consumers of hearing and speech services, members of the public and audiologists and speech-language pathologists regarding the acceptable standards of practice

Proposal does not change existing rules.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

and

Economic Impact Analysis

This report contains the economic impact analysis used by health professions quality assurance in determining program costs associated with implementing standards of practice.

Background: The state of Washington recognizes speech-language pathology as a profession that provides services related to the development and disorders that impede oral, pharyngeal, or laryngeal sensorimotor competencies and the normal process of communication. These services are provided in a number of professional health care and educational settings to infants, children, adults and elderly.

The state of Washington recognizes audiology as a profession that provides services related to hearing and the disorders of hearing and to related language and speech disorders, that impede the normal process of communication. It is also acknowledged that this profession fits and dispenses hearing instruments and provides cerumen management. These services are provided in a number of professional health care and education settings to infants, children, adults and elderly.

The proposed standards of practice for speech-language pathologists and audiologists is intended to protect the public from being misled by incompetent, unethical and unauthorized persons; and to assure the availability of hearing and speech services of high quality to citizens of Washington state.

The potential for physical, economical and mental harm compelled the industry to seek regulation. Some examples of harm that could and have resulted from incompetent practice include: Defrauding individuals of thousands of dollars; failure to recognize early signs of chronic disease and misuse of hearing instrumentation causing infections or lacerations of the ear or perforation of the ear drum.

Pursuant to RCW 18.35.161, the board shall have the power and duty to adopt rules relating to standards of care relating to hearing instrument fitter/dispensers, audiologists and speech-language pathologists.

ESHB 2309 expanded the professionals regulated under chapter 18.35 RCW to include not only hearing instrument fitter/dispensers as it did previously but also audiologists and speech-language pathologists. Rules are in place that define the standards of practice for hearing instrument fitter/dispensers. The proposed regulation creates a voluntary certification for speech-language pathologists and audiologists. The proposed voluntary certification of these professions will provide defined standards of practice and a means for the public to verify that the professional meets those defined standards.

Economic Impact Analysis

Costs to a Business: Due to the voluntary nature of certification of speech-language pathologists and audiologists there is no imposed impact on business. Those individuals with current certification from the national organization or from the state of Washington Superintendent of Public Instruction currently practice under the proposed standards. Research demonstrates that the majority of professionals currently practicing hold at least one of these certifications.

There would be no disproportionate effect on small and large entities. The regulated entities are all small businesses. These businesses have been involved in work groups to develop the rules defining standards of practice for the professions and suggestions submitted by individuals in writing have been incorporated into the proposed rules.

Department of Health Costs to Administer the Regulation: Audiology and speech-language pathology are newly regulated health professions; therefore, there is no program history on cost. Estimated expenditures are based on the Department of Health standard cost factors for budgeting. These include phase-in costs support staffing, purchase of workstation furniture and other equipment, purchase of attorney general services, the Department of Health investigation services and agency indirect costs.

This revenue must be collected from fees assessed on the regulated entities.

The required program revenue includes funds to support both start-up costs as well as recurring expenses for program administration.

The following table illustrates overall administration cost and estimated revenue.

A copy of the statement may be obtained by writing to the Department of Health, Hearing and Speech Program, P.O. Box 47869, Olympia, WA 98504-7869, phone (360) 586-0205, or FAX (360) 586-7840

RCW 34.05.328 does not apply to this rule adoption. Speech-language pathology and audiology certification is voluntary.

Hearing Location: WSU-Spokane, 601 West First Avenue, Spokane, WA, on May 5, 1998, at 9:00 a.m

Assistance for Persons with Disabilities: Contact Betty Bird by April 21, 1998, TDD (800) 525-0127, or (360) 586-8577

Submit Written Comments to: Department of Health, Diane Young, P.O. Box 47869, Olympia, WA 98504-7869, FAX (360) 586-7840, by May 1, 1998

Date of Intended Adoption: May 8, 1998

March 20, 1998

Dolores E. Spice

Executive Director

OTS-1630.2

NEW SECTION

WAC 246-828-095  Audiology minimum standards of practice. Certified audiologists are independent practitioners who provide a comprehensive array of services related to the identification, assessment, habitation/rehabilitation and prevention of auditory and vestibular impairments.

Audiologists serve in a number of roles including but not limited to clinician, therapist, teacher, consultant, researcher, and administrator. Audiologists provide services in hospitals, clinics, schools, nursing facilities, care centers, private practice and other settings in which audiological services are relevant. Audiologists provide services to individuals of all ages.

Audiologists must engage in and supervise only those aspects of the profession that are within the scope of their education, training and experience.

Standard procedures for providing audiology services may include one or more of the following:

(1) Case history to include:

(a) Documentation of referrals.

(b) Historical review of the nature, onset, progression and stability of the hearing problem, and associated otic and/or vestibular symptoms.

(c) Review of communication difficulties.

(d) Review of medical, pharmacology, vocational, social and family history pertinent to the etiology, assessment and management of the underlying hearing disorder.

(2) Physical examination of the external ear includes:

(a) Otoscopic examination of the external auditory canal to detect:

(i) Congenital or traumatic abnormalities of the external canal or tympanic membrane.

(ii) Inflammation or irritation of the external canal or tympanic membrane.

