FIRST REGULAR SESSION
94TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES TILLEY (Sponsor), SCHARNHORST, SMITH (14), ROBINSON, SMITH (150), PARSON, YOUNG, YAEGER AND KRATKY (Co-sponsors).
Read 1st time January 30, 2007 and copies ordered printed.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 345.015, 345.030, 345.045, 345.055, 346.030, 346.035, and 346.055, RSMo, and to enact in lieu thereof eight new sections relating to hearing instrument dispensing.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 345.015, 345.030, 345.045, 345.055, 346.030, 346.035, and 346.055, RSMo, are repealed and eight new sections enacted in lieu thereof, to be known as sections 345.015, 345.030, 345.033, 345.045, 345.055, 346.030, 346.035, and 346.055, to read as follows:
345.015. As used in sections 345.010 to 345.080, the following terms mean:
(1) "Audiologist", a person who is licensed as an audiologist pursuant to sections 345.010 to 345.080 to practice audiology;
(2) "Audiology aide", a person who is registered as an audiology aide by the board, who does not act independently but works under the direction and supervision of a licensed audiologist. Such person assists the audiologist with activities which require an understanding of audiology but do not require formal training in the relevant academics. To be eligible for registration by the board, each applicant shall submit a registration fee, be of good moral and ethical character; and:
(a) Be at least eighteen years of age;
(b) Furnish evidence of the person's educational qualifications which shall be at a minimum:
a. Certification of graduation from an accredited high school or its equivalent; and
b. On-the-job training;
(c) Be employed in a setting in which direct and indirect supervision are provided on a regular and systematic basis by a licensed audiologist.
However, the aide shall not administer or interpret hearing screening or diagnostic tests, fit or dispense hearing instruments, make ear impressions, make diagnostic statements, determine case selection, present written reports to anyone other than the supervisor without the signature of the supervisor, make referrals to other professionals or agencies, use a title other than speech-language pathology aide or clinical audiology aide, develop or modify treatment plans, discharge clients from treatment or terminate treatment, disclose clinical information, either orally or in writing, to anyone other than the supervising speech-language pathologist/audiologist, or perform any procedure for which he or she is not qualified, has not been adequately trained or both;
(3) "Board", the state board of registration for the healing arts;
(4) "Clinical fellowship", the supervised professional employment period following completion of the academic and practicum requirements of an accredited training program as defined in sections 345.010 to 345.080;
(5) "Commission", the advisory commission for speech-language pathologists and audiologists;
(6) "Hearing instrument" or "hearing aid", any wearable device or instrument designed for or offered for the purpose of aiding or compensating for impaired human hearing and any parts, attachments or accessories, including ear molds, but excluding batteries, cords, receivers and repairs;
(7) "Person", any individual, organization, or corporate body, except that only individuals may be licensed pursuant to sections 345.010 to 345.080;
(8) "Practice of audiology":
(a) The application of accepted audiologic principles, methods and procedures for the measurement, testing, interpretation, appraisal and prediction related to disorders of the auditory system, balance system or related structures and systems;
(b) Provides consultation, counseling to the patient, client, student, their family or interested parties;
(c) Provides academic, social and medical referrals when appropriate;
(d) Provides for establishing goals, implementing strategies, methods and techniques, for habilitation, rehabilitation or aural rehabilitation, related to disorders of the auditory system, balance system or related structures and systems;
(e) Provides for involvement in related research, teaching or public education;
(f) Provides for rendering of services or participates in the planning, directing or conducting of programs which are designed to modify audition, communicative, balance or cognitive disorder, which may involve speech and language or education issues;
(g) Provides and interprets behavioral and neurophysiologic measurements of auditory balance, cognitive processing and related functions, including intraoperative monitoring;
(h) Provides involvement in any tasks, procedures, acts or practices that are necessary for evaluation of audition, hearing, training in the use of amplification or assistive listening devices;
(i) Provides selection [and] , assessment, fitting, programming, and dispensing of hearing instruments, assistive listening devices, and other amplification systems;
(j) Provides for taking impressions of the ear, making custom ear molds, ear plugs, swim molds and industrial noise protectors;
(k) Provides assessment of external ear and cerumen management;
