2023 -- S 0565

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LC002394

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PROFESSIONAL LICENSING AND

REGULATION OF SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS

     Introduced By: Senators Gallo, Quezada, Pearson, Cano, Mack, and Zurier

     Date Introduced: March 07, 2023

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS"

is hereby amended by adding thereto the following chapter:

CHAPTER 48.2

PROFESSIONAL LICENSING AND REGULATION OF SPEECH-LANGUAGE

PATHOLOGISTS AND AUDIOLOGISTS

     5-48.2-1. Purpose.

     The purpose of this chapter is to establish and codify prevailing standards and procedures

for licensing speech-language pathologists and audiologists in Rhode Island.

     5-48.2-2. Incorporated materials.

     This chapter hereby adopts and incorporates the American Speech-Language-Hearing

Association’s "American Speech-Language-Hearing Association Code of Ethics" (2016) by

reference, not including any further editions or amendments thereof and only to the extent that the

provisions therein are not inconsistent with these regulations.

     5-48.2-3. Definitions.

     (a) As used in this chapter, the following words and terms shall have the following

meanings, except where the context clearly indicates otherwise.

     (1) "Accredited/approved" means that an institution/program holds regional accreditation

from one of six (6) regional accrediting bodies: Middle States Association of Colleges and Schools,

New England Association of Schools and Colleges, North Central Association of Colleges and

Schools, Northwest Association of Schools and Colleges, Southern Association of Colleges and

Schools, and Western Association of Schools and Colleges.

     (2) "Act" means chapter 48 of title 5 entitled, "speech-language pathology and audiology,"

as well as the provisions of this chapter, where the context so indicates.

     (3) "Audiologist" means an individual who is licensed by the board to practice audiology

either in person or via telepractice.

     (4) "Audiology" means the audiologist applies the principles, methods, and procedures

related to hearing and the disorders of the hearing and balance systems, to related language and

speech disorders, and to aberrant behavior related to hearing loss. A hearing disorder is defined as

altered sensitivity, acuity, function, processing, and/or damage to the integrity of the physiological

auditory/vestibular systems, in individuals or groups of individuals who have or are suspected of

having such disorders.

     (5) "Audiology support personnel" shall operate under the title "audiometric aide" or

"audiology assistant" and means an individual who meets minimum qualifications established by

the board, which are less than those established by the act as necessary for licensing as an

audiologist; does not act independently; is limited to hearing screening with pass/fail criteria, and

works under the direction and supervision of an audiologist licensed under the act who has been

actively working in the field for twenty-four (24) months after completion of the postgraduate

professional experience and who accepts the responsibility for the acts and performances of the

audiometric aide or audiology assistant while working under the act .

     (6) "Board" means the state board of examiners for speech-language pathology and

audiology established pursuant to § 5-48-2.

     (7) "Clinical fellowship or traineeship" means the direct clinical work, consultation or other

duties relevant to clinical speech-language pathology work with individuals presenting disorders in

communication, for a cumulative or equivalent total of nine (9) months of full-time employment

following completion of professional speech-language pathology education under supervision

pursuant to § 5-48-7 and the provisions of this chapter.

     (8) "Clinical fellow" means the person who is practicing speech-language pathology under

the supervision of a licensed speech-language pathologist while completing the postgraduate

professional experience as required by the act and who holds a current provisional license in

accordance with the requirements described in this chapter.

     (9) "Department" means the Rhode Island department of health.

     (10) "Director" means the director of the Rhode Island department of health.

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     (11) "Graduate program" means a post-baccalaureate accredited program leading to a

master’s or doctoral degree, including a professional doctoral degree, whether offered through an

accredited graduate or professional school.

     (12) "Newborn hearing screener" means an audiometric aide or audiology assistant

working in a hospital-based newborn hearing screening program under the direction of the

department of health newborn hearing screening program, or its appointee.

     (13) "Person" means an individual, partnership organization or corporation, except that

only individuals can be licensed under this chapter.

     (14) "The practice of audiology" means an audiologist rendering or offering to render any

service in audiology either in person or via telepractice as defined in § 5-48-1 and in this section.