(iii) Perforation of the tympanic membrane and/or discharge from the external canal.

(iv) A foreign body or impacted cerumen in the external canal.

(b) Cerumen management to clean the external canal and to remove excess cerumen for the preservation of hearing.

(c) Referral for otologic evaluation and/or treatment when indicated.

(3) Identification of audiometry:

(a) Hearing screening administered as needed, requested, or mandated for those persons who may be identified as at risk for hearing impairment.

(b) Referral of persons who fail the screening for rescreening, audiologic assessment and/or for medical or other examination and services.

(c) Audiologists may perform speech and language screening measures for initial identification and referral.

(4) Assessment of auditory function includes:

(a) The administration of behavioral and/or objective measures of the peripheral and central auditory system to determine the presence, degree and nature of hearing loss or central auditory impairment, the effect of the hearing impairment on communication, and/or the site of the lesion within the auditory system. Assessment may also include procedures to detect and quantify nonorganic hearing loss.

(i) When traditional audiometric techniques cannot be employed as in infants, children or multiple impaired clients, developmentally appropriate behavioral and/or objective measures may be employed.

(ii) Assessment and intervention of central auditory processing disorders in which there is evidence of communication disorders may be provided in collaboration with other professionals.

(b) Interpretation of measurement recommendations for habilitative/rehabilitative management and/or referral for further evaluation and the counseling of the client and family.

(5) Assessment of vestibular function includes administration and interpretation of behavioral and objective measures of equilibrium to detect pathology within the vestibular system, to determine the site of lesion, to monitor changes in balance and to determine the contribution of visual, vestibular and proprioceptive systems to balance.

(6) Habilitation/rehabilitation of auditory and vestibular disorders may include:

(a) Aural rehabilitation therapy.

(b) Fitting and dispensing of hearing instruments and assistive listening devices.

(c) Habilitative and rehabilitative nonmedical management of disorders of equilibrium.

(7) Industrial and community hearing conservation programs.

(8) Intraoperative neurophysiologic monitoring.

(9) Standardized and nonstandardized procedures may be employed for assessment, habilitation/rehabilitation of auditory and vestibular disorders. When standardized procedures are employed they must be conducted according to the standardized procedure or exception documented. Nonstandardized measures must be conducted according to established principles and procedures of the profession.

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NEW SECTION

WAC 246-828-105  Speech-language pathology--Minimum standards of practice. Certified speech-language pathologists are independent practitioners who provide a comprehensive array of services related to the identification, assessment, habilitation/rehabilitation, of communication disorders and oro-pharyngeal and dysphasia. Speech-language pathologists serve in a number of roles including but not limited to clinician, therapist, teacher, consultant, researcher, and administrator. Speech-language pathologists provide services in hospitals, clinics, schools, nursing facilities, care centers, private practice, and other settings in which speech-language pathology services are relevant. Speech-language pathologists provide services to individuals of all ages.

Services must be provided and products dispensed only when benefit can reasonably be expected. All services provided and products dispensed must be evaluated for effectiveness. A certified speech-language pathologist must engage in and supervise only those aspects of the profession that are within the scope of their education, training, and experience. Speech-language pathologists must provide services appropriate to each individual in his or her care, which may include one or more of the following standard procedures:

(1) Case history, to include the following:

(a) Documentation of referral.

(b) Review of the communication, cognitive and/or swallowing problem.

(c) Review of pertinent medical, pharmacological, social and educational status.

(2) Examination of the oral mechanism for the purposes of determining adequacy for speech communication and swallowing.

(3) Screening to include: Speech and language.

(a) Hearing screening, limited to pure-tone air conduction and screening tympanometry.

(b) Swallowing screening. Children under the age of three years who are considered at risk are assessed, not screened;

(4) Assessment may include the following:

(a) Language may include parameters of phonology, morphology, syntax, semantics, and pragmatics; and include receptive and expressive communication in oral, written, graphic and manual modalities;

(b) Speech may include articulation, fluency, and voice (including respiration, phonation and resonance). Treatment shall address appropriate areas;

(c) Swallowing;

(d) Cognitive aspects of communication may include communication disability and other functional disabilities associated with cognitive impairment;

(e) Central auditory processing disorders in collaboration with other qualified professionals;

(f) Social aspects of communication may include challenging behaviors, ineffective social skills, lack of communication opportunities;

(g) Augmentative and alternative communication include the development of techniques and strategies that include selecting, and dispensing of aids and devices (excluding hearing instruments) and providing training to individuals, their families, and other communication partners in their use.

(5) Habilitation/rehabilitation of communication and swallowing to include the following:

(a) Treatment of speech disorders including articulation, fluency and voice.

(b) Treatment of language disorders including phonology, morphology, syntax, semantics, and pragmatics; and include receptive and expressive communication in oral, written, graphic and manual modalities.

(c) Treatment of swallowing disorders.

(d) Treatment of the cognitive aspects of communication.

(e) Treatment of central auditory processing disorders in which there is evidence of speech, language, and/or other cognitive communication disorders.

(f) Treatment of individuals with hearing loss, including aural rehabilitation and related counseling.

(g) Treatment of social aspects of communication, including challenging behaviors, ineffective social skills, and lack of communication opportunities.

(6) All services must be provided with referral to other qualified resources when appropriate.

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