(l) Provides advising, fitting, mapping assessment of implantable devices such as cochlear or auditory brain stem devices;
(m) Provides information in noise control and hearing conservation including education, equipment selection, equipment calibration, site evaluation and employee evaluation;
(n) Provides performing basic speech-language screening test;
(o) Provides involvement in social aspects of communication, including challenging behavior and ineffective social skills, lack of communication opportunities;
(p) Provides support and training of family members and other communication partners for the individual with auditory balance, cognitive and communication disorders;
(q) Provides aural rehabilitation and related services to individuals with hearing loss and their families;
(r) Evaluates, collaborates and manages audition problems in the assessment of the central auditory processing disorders and providing intervention for individuals with central auditory processing disorders;
(s) Develops and manages academic and clinical problems in communication sciences and disorders;
(t) Conducts, disseminates and applies research in communication sciences and disorders;
(9) "Practice of speech-language pathology":
(a) Provides screening, identification, assessment, diagnosis, treatment, intervention, including but not limited to prevention, restoration, amelioration and compensation, and follow-up services for disorders of:
a. Speech: articulation, fluency, voice, including respiration, phonation and resonance;
b. Language, involving the parameters of phonology, morphology, syntax, semantics and pragmatic; and including disorders of receptive and expressive communication in oral, written, graphic and manual modalities;
c. Oral, pharyngeal, cervical esophageal and related functions, such as dysphagia, including disorders of swallowing and oral functions for feeding; orofacial myofunctional disorders;
d. Cognitive aspects of communication, including communication disability and other functional disabilities associated with cognitive impairment;
e. Social aspects of communication, including challenging behavior, ineffective social skills, lack of communication opportunities;
(b) Provides consultation and counseling and makes referrals when appropriate;
(c) Trains and supports family members and other communication partners of individuals with speech, voice, language, communication and swallowing disabilities;
(d) Develops and establishes effective augmentative and alternative communication techniques and strategies, including selecting, prescribing and dispensing of augmentative aids and devices; and the training of individuals, their families and other communication partners in their use;
(e) Selects, fits and establishes effective use of appropriate prosthetic/adaptive devices for speaking and swallowing, such as tracheoesophageal valves, electrolarynges, or speaking valves;
(f) Uses instrumental technology to diagnose and treat disorders of communication and swallowing, such as videofluoroscopy, nasendoscopy, ultrasonography and stroboscopy;
(g) Provides aural rehabilitative and related counseling services to individuals with hearing loss and to their families;
(h) Collaborates in the assessment of central auditory processing disorders in cases in which there is evidence of speech, language or other cognitive communication disorders; provides intervention for individuals with central auditory processing disorders;
(i) Conducts pure-tone air conduction hearing screening and screening tympanometry for the purpose of the initial identification or referral;
(j) Enhances speech and language proficiency and communication effectiveness, including but not limited to accent reduction, collaboration with teachers of English as a second language and improvement of voice, performance and singing;
(k) Trains and supervises support personnel;
(l) Develops and manages academic and clinical programs in communication sciences and disorders;
(m) Conducts, disseminates and applies research in communication sciences and disorders;
(n) Measures outcomes of treatment and conducts continuous evaluation of the effectiveness of practices and programs to improve and maintain quality of services;
(10) "Speech-language pathologist", a person who is licensed as a speech-language pathologist pursuant to sections 345.010 to 345.080; who engages in the practice of speech-language pathology as defined in sections 345.010 to 345.080;
(11) "Speech-language pathology aide", a person who is registered as a speech-language aide by the board, who does not act independently but works under the direction and supervision of a licensed speech-language pathologist. Such person assists the speech-language pathologist with activities which require an understanding of speech-language pathology but do not require formal training in the relevant academics. To be eligible for registration by the board, each applicant shall submit a registration fee, be of good moral and ethical character; and:
(a) Be at least eighteen years of age;
(b) Furnish evidence of the person's educational qualifications which shall be at a minimum:
