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AB-780 Hearing aid dispensers: practice: cerumen management: apprentice license.(2019-2020)

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Date Published: 04/25/2019 09:00 PM
AB780:v96#DOCUMENT

Amended  IN  Assembly  April 25, 2019
Amended  IN  Assembly  April 22, 2019
Amended  IN  Assembly  March 21, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 780


Introduced by Assembly Member Brough

February 19, 2019


An act to amend Sections 2538.10, 2538.11, and 2538.30 of, and to add Section 2538.58 to, the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


AB 780, as amended, Brough. Hearing aid dispensers: practice: cerumen management: apprentice license.
Existing law, the Speech-Language Pathologists and Audiologists and Hearing Aid Dispensers Licensure Act, provides for the licensure and regulation of hearing aid dispensers by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board within the Department of Consumer Affairs. A violation of the act is a crime. Existing law defines the practice of fitting or selling hearing aids for purposes of the licensure provisions, requires any audiometer or other equipment used to be kept properly calibrated and in good working condition, specifies the types of tests authorized to be conducted, and prohibits a hearing aid dispenser to conduct from conducting diagnostic hearing tests, and specifies the types of hearing tests conducted for purposes of these provisions. tests.
This bill would include within the definition of the practice of fitting or selling hearing aids cerumen management and tympanometry, as defined in the bill, for patients 18 years of age and older. The bill would authorize a licensed hearing aid dispenser to sit for an examination assessing techniques and patient safety measures in cerumen management or tympanometry, would require the board to apply courses in cerumen management and tympanometry to the continuing education requirements, and would require the administration of cerumen management to occur under supervision of a physician and surgeon. prohibit a licensed hearing aid dispenser from testing a prospective hearing aid user or dispensing a hearing aid if the licensee determines that the prospective hearing aid user has one of specified conditions, including pain or discomfort in the ear. The bill would authorize the board to issue an advanced practice certificate to a licensed hearing aid dispenser who meets specified requirements, including that the licensee has at least 2 years of practice as a licensed hearing aid dispenser and the licensee and the licensee’s supervising mentor or trainer attest under penalty of perjury that the licensee has received direct supervised training from the supervising licensee sufficient to ensure the safe administration of cerumen management. By expanding the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize a licensee with an advanced practice certificate to perform cerumen management and tympanometry, as those terms are defined, in accordance with specified guidelines and requirements. The bill would authorize the board to revoke the advanced practice certificate of a licensee who violates the laws regulating hearing aid dispensers.
Existing law provides for a trainee license to be issued by the board for a period of 6 months, subject to satisfaction of specified requirements, authorizes a trainee licensee to fit or sell hearing aids under the supervision of a licensed hearing aid dispenser, and authorizes a trainee to take the hearing aid dispenser’s licensure examination, subject to compliance with specified requirements.
This bill would also provide for the issuance of an apprentice hearing aid dispenser license to applicants who satisfy specified requirements, including submitting to the board a written statement by a licensed hearing aid dispenser that the licensee agrees to act as the applicant’s apprentice sponsor, as specified, and payment of a fee established by the board. The bill would establish that the duration of the apprenticeship is 18 months and would establish requirements for an apprentice to sit for the practical examination required for licensure as a hearing aid dispenser, including completion of a specified course and at least 12 months of directly supervised practicum training. The bill would require the board, by regulation, to establish a list of approved courses for an apprentice hearing aid dispenser training program, as specified.
Because a violation of the bill’s requirements would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 (a) The Legislature finds and declares all of the following:
(1) The Legislature recognizes that the dispensing of hearing aids requires specific knowledge and skill to ensure that the interests and needs of people with hearing loss will be served in a safe manner by persons who are qualified.
(2) The Legislature recognizes that appropriately selected hearing aids improve quality of life, decrease social isolation, and promote the public health.
(3) In order to meet these goals, the Legislature recommends that licensed hearing aid dispensers should be able to engage in duties that are of benefit to their patients, cut down on costs, and facilitate the improved hearing of their patients, and that restrictions on the dispensing of hearing aids shall be imposed only to the extent necessary to protect the public from physical and economic harm, and restrictions shall not be imposed in a manner which would unreasonably affect the competitive market or impede accessibility for people with hearing loss to all qualified licensed providers.
(4) There are currently over 1,100 licensed hearing aid dispensers in the State of California, who must pass a rigorous written and practical exam to obtain a license to practice in the state. Given that there is no formal course of education to become a hearing aid dispenser in California, many hearing aid dispensers acquire a trainee license and receive on the job on-the-job training from licensed hearing aid dispensers. It is the intent of the Legislature to acknowledge the existing apprenticeship framework approved by the International Hearing Society as a basis for establishing an alternate pathway for licensure.
(5) Licensed hearing aid dispensers are required to complete 12 hours of continuing education annually, with all courses approved by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board.
(6) Beyond California’s licensing standards, many hearing aid dispensers obtain additional accreditation, known as the Board Certified Hearing Instrument Specialist designation, which requires a separate examination and course study that advances the hearing aid dispenser’s knowledge and skills.
(b) It is the intent of the Legislature to allow licensed hearing aid dispensers to practice at the highest levels of their training in order to better serve their clients and to provide the board with enforceable statutory provisions to protect the public.

