Rule 64B20-4.003, F.A.C.-The Board proposes the development of a rule amendment to update the rule language regarding On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants. Rule 64B20-4.004, F.A.C.-The ...

 

DEPARTMENT OF HEALTH

Board of Speech-Language Pathology and Audiology

RULE NOS.:RULE TITLES:

64B20-4.003On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants

64B20-4.004Supervision of Speech-Language Pathology Assistants and Audiology Assistants

PURPOSE AND EFFECT: Rule 64B20-4.003, F.A.C.-The Board proposes the development of a rule amendment to update the rule language regarding On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants. Rule 64B20-4.004, F.A.C.-The Board proposes the development of a rule amendment to update the rule language regarding Supervision of Speech-Language Pathology Assistants and Audiology Assistants.

SUMMARY: Rule 64B20-4.003, F.A.C.-Update rule language regarding On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants. Rule 64B20-4.004, F.A.C.-Update rule language regarding Supervision of Speech-Language Pathology Assistants and Audiology Assistants.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: During discussion of the economic impact of this rule at its Board meeting, the Board concluded that this rule change will not have any impact on licensees and their businesses or the businesses that employ them. The rule will not increase any fees, business costs, personnel costs, will not decrease profit opportunities, and will not require any specialized knowledge to comply. This change will not increase any direct or indirect regulatory costs. Hence, the Board determined that a Statement of Estimated Regulatory Costs (SERC) was not necessary and that the rule will not require ratification by the Legislature. No person or interested party submitted additional information regarding the economic impact at that time.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 468.1125(9), 468.1135(4), FS.

LAW IMPLEMENTED: 468.1125(3), (4), (9), 468.1215, FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Kama Monroe, Executive Director, Board of Speech-Language Pathology and Audiology, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 32399-3256, [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64B20-4.003 On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants.

(1) A licensee who employs a speech-language pathology assistant or an audiology assistant shall provide such assistant with on-the-job training, and shall maintain responsibility for all services performed or omitted by such assistant. The licensee shall not permit the assistant to perform any service on a client unless:

(a) The licensee provides the assistant with on-the-job training for each service for which there is no available documentation of a previously acquired competency; and,

(b) The assistant is clearly identified as an assistant by means of a nametag or similar identification.

(2) At a minimum, on-the-job training shall include step by step instruction and demonstration of each and every service the assistant is to perform and continuous visual observation by the licensee of the assistant’s performance of such service until the licensee establishes the assistant’s competency. The licensee shall maintain a record of each service indicating the activity, date, time, and location of the foregoing demonstration and observations concerning competency. The record shall be signed by both the licensee and the assistant and a copy thereof shall be provided to the assistant and shall be maintained by the supervising licensee for the duration of employment and shall be maintained by the assistant as long as the assistant is certified by the Board. A new supervising licensee shall obtain and maintain for the duration of employment, records demonstrating competency for all services performed by the assistant. Upon request of the Department or Board, the supervising licensee and the assistant shall produce the documentation of competency records required herein.

(3) The speech-language pathology or audiology licensee shall notify the Department within thirty (30) days of any changes in the roster of assistants registered under his or her name by submitting Form DH-MQA 1269 (4/13), entitled “Board of Speech-Language Pathology and Audiology Assistant Activity and Supervisory Plan,” hereby adopted and incorporated by reference, and can be obtained from the following website at http://www.flrules.org/Gateway/reference.asp?No=Ref-03085., or http://www.doh.state.fl.us/mqa/speech/index.html. 

(4) Following the completion of on-the-job training, the speech-language pathology assistant shall engage only in those services that are planned, designed and supervised by the speech-language pathology licensee. The scope of services which a speech-language pathology assistant may provide includes:

(a) Record case history information.

(b) Screen speech, language or hearing by the use of procedures that are included in published material containing directions for administration and scoring.

(c) Implement, without diagnostic interpretation, evaluative procedures that are:

1. Planned and designed by the licensee; and,

2. Included in published materials which have directions for administration and scoring.

(d) Implement treatment programs that:

1. Are planned and designed by the licensee to meet pre-established goals; and,

2. Contain pre-established criteria for mastery.

(e) Record, chart, graph or otherwise display data relative to client performance.

(f) Perform clerical functions necessary to maintain clinical records.

(g) Report changes in client performance to the licensee having responsibility for that client.

(h) Prepare clinical materials.

(i) Test equipment to determine if the equipment is performing according to published specifications.

(j) Participate with the licensee in research projects, in-service training, public relations programs, or similar activities as planned, designed and directed by the licensee.

(k) Serve as an interpreter (translator) for the speech-language pathology licensee during clinical procedures.

(l) Assist in the evaluation or treatment of difficult-to-test clients.