     (15) "The practice of speech-language pathology" means rendering or offering to render

any service in speech-language pathology either in person or via telepractice as defined in this

section.

     (16) "Regionally accredited" means the official guarantee that a college or university or

other educational institution is in conformity with the standards of education prescribed by a

regional accrediting commission recognized by the United States Secretary of Education.

     (17) "School hearing screener" means an audiometric aide or audiology assistant working

in a school-based hearing screening program under the direction of the Rhode Island department

of elementary and secondary education or its appointee.

     (18) "Speech-language pathologist" means an individual who is licensed by the board to

practice speech-language pathology either in person or via telepractice.

     (19) " Speech-language pathology" means the activities defined in § 5-48-1 and in this

section.

     (20) "Speech-language pathology assistant (SLPA) support personnel" means an individual

who meets minimum qualifications established by the board, which are less than those established

by the act as necessary for licensing as a speech-language pathologist; does not act independently;

and works under the direction and supervision of a speech-language pathologist licensed under the

act who has been actively working in the field for twenty-four (24) months after completion of the

postgraduate professional experience and who accepts the responsibility for the acts and

performances of the speech language speech-language pathology assistant while working under

this chapter.

     (21) "Telepractice" means the use of telecommunication technology to deliver speech-

language pathology and audiology services remotely. Other terms such as teleaudiology, telespeech

and speech teletherapy are also used in addition to telepractice. Use of telepractice should be of

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equal quality to services provided in person and consistent with adherence to ASHA’s Code of

Ethics (ASHA, 2016a), Scope of Practice in Audiology (ASHA, 2018), Scope of Practice in

Speech-Language Pathology (ASHA, 2016b), and Assistants Code of Conduct (ASHA, 2020)

     5-48.2-4. License requirements.

     (a) No person shall practice as, advertise as, or use the title of speech-language pathologist

or audiologist unless licensed in accordance with the provisions of the act and this section. The

provisions of the act and this section shall not apply to individuals specifically exempt from the

provisions thereof by § 5-48-10.

     (b) A provisional license for the clinical fellow as defined in this chapter shall be required

in speech-language pathology for that period of postgraduate professional experience as required

in §§ 5-48-7 and 5-48.2-5. A provisional license shall authorize an individual to practice speech-

language pathology solely in connection with the completion of the supervised postgraduate

professional experience.

     (c) Any person residing in and/or licensed in another state who provides telepractice

services in the area of speech-language pathology and audiology within the State of Rhode Island

regardless of their legal residence must be licensed in the state in accordance with the provisions

of the act and this chapter. The provisions of the act and this chapter shall not apply to individuals

specifically exempt from the provisions thereof by § 5-48-10.

     5-48.2-5. Qualifications for licensure.

     (a) Audiologists.

     (1) In addition to the requirements set forth in § 5-48-7.2, persons seeking initial licensure

as an audiologist providing in-person or telepractice services shall meet the following requirements:

     (i) Submit an official transcript indicating possession of an earned doctorate degree in

audiology from a regionally accredited educational institution or other national accrediting

organization as may be approved by the board;

     (ii) Pass a national examination in audiology approved by the board;

     (iii) Present evidence of practicum experience that is equivalent to a minimum of twelve

(12) months of full-time, supervised experience, that may be completed as part of the graduate

degree, as delineated in this chapter;

     (iv) Applicants with a master’s degree holding licensure from another state must present

verification of a Certificate of Clinical Competence from the American Speech-Language-Hearing

Association (ASHA) or other national accrediting association as may be approved by the board.

     (b) Qualifications for audiologists licensed in alternate jurisdictions.

     (1) Persons licensed as an audiologist in alternate jurisdictions on or before January 1,

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2008, shall meet the requirements of Rhode Island that were in effect at the time of initial licensure

in the alternate jurisdiction.

     (c) Speech-language pathologists.