SEC. 2.

 Section 2538.10 of the Business and Professions Code is amended to read:

2538.10.
 For the purposes of this article, the following definitions shall apply:
(a) “Advertise” and its variants include the use of a newspaper, magazine, or other publication, book, notice, circular, pamphlet, letter, handbill, poster, bill, sign, placard, card, label, tag, window display, store sign, radio, or television announcement, or any other means or methods now or hereafter employed to bring to the attention of the public the practice of fitting or selling of hearing aids.
(b) “License” means a hearing aid dispenser’s license issued pursuant to this article and includes a temporary, trainee, or apprentice license.
(c) “Licensee” means a person holding a license.
(d) “Hearing aid” means any wearable instrument or device designed for, or offered for the purpose of, aiding or compensating for impaired human hearing.
(e) “Fund” means the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Fund.

SEC. 3.

 Section 2538.11 of the Business and Professions Code is amended to read:

2538.11.
 (a)(1)“Practice (a) As used in this article:
(1) “Cerumen management” means the removal of cerumen no further than the cartilaginous outer one-third of the ear canal for the sole purpose of inspecting the ears, making impressions, or fitting and maintaining hearing aids.
(2) “Practice of fitting or selling hearing aids,” as used in this article, aids means those practices used for the purpose of selection and adaptation of hearing aids, including direct observation of the ear, testing of hearing in connection with the fitting and selling of hearing aids, taking of ear mold impressions, fitting or sale of hearing aids, and any necessary postfitting counseling. The practice of fitting or selling hearing aids may include cerumen management and tympanometry for patients 18 years of age and older.
The practice of fitting or selling hearing aids does not include the act of concluding the transaction by a retail clerk.
When any audiometer or other equipment is used in the practice of fitting or selling hearing aids, it shall be kept properly calibrated and in good working condition, and the calibration of the audiometer or other equipment shall be checked at least annually.

(2)For the purposes of this section, cerumen management means the removal of cerumen for the sole purpose of inspecting the ears, making impressions, or fitting and maintaining hearing aids.

(3) “Screening tympanometer” means a device that has been approved by the United States Food and Drug Administration for auditory impedance testing and meets the following criteria:
(A) Is a handheld device with a digital screen that uses a probe.
(B) Notifies the user of issues that will impact the accuracy of the measurement, including, but not limited to, whether the probe is in the ear and has formed a seal or there is a block or leak.
(C) Performs an automatic tympanogram measurement on a single ear.
(D) Displays results on a digital screen or printout.
(E) Includes screening functions for each result that do not require calculation or discretionary intervention by the user, including, but not limited to, a pass/fail indicator or a box indicating a normative range where the peak of the tympanogram is expected under normal conditions.

(3)For the purposes of this section, tympanometry

(4) “Tympanometry” means the administration of the test use of a screening tympanometer for the sole purposes of screening related to fitting and maintaining hearing aids or and referring a patient to a specialist physician and surgeon. surgeon specializing in otolaryngology.
(b) A hearing aid dispenser shall not conduct diagnostic hearing tests when conducting tests in connection with the practice of fitting or selling hearing aids.
(c) Hearing tests conducted pursuant to this article shall include those that are in compliance with the Food and Drug Administration Guidelines for Hearing Aid Devices and those that are specifically covered in the licensing examination prepared and administered by the board.