(5) The speech-language pathology licensee shall not delegate to the speech-language pathology assistant any tasks which call for a diagnostic interpretation or put the client at physical risk. The following tasks shall not be delegated to a speech-language pathology assistant:

(a) Conducting the initial interview with the client.

(b) Performing initial testing or evaluation.

(c) Determining or discussing specific diagnoses with the client or making statements regarding prognosis or levels of proficiency.

(d) Relating or discussing with clients or consumers of services the reports from other professionals or related services unless those findings have previously been interpreted and reported by the supervising licensee.

(e) Providing any interpretation or elaboration of information that is contained in reports written by the licensee, although he or she may, upon assignment from the licensee, present information regarding clients at staffings or conferences; however, the assistant may discuss with the client or consumer specifically observed behaviors that have occurred during a treatment when they are supported by objective data.

(f) Performing any procedure where there is a risk of physical injury as a result of the procedure; specifically, the insertion of tracheoesophageal prostheses or catheter into the esophageal puncture; endoscopy; administration of barium or other substances for the assessment of swallowing; fitting or insertion of tracheal valves or instrumentation for generation of voice; and initial measurements and fitting of oral prostheses.

(g) Devising or planning treatment based upon assessment or diagnostic findings.

(h) Providing counseling to the client or to his or her family.

(i) Making referrals for additional services.

(j) Signing any document without the co-signature of the licensee.

(k) Using any title other than the Speech-Language Pathology Assistant.

(l) Determining patient or client dismissal criteria have been met.

(6) Following the completion of on-the-job training by the supervising audiology licensee, the audiology assistant may engage only in those services that are planned, designed, and supervised by the licensee.

(7) The audiology licensee may permit the audiology assistant to perform the following services under the direct supervision of the supervising licensee:

(a) Conduct basic hearing testing without diagnostic interpretation, including air and bone conduction thresholds and speech audiometry.

(b) Conduct impedance audiometric testing.

(c) Assist in the evaluation of difficult-to-test patients.

(d) Record case history information.

(e) Assist in conducting real ear measurements.

(f) Assist in ABR, ENG, and otoacoustic emissions testing.

(g) Report changes in client performance to the audiology licensee having responsibility for that client.

(h) Participate with the audiology licensee in research projects, in-service training, in public relations programs, or similar activities as planned, designed and directed by the audiology licensee.

(i) Assistant in implementing a plan or program for management and/or treatment developed by the supervising audiology licensee.

(8) The following activities of a certified audiology assistant are permitted under the responsible supervision of the supervising audiologist without the requirement of the physical presence of a supervising audiologist:

(a) Demonstrate assistive listening devices.

(b) Test hearing aids to determine if they meet appropriate specification and/or mechanical performance.

(c) Demonstrate care and use of the hearing aid controls, battery insertion and insertion of the hearing aid or ear mold into the ear.

(d) Perform clerical functions necessary to maintain clinical records.

(e) Prepare clinical materials and where appropriate, in accordance with universal precautions.

(f) Test equipment to determine if the equipment is performing according to published specifications.

(g) Screen hearing using established criteria on a pass/fail basis, including but not limited to newborn hearing screening.

(9) The audiology licensee shall not delegate to the audiology assistant any tasks which call for a diagnostic interpretation or put the client at physical risk. The following tasks shall not be delegated to an audiology assistant:

(a) Providing diagnostic services to children below the age of five years or to other clients whose hearing impairment, medical condition, behavior or other disabling condition would preclude the use of services from anyone other than the licensed audiologist.

(b) Performing any procedure where there is a risk of physical injury as a result of the procedure; specifically, where injury to the physical structures of hearing is likely to occur.

(c) Developing a plan of care or treatment for auditory or vestibular disorders.

(10) The speech-language pathologist shall directly observe the speech-language pathology assistant’s service as follows:

(a) Solely by direct supervision dDuring the period devoted to on-the-job training and until the assistant achieves the required certification and documentation of competency for each required task first 12 months of continuous employment on at least one occasion, and if treatment is provided, a minimum of one out of every five sessions or a minimum of one session every two weeks per client.

(b) After the assistant receives certification and documentation of achieved competency for each required task, the licensee shall have the option of providing direct supervision, as the licensee deems necessary, or indirect supervision that does not require the licensee to physically be on site during the assistant’s service. Following the first 12 months of continuous employment on at least one occasion and, if treatment is provided, a minimum of one out of every fifteen sessions or more frequently depending upon the individual client’s needs.

(c) When supervising the speech-language pathology assistant through indirect supervision, the speech-language pathologist shall monitor the activities of the speech-language pathology assistant by reviewing all client-care documentation, including therapy progress notes, at least once per week. The speech-language pathologist shall sign and date each document when reviewed as proof of monitoring and before billing for the rendered speech-language pathologist services.

