WSR 97-12-086

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed June 4, 1997, 11:40 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-04-040.

Title of Rule: Apprenticeship program--Definitions and Apprenticeship program--Minimum training requirements.

Purpose: Establishes a mandatory training program for the licensure of hearing instrument fitter/dispensers. These amendments will ensure that all practicing hearing instrument fitter/dispensers have met training requirements defined by the board. The amendments will help protect consumers from incompetent providers.

Other Identifying Information: These amendments are proposed in accordance with SHB 2309, chapter 200, Laws of 1996.

Statutory Authority for Adoption: RCW 18.35.040 and 18.35.161.

Statute Being Implemented: RCW 18.35.040.

Summary: Amendments to WAC 246-828-055 and 246-828-070 are necessary to provide direction for the new legislature mandated apprenticeship program. Individuals applying for hearing instrument fitter/dispenser licensure must complete an apprenticeship program established by the Board of Hearing and Speech. The amendments to these rules will provide those individuals with the needed curriculum to complete for licensure.

Reasons Supporting Proposal: At this time there are no training or education requirements for hearing instrument fitter/dispensers.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Diane Young, 1300 S.E. Quince Street, Olympia, WA 98504-7869, (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 proposed requirements for hearing instrument fitter/dispenser apprenticeship programs replace the previous hearing aid fitter/dispenser trainee program. The requirements are intended to protect the public from being mislead by incompetent, unethical and unauthorized persons and to assure the availability of hearing services of high quality to citizens of Washington state.

Proposal Changes the Following Existing Rules: The proposal will change trainee to the apprenticeship program.

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

This report contains, the Economic Impact Analysis used by Health Professions Quality Assurance in determining program costs associated with the apprenticeship training requirements.

Background: The state of Washington recognizes hearing instrument fitting/dispensing as a profession that provides services related to the sale, lease or rental of hearing instruments together with the selection and modification of hearing instruments; the administration of nondiagnostic tests; the use of procedures essential to the performance of these functions; and includes recommending specific hearing instruments or systems, the taking of impressions for ear molds for these purposes, the use of nondiagnostic procedures and equipment to verify the appropriateness of the hearing instrument fitting. These services are provided in a number of professional health care settings to infants, children, adults and elderly.

The proposed requirements for hearing instrument fitter/dispenser apprenticeship programs replace the previous hearing aid fitter/dispenser trainee program. The requirements are intended to protect the public from being mislead by incompetent, unethical and unauthorized persons and to assure the availability of hearing 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 18.35.040 (1)(b) after December 31, 1996, applicants for hearing instrument fitter/dispenser licensure must have at least six months of apprenticeship training that meets requirements established by the board.

Costs to a Business: Considering the newly required apprenticeship program merely replaces the previously necessary trainee program there is no new impact on businesses or the prospective licensees. Research demonstrates the majority of applicants complete a trainee program at least six months in duration or a formal education program.

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 the apprenticeship program requirements and suggestions submitted by individuals in writing have been incorporated into the proposed rule.

Department of Health Costs to Administer the Regulation: Estimated expenditures are based on the Department of Health standard cost factors for budgeting. These include costs for support staffing and agency indirect costs.

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

The required program revenue includes funds to support recurring expenses for program administration.

The following table illustrates overall administration cost and estimated revenue.

[Open Style:Columns Off]

[Open Style:Columns On]

A copy of the statement may be obtained by writing to Diane Young, Program Manager, Board of Hearing and Speech, 1300 S.E. Quince Street, P.O. Box 47869, Olympia, WA 98504-7869, phone (360) 586-0205, or FAX (360) 586-7840.

Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This rule does not make significant amendments to policy.

Hearing Location: Department of Health, Office of Emergency and Trauma Prevention, Target Plaza, 2725 Harrison N.W., Olympia, WA 98502, on July 8, 1997, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Betty Bird by June 27, 1997, TDD (800) 525-0127, or FAX (360) 586-7840.

Submit Written Comments to: Diane Young, FAX (360) 586-7840, by July 4, 1997.