(d)(1)A licensed hearing aid dispenser who has passed the examinations described in Section 2538.25 is eligible to sit for board-approved examinations assessing techniques and patient safety measures in cerumen management or tympanometry. The examinations approved by the board shall be sufficient to demonstrate proficiency in cerumen management or tympanometry and the knowledge, skills, and abilities needed to perform these techniques safely.

(2)Notwithstanding any other law, the board shall apply board-approved courses in cerumen management and tympanometry to the continuing education requirement described in Section 2538.18. In order to be board approved, a course shall cover the knowledge, skills, and abilities needed to perform cerumen management or tympanometry safely.

(3)The administration of cerumen management by a licensed hearing aid dispenser shall occur under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician and surgeon, but does include (A) collaboration on the development of the standardized procedure, (B) approval of the standardized procedure, and (C) availability by telephonic contact at the time of patient examination by the licensed hearing aid dispenser.

(4)A licensed hearing aid dispenser shall immediately refer a patient to an appropriate physician or surgeon if the patient demonstrates any trauma, including tears, bleeding, or other pathology of the ear discovered in the process of cerumen management.

(5)A physician and surgeon may not simultaneously supervise more than two hearing aid dispensers for purposes of cerumen management.

(d) A licensed hearing aid dispenser shall advise a prospective hearing aid user to consult promptly with a physician and surgeon who specializes in otolaryngology and shall not test a prospective hearing aid user or dispense a hearing aid, except upon referral by a physician and surgeon, if the hearing aid dispenser determines through inquiry, actual observation, or review of any other available information concerning the prospective hearing aid user that the prospective hearing aid user has any of the following conditions:
(1) Visible congenital or traumatic deformity of the ear.
(2) History of active drainage from the ear within the previous 90 days.
(3) History of sudden or rapidly progressive hearing loss within the previous 90 days.
(4) Acute or chronic dizziness.
(5) Unilateral hearing loss of sudden or recent onset within the previous 90 days.
(6) Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz, 1,000 hertz, and 2,000 hertz.
(7) Except as provided under subdivision (e), visible evidence of significant cerumen accumulation or a foreign body in the ear canal.
(8) Pain or discomfort in the ear.
(e) (1) The board shall issue an advanced practice certificate to a licensed hearing aid dispenser who meets all of the following requirements:
(A) The licensee has at least two years of practice as a licensed hearing aid dispenser.
(B) The licensee is not subject to discipline or other enforcement action by the board.
(C) The licensee has completed the International Hearing Society’s Distance Learning for Professionals in Hearing Health Sciences course or another comparable course or certificate program approved by the board.
(D) The licensee and a supervising mentor or trainer licensed under this chapter who is competent to provide cerumen management attest under penalty of perjury that the licensee has received direct supervised training from the supervising licensee sufficient to ensure the safe administration of cerumen management.
(2) In addition to the practices specified under paragraph (2) of subdivision (a), a licensed hearing aid dispenser with an advanced practice certificate issued by the board may perform cerumen management and tympanometry screening for patients 18 years of age and older.
(3) A licensed hearing aid dispenser with an advanced practice certificate shall perform tympanometry in accordance with all of the following:
(A) The licensed hearing aid dispenser obtains specific informed consent from the prospective hearing aid user to perform tympanometry for screening purposes only and advises the prospective hearing aid user that the licensee is not a physician and surgeon, licensed audiologist, or any other licensee authorized to diagnose under state law.
(B) The tympanometry is only performed in conjunction with otoscopy and pure tone and speech audiometry. If any test detects an abnormality, the licensee shall refer the prospective hearing aid user to a physician and surgeon. Tympanometry shall not be used to invalidate the results of another test with the intent of improperly dispensing a hearing aid.
(C) The licensed hearing aid dispenser has a referral and medical contingency agreement with a physician and surgeon who is an otolaryngologist and is readily available.
(4) A licensed hearing aid dispenser with an advanced practice certificate shall conduct the administration of cerumen management in accordance with all of the following conditions:
(A) The cerumen management is performed using a cotton swab or plastic curette. A suction or irrigation device approved by the United States Food and Drug Administration for cerumen removal may only be used if the prospective hearing aid user does not have diabetes, a perforated tympanic membrane, a tube in the tympanic membrane, or a weakened immune system.
(B) The licensee follows the federal Centers for Disease Control and Prevention guidelines for infection control.
(C) The licensee carries liability insurance covering cerumen management.
(D) The licensee obtains specific informed consent from the prospective hearing aid user to perform cerumen management and advises the prospective hearing aid user of the risks of cerumen management, as specified in subparagraph (E).
(E) The licensee has a referral and medical contingency agreement with a physician and surgeon specializing in otolaryngology who is readily available and the licensee immediately refers a prospective hearing aid user to the physician or surgeon if the prospective hearing aid user demonstrates any trauma, including tears, bleeding, or other pathology of the ear discovered in the process of cerumen management.
(5) In addition to the penalty specified in Section 2538.42, the board may revoke the advanced practice certificate of a licensee who violates any provision of this article.