a. Certification of graduation from an accredited high school or its equivalent; and
b. On-the-job training;
(c) Be employed in a setting in which direct and indirect supervision is provided on a regular and systematic basis by a licensed speech-language pathologist. However, the aide shall not administer or interpret hearing screening or diagnostic tests, fit or dispense hearing instruments, make ear impressions, make diagnostic statements, determine case selection, present written reports to anyone other than the supervisor without the signature of the supervisor, make referrals to other professionals or agencies, use a title other than speech-language pathology aide or clinical audiology aide, develop or modify treatment plans, discharge clients from treatment or terminate treatment, disclose clinical information, either orally or in writing, to anyone other than the supervising speech-language pathologist/audiologist, or perform any procedure for which he or she is not qualified, has not been adequately trained or both;
(12) "Speech-language pathology assistant", a person who is registered as a speech-language pathology assistant by the board, who does not act independently but works under the direction and supervision of a licensed speech-language pathologist and whose activities require both academic and practical training in the field of speech-language pathology although less training than those established by sections 345.010 to 345.080 as necessary for licensing as a speech-language pathologist. To be eligible for registration by the board, each applicant shall submit the registration fee, be of good moral character and furnish evidence of the person's educational qualifications which meet the following:
(a) Hold a bachelor's level degree in the field of speech-language pathology from an institution accredited or approved by a regional accrediting body recognized by the United States Department of Education or its equivalent; and
(b) Submit official transcripts from one or more accredited colleges or universities presenting evidence of the completion of bachelor's level course work and clinical practicum requirements equivalent to that required or approved by a regional accrediting body recognized by the United States Department of Education or its equivalent.
345.030. 1. The board shall administer, coordinate, and enforce the provisions of sections 345.010 to 345.080, evaluate the qualifications of applicants, supervise the examination of applicants, issue licenses, and shall investigate persons engaging in practices which appear to violate the provisions of sections 345.010 to 345.080.
2. The board shall conduct such hearings and keep such records and minutes as shall be necessary to an orderly dispatch of business.
3. The board shall adopt reasonable rules and regulations which establish ethical standards of practice and may amend or repeal the same. Rules and regulations shall be adopted that ensure consumer protection related to hearing instrument dispensing that meet or exceed those provided under sections 346.007 to 346.250, RSMo, and rules and regulations promulgated pursuant thereto.
4. Regular meetings of the commission shall be held at such times and places as it prescribes, and special meetings may be held upon the call of the chairperson or by request of at least two other members of the commission, but at least one regular meeting shall be held each year.
5. No rule or portion of a rule promulgated pursuant to the authority of sections 345.010 to 345.080 shall become effective unless it has been promulgated pursuant to the provisions of chapter 536, RSMo.
345.033. 1. Any person licensed under sections 345.010 to 345.081 who dispenses products associated with professional practice to clients for remuneration shall deliver to each person supplied with a product a completed purchase agreement which shall include the terms of the sale clearly stated using ordinary English language and terminology which is easily understood by the purchaser. If a product which is not new is sold, the purchase agreement and the container thereof shall be clearly marked as "used", "recased", or "reconditioned", whichever is applicable, with terms of guarantee, if any.
2. Any audiologist licensed under sections 345.010 to 345.080 who dispenses hearing instruments shall include in the purchase agreement for a hearing instrument the following:
(1) The licensee's signature, business address, and license number;
(2) The specifications of the hearing instrument dispensed including make, model, and serial number;
(3) The exact amount of any down payment;
(4) The length of any trial period provided;
(5) The amount of any charges or service fees connected with any trial period;
(6) A description of the right of the purchaser to return the hearing instrument or written notification that no such right exists;
(7) The name of the manufacturer of the component parts and the assembler or reassembler of the hearing instrument when the product sold is remanufactured or assembled by someone other than the manufacturer of the component parts.