Date of Intended Adoption: July 8, 1997.

May 29, 1997

Delores E. Spice

Executive Director

AMENDATORY SECTION (Amending WSR 94-11-108, filed 5/18/94, effective 6/18/94)

WAC 246-828-055 ((Trainees)) Apprenticeship program--Definitions. For the purposes of this chapter, these terms shall be defined as follows:

(1) "Sponsor" ((shall mean)) means the licensed hearing ((aid)) instrument fitter/dispenser or certified audiologist who is registered with the department of health to provide sponsorship to ((a trainee)) an apprentice. The sponsor must ((have been)) be licensed or certified in good standing as a hearing ((aid)) instrument fitter/dispenser ((in)) or audiologist with the state of Washington for at least ((one)) two years.

(2) "Direct supervision" ((shall mean)) means that the sponsor is physically present and in the same room with the ((trainee)) apprentice, observing the testing, fitting and dispensing activities of the ((trainee)) apprentice at all times.

(3) (("Indirect supervision" shall mean the sponsor is immediately available for consultation.

(4))) "Sponsor in good standing" ((shall mean)) means a sponsor whose license or certificate has not been subject to sanctions ((pursuant to)) under RCW 18.130.160 in the last ((one)) two years.

[Statutory Authority: RCW 18.35.161. 94-11-108, 246-828-055, filed 5/18/94, effective 6/18/94.]

AMENDATORY SECTION (Amending WSR 95-19-017, filed 9/7/95, effective 10/8/95)

WAC 246-828-070 ((Trainees)) Apprenticeship program--Minimum ((standards of)) training requirements. (1) ((The sponsor shall provide training in the following areas during the direct supervision period:

(a) Basic physics of sound;

(b) The human hearing mechanism, including the science of hearing and the causes and rehabilitation of abnormal hearing and hearing disorders;

(c) Structure and function of hearing aids;

(d) Pure tone audiometry, including air conduction testing and bone conduction testing;

(e) Live voice or recorded voice speech audiometry, including speech reception, threshold testing, most comfortable level, uncomfortable level, and speech discrimination testing;

(f) Effective masking;

(g) Recording and evaluation of audiograms and speech audiometry to determine hearing aid candidacy;

(h) Selection and adaptation of hearing aids and testing of hearing aids;

(i) Taking ear mold impressions;

(j) Otoscopy;

(k) Evidence of knowledge regarding the medical and rehabilitation facilities that are available for children and adults in the area served;

(l) Evidence of knowledge of grounds for revocation or suspension of license under the provisions of this chapter;

(m) Fitting verification and post-fitting follow-up.

(2) Completion of the above training and competency of the trainee to perform such duties shall be documented by initial of both trainee and sponsor on a form provided by the department. The completed training verification form shall be submitted to the department upon completion of the direct supervision period. Failure to maintain a training log or to verify training to the department shall be a violation of this chapter and may subject the sponsor to disciplinary action by the board.

(3) Trainees who have met one of the following are exempt from the minimum standards of training requirement. Documentation of the exemption shall be certified by the sponsor and submitted on a form provided by the department.

(a) Successful completion of the National Institute for Hearing Instruments Studies (NIHIS) Basic Course for Independent Study;

(b) Documentation that the trainee is either licensed in audiology in another state, or certified as an audiologist by the American Speech and Hearing Association, or holds a masters degree in audiology;

(c) Certification by the sponsor that the trainee has received the required minimum training from a previous sponsor.

(d) Successful completion of a vocational training program approved by the board.)) An apprenticeship program will be at least six months in duration. The apprentice is in an apprenticeship program for a minimum of ten hours each week. The apprentice is under the direct supervision of the sponsor at all times when performing the functions of a hearing instrument fitter/dispenser apprentice. An apprentice must hold a valid hearing instrument fitter/dispenser permit. An apprentice must complete the National Hearing Aid Society home study course and submit proof of passing the home study course final examination and complete all stages of the apprenticeship program prior to taking the Washington state examination. If the apprentice passes the home study course final examination but fails the Washington state licensure examination, the apprentice will not have to repeat the home study course before the next available Washington state licensure examination. The apprenticeship program is divided into three stages:

(a) Stage 1 is at least 1 month in duration. During this stage, the apprentice may perform audiometric tests, and make ear mold impressions and modifications. The sponsor is physically present, in the same room at all times when the apprentice is performing these functions. The apprentice can not recommend the selection of a hearing instrument, dispense a hearing instrument, or counsel a client.