(11) A speech-language pathology assistant who has greater than 12 months continuous employment at one site and changes employment settings shall, for the first 30 calendar days of employment within a new facility, be provided the same level of supervision/observation as required for new assistants. After the initial 30 days, with licensee certification of competency, then the assistant will be provided supervision as required for the assistant who has greater than 12 months experience.

Rulemaking Authority 468.1135(4) FS. Law Implemented 468.1125(3), (4), 468.1215 FS. History–New 3-14-91, Formerly 21LL-4.003, 61F14-4.003, Amended 9-8-94, 8-17-95, Formerly 59BB-4.003, Amended 2-2-04, 2-21-05, 9-9-13,                        .

 

64B20-4.004 Supervision of Speech-Language Pathology Assistants and Audiology Assistants.

(1) A licensee shall supervise and be responsible for all client services provided by an assistant.

(2) Any licensee who employs a speech-language pathology assistant or audiology assistant shall shall notify the Department of all new assistants or other changes in assistants under the licensee’s supervision by submitting Form 1269, entitled “Board of Speech-Language Pathology and Audiology Assistant Activity and Supervisory Plan” set forth in Rule 64B20-4.003, F.A.C., and the licensee also shall:

(a) Ensure that the assistant is not responsible for making decisions regarding the diagnosis, management and future disposition of clients.

(b) Ensure that the assistant is assigned only to those duties for which the assistant has been specifically trained and is authorized to perform under Chapter 468, Part I, F.S., and Rule Division 64B20, F.A.C.

(c) Maintain contact with each client during the course of clinical management.

(d) Conduct performance reviews on the assistant on a quarterly basis during the first year of employment, on an annual basis thereafter, and on termination. Such reviews shall document direct observation of the role and of the task experience of the assistant. These reviews shall be signed by the supervisor and the assistant. These reviews shall be retained for four (4) years by the licensee and submitted to the Board upon request. Performance reviews shall be submitted to the Board office on Form SPA-3D-D, entitled “Annual Evaluation Report for Speech-Language Pathology and Audiology Assistants,” revised (4/2018), effective 9-8-94which is hereby incorporated by reference http://www.flrules.org/Gateway/reference.asp?No=Ref-_________.  Copies of the form are available from the Board office, located at Board of Speech-Language Pathology and Audiology, Department of Health, 4052 Bald Cypress Way, Bin #C-06, Tallahassee, Florida 32399-3256.

(e) Reassess and redesign programs when either the task or the environment changes significantly.

(f) Discontinue clinical services provided by the assistant should conditions arise in which any of the above cannot be adhered to.

(3) Assistants must be under the direct supervision of a licensee who has met all the requirements of Section 468.1185, F.S. Direct supervision, pursuant to Section 468.1125(9), F.S., requires the physical presence of the licensee in the same facility when the assistant is carrying out assigned responsibilities, in order for the licensee to be available for consultation and direction. The supervising licensee shall make provisions for emergency situations including the designation of another licensee who has agreed to be available to provide direct supervision to the assistant when the supervising licensee is not available. In the event that a supervising licensee is not on the premises, the assistant may only perform duties not involving direct client contact.

(a) Audiology assistants must be under the direct supervision of a licensee at all times unless the assistant is performing duties not involving direct client contact.

(b) Speech-Language Pathology assistants shall be under direct supervision during the period of time devoted to on-the-job training of required tasks and until the Speech-Language Pathology Assistant has demonstrated competency to carry out required tasks as defined in 64B20-4.003, F.A.C.   The speech-language pathologist shall otherwise have the option to supervise the speech-language pathology assistant using direct or indirect supervision as the licensee deems necessary.

(4) The maximum number of assistants supervised by one licensee shall not exceed two (2) full-time or three (3) part-time assistants.

(5) In the event that multiple licensees are employed by a business entity, an assistant may be supervised by more than one licensee, but no more than three licensees, when the following conditions are met:

(a) The assistant has been continuously employed for more than twelve (12) months;

(b) The assistant has been in that employment setting for more than 30 days;

(c) Each individual licensee takes responsibility for training, planning, and supervising the assistant or assistants for those clients for whom they have direct responsibility; and,

(d) One primary supervisor shall be designated to be responsible for conducting performance reviews and notifying the Department of any changes in the supervisory plan or roster.

Rulemaking Authority 468.1125(9) FS. Law Implemented 468.1125(3), (4), (9) FS. History–New 3-14-91, Amended 11-3-92, 2-4-93, Formerly 21LL-4.004, 61F14-4.004, Amended 9-8-94, 8-17-95, 5-22-96, Formerly 59BB-4.004, Amended 9-9-13,             .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Speech-Language Pathology and Audiology

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Speech-Language Pathology and Audiology

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 9, 2018

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 6, 2018