SEC. 4.

 Section 2538.30 of the Business and Professions Code is amended to read:

2538.30.
 (a) A temporary, trainee, or apprentice licensee shall not be the sole proprietor of, manage, or independently operate a business which engages in the fitting or sale of hearing aids.
(b) A temporary, trainee, or apprentice licensee shall not advertise or otherwise represent that the person holds a license as a hearing aid dispenser.

SEC. 5.

 Section 2538.58 is added to the Business and Professions Code, to read:

2538.58.
 (a) As an alternative to the trainee license described in Section 2538.28, this section establishes requirements for licensure as an apprentice hearing aid dispenser. An apprentice hearing aid dispenser license authorizes the licenseholder to engage in the practice of dispensing hearing aids under the supervision of an apprentice sponsor in accordance with this section.
(b) An apprentice sponsor is a licensed hearing aid dispenser who has held a valid hearing aid dispenser’s license issued by the board for at least three years years, is not subject to discipline or other enforcement action by the board, is the holder of an advanced practice certificate under Section 2538.11, and has agreed to act as an apprentice sponsor to the applicant. An apprentice sponsor shall be responsible for the day-to-day supervision of the apprentice, and shall be responsible for services provided to a client by the apprentice hearing aid dispenser.
(c) The board shall issue an apprentice hearing aid dispenser license to an applicant who meets all of the following requirements:
(1) The applicant has filed a completed application form and paid the apprentice licensee license fee, as established by the board by regulation. The regulatory fee shall be in an amount no greater than the reasonable cost to the board to administer this section and shall be deposited into the fund.
(2) The applicant has met all academic qualifications for licensure as a hearing aid dispenser.
(3) The applicant has a signed statement from a person licensed as a hearing aid dispenser that the person will act as the applicant’s apprentice sponsor for the duration of the apprentice’s training in accordance with this section.
(d) The duration of the apprenticeship shall begin on the date the board issues an apprentice hearing aid dispenser license and expires 18 months thereafter. An apprentice hearing aid dispenser shall maintain a valid apprentice license during the duration of the apprenticeship.
(e) The training of an apprentice hearing aid dispenser shall be performed under the supervision of an apprentice sponsor approved by the board.
(f) The board shall, by regulation, establish a list of approved courses for purposes of the training program for an apprentice hearing aid dispenser that includes a minimum number of hours of coursework that is appropriate for the experience and functions necessary for an apprentice that is consistent with Section 2531.02.
(g) An apprentice hearing aid dispenser shall be required to complete a minimum number of supervised practicum contact hours of inpatient care, as determined by the board, including a minimum of directly supervised hours, to sit for the written and practical examinations required pursuant to Section 2538.25.
(h) In order to be eligible to sit for the practical examination specified in Section 2538.31, an apprentice hearing aid dispenser shall do the following:
(1) Successfully complete the International Hearing Society’s Distance Learning for Professionals in Hearing Health Sciences course or another comparable course approved by the board.
(2) Successfully complete the directly supervised practicum training for at least 12 months in accordance with this section.
(i) Upon successful completion of the practical examination required pursuant to Section 2538.31, the apprentice shall complete the remainder of the apprenticeship under the indirect supervision of the apprentice sponsor.
(j) An apprentice sponsor shall not supervise more than three apprentices at one time. one apprentice at a time, except as authorized by the board.
(k) An apprentice sponsor shall submit a written notification of termination of sponsorship to the board and the apprentice licenseholder within 10 working days of cessation of sponsorship.
(l) The apprentice hearing aid dispenser shall give written notice to the board of a change in sponsorship within 10 working days of the change in sponsorship.

SEC. 6.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.