(b) Stage 2 - at least 2 months. During this stage the apprentice may perform all tasks in Stage 1, recommend the selection of a hearing instrument, and counsel a client. The sponsor is physically present, in the same room at all times when the apprentice is performing these functions. The apprentice can not dispense a hearing instrument.

(c) Stage 3 - at least 3 months. During this stage the apprentice may perform all the tasks in Stage 1 and 2 and dispense hearing instruments, but the sponsor is physically present in the same room at the time a hearing instrument is delivered to the client. The receipt required by RCW 18.35.030 must have the signatures and the license/permit numbers of the sponsor and apprentice. The title of the sponsor and apprentice is next to the respective signatures.

(2) It is the sponsor's responsibility to provide instruction and guidance, in order to adequately prepare the apprentice for practice as a hearing instrument fitter/dispenser and for the written and practical examinations. Training received by an apprentice during the apprenticeship program must include at least the following subject areas:

(a) Chapters 18.35 and 18.130 RCW, and chapter 246-828 WAC;

(b) Physics of sound;

(c) Anatomy of the outer, middle and inner ear;

(d) Otoscopy;

(e) Hearing disorders: Conductive hearing loss, sensorineural hearing loss, mixed hearing loss, central auditory processing disorder, nonorganic hearing loss;

(f) Diseases of the ear;

(g) Current criteria for medical referral;

(h) Pure tone audiometry, air conduction and bone conduction;

(i) Masking for pure tone audiometry: Rationale; methods; techniques;

(j) Speech audiometry;

(k) Masking for speech audiometry: Rationale; methods; techniques;

(l) Sound field testing;

(m) Audiogram analysis and interpretation;

(n) Proper ear/ears selection: Hearing instrument selection/modifications (evaluating fitting criteria);

(o) Cros/bi-cros: Rationale and its application;

(p) Hearing aid measurements (ANSI)standard);

(q) Interpretation of hearing instruments specification data;

(r) Impression technique;

(s) Earmolds: Shell design and their effects on frequency response;

(t) Types and styles of hearing instruments; components, functions, and benefits;

(u) Dispensing hearing instruments and counseling on usage and care.

(3) The sponsor must file a report with the department at the end of each stage of the apprentice program; this report must be filed no later than ten days after the completion of each stage. The sponsor must certify that the educational and training objectives of each stage have been met and the number of hours of training provided.

(4) The apprenticeship program begins at the date of department approval, unless the board specifies another date.

(5) Transfer of apprentice to another sponsor. The department may approve transfers of an apprentice to another eligible sponsor, prior to the completion of the apprenticeship program, upon the request of either the sponsor or the apprentice.

(a) An apprentice who changes his or her sponsor for any reason must not continue his or her apprenticeship status with a new sponsor until a new apprenticeship application and fee has been filed and approved by the department.

(b) It is the apprentice's responsibility to report the loss of such sponsorship to the department in writing within ten days of such occurrence and to stop the practice of fitting and dispensing.

(c) The sponsor of an apprentice who desires to terminate the responsibilities of sponsorship must provide the apprentice two weeks written notice of such termination, stating reasons for termination, and shall immediately notify the department, by registered or certified mail, of the sponsorship termination and the reasons for termination.

(d) In the event the apprentice terminates the program, the sponsor must notify the department immediately by registered or certified mail.

The sponsor is responsible for the apprentice until such time as the notification of termination to the department is deposited in the United States mail.

(e) Whenever a transfer is approved, credit is transferred for the completed stages of the apprenticeship program.

(f) Transfer of credit for stages uncompleted is subject to review and approval by the board.