345.045. 1. All moneys received [pursuant to sections 345.010 to 345.080] under subdivision (1) of subsection 3 of section 345.055 shall be collected by the division of professional registration and shall be transmitted to the department of revenue for deposit in the state treasury to the credit of the board of registration for the healing arts fund.
2. All moneys received under subdivision (2) of subsection 3 of section 345.055 shall be collected by the division of professional registration and shall be transmitted to the department of revenue for deposit in the state treasury to the credit of the hearing instrument specialist fund created under section 346.135, RSMo. Moneys collected and deposited under this subsection may be used to assist in the enforcement of the statutes relating to the fitting and dispensing of hearing aids by unlicensed individuals.
345.055. 1. The board shall charge a license or registration renewal fee for each license or registration renewed. Persons possessing the required training and qualifications to be licensed or registered as both a speech-language pathologist and audiologist shall receive both licenses, which for the purposes of this section shall be considered as a single license or certificate. Duplicate licenses or certificates shall be issued without additional charge to persons practicing in more than one location. Persons who allow their licenses to lapse shall submit a reinstatement fee, and if the license has lapsed for more than a three-year period, the board may require reexamination.
2. The fees prescribed by section 345.051 and this section shall be exclusive, and notwithstanding any other provision of law, no municipality may require any person licensed pursuant to the provisions of sections 345.010 to 345.080 to furnish any bond, pass any examination, or pay any license fee or occupational tax.
3. The board shall set the amount of the fees which sections 345.010 to 345.080 authorize and require by rules and regulations promulgated pursuant to section 536.021, RSMo. The fees shall be set at a level to produce:
(1) Revenue which shall not substantially exceed the cost and expense of administering sections 345.010 to 345.080; and
(2) An annualized contribution to the fund created under section 346.135, RSMo, in an amount equal to the fees paid by individuals licensed under subsection 2 of section 346.060, RSMo, annualized for fiscal year 2007.
346.030. Sections 346.010 to 346.015 and 346.030 to 346.250 [are not intended to prevent] shall not apply to any audiologist licensed pursuant to chapter 345, RSMo, [from engaging in the practice of measuring human hearing for the purpose of selection of hearing aids, provided such audiologist, or organization employing such audiologist, does not sell hearing instruments, or accessories thereto, except in the case of earmolds provided by an audiologist to be used only for the purpose of audiologic evaluation] while practicing exclusively under that license.
346.035. [1.] Sections 346.010 to 346.250 shall not apply to a person who is a physician licensed to practice in Missouri pursuant to chapter 334, RSMo.
[2. Sections 346.010 to 346.250 shall not apply to an audiologist, provided such person or organization employing such person does not engage in the sale of hearing aids.]
346.055. 1. An applicant may obtain a license by successfully passing a qualifying examination of the type described in sections 346.010 to 346.250, provided the applicant:
(1) Is at least twenty-one years of age;
(2) Is of good moral character; and
(3) Until December 31, 2008, has an education equivalent to at least a high school diploma from an accredited high school.
2. Beginning January 1, 2009, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall demonstrate successful completion of a minimum of sixty semester hours, or its equivalent, at a state or regionally accredited institution of higher education.
3. Beginning January 1, 2011, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall hold an associate's level degree or higher from a state or regionally accredited institution of higher education.
4. Beginning, January 1, 2013, or any date thereafter when an associate degree program in hearing instrument sciences is available from a state or regionally accredited institution within Missouri, an applicant for a hearing instrument specialist license or a hearing instrument specialist-in-training permit shall hold:
(1) An associate's degree or higher in hearing instrument sciences; or
(2) A master's or doctoral degree in audiology from a state or regionally accredited institution.
5. The provisions of subsections 2, 3, and 4 of this section shall not apply to any person holding a valid Missouri hearing instrument specialist license under this chapter when applying for the renewal of that license. These provisions shall apply to any person holding a hearing instrument specialist-in-training permit at the time of their application for licensure or renewal of said permit.
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