     (1) In addition to the requirements set forth in § 5-48-7, an applicant seeking licensure to

practice as a speech-language pathologist who provides in person or telepractice services in Rhode

Island must:

     (i) Have attained a master's degree or a doctoral degree or equivalent in speech-language

pathology from an accredited educational institution accredited by the Council on Academic

Accreditation (CAA) of the American Speech-Language-Hearing Association (ASHA) or other

national accrediting association as may be approved by the board. The degree shall consist of course

work in accordance with the current minimum requirements for the Certificate of Clinical

Competence issued by the American Speech-Language-Hearing Association (ASHA) or other

national accrediting association as may be approved by the board.

     (d) Qualifications for a provisional license for speech-language pathologists.

     (1) To be eligible for provisional licensure by the department, the speech-language

pathologist must submit an application with the required application fee and be in compliance with

the requirements of this chapter and § 5-48-7.1.

     5-48.2-6. Issuance and renewal of license and fee.

     (a) The department shall issue a license as an audiologist or speech-language pathologist,

or renewal thereof, for a period of two (2) years. The license, unless sooner suspended or revoked,

shall expire on the first day of July, two (2) years following its issuance, and may be renewed

biennially (in even years); provided the applicant meets the requirements of this chapter and the

statutory provisions of the act. The licensee must maintain their certificate of clinical competence

in their practicing area (speech-language pathology or audiology) in order to renew their license.

     (b) A license may be renewed by submission of the renewal application and renewal fee as

set forth in the fee structure for licensing, laboratory and administrative services provided by the

department of health in their regulations payable before July 1 of even years (biennially).

     (c) A provisional license may be renewed annually from the date of issue, if the post-

graduate professional experience has exceeded one year, by submission of the renewal application

and renewal fee as set forth in the fee structure for licensing, laboratory and administrative services

provided by the department of health. A provisional license shall not exceed thirty-six (36) months

past the initiation of the professional experience and will expire ninety (90) days after the end of

the postgraduate professional experience.

     (d) Any licensee who allows his or her license to lapse by failing to renew it on or before

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the thirtieth day of June of even years (biennially), may have the license renewed by submitting to

the department an application and renewal fee plus an additional late fee as set forth in the fee

structure for licensing, laboratory and administrative services provided by the department of health.

     (1) Any person who allows his or her license to lapse longer than two (2) consecutive

licensing periods may be reinstated by the department, upon the filing of:

     (i) A reinstatement application for licensure;

     (ii) Payment of the current licensure renewal fee plus an additional late fee as set forth in

the fee structure for licensing, laboratory and administrative services provided by the department

of health; and

     (iii) Documentation of completion of CEUs as required in this chapter taken during the

previous two (2) years.

     (e) Inactive status.

     (1) An individual licensed as a speech-language pathologist and/or audiologist in Rhode

Island, not in the active practice of speech-language pathology or audiology within Rhode Island

during any year, may upon request to the department, have his or her name transferred to an inactive

status and shall not be required to register biennially or pay any fee as long as he or she remains

inactive.

     (2) Inactive status may be maintained for no longer than two (2) consecutive licensing

periods, after which period licensure will be terminated and a reinstatement application submitted

to the department will be required to resume practice.

     (3) Any individual whose name has been transferred to an inactive status may be restored

to active status within two (2) licensing periods to practice speech-language pathology or audiology

without a penalty fee, upon the filing of:

     (i) An application for licensure renewal with a licensure renewal fee as set forth in the fee

structure for licensing, laboratory and administrative services provided by the department of health;

and

     (ii) Such other information as may be requested by the board.

     5-48.2-7. Denial, suspension and revocation of license.

     (a) The board is authorized to suspend or revoke any license to practice speech-language

pathology and/or audiology upon finding by the board that the person is guilty of conduct as set

forth in § 5-48-11, and in addition:

     (1) Violating any provision of the act, any lawful order given, or rule or regulation adopted

by the board or departure from or failure to conform to the current standards of acceptable

prevailing practice and code of ethics of speech-language pathology or audiology as adopted by the

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board and as contained in the "American Speech-Language-Hearing Association Code of Ethics"

as incorporated in this chapter. The board need not establish actual injury to clients in order to

adjudge a speech-language pathologist or audiologist of the above named conduct.

     (2) The procedure for denial, revocation or suspension shall be as that set forth § 5-48-13.

     5-48.2-8. Support personnel.

     (a) A speech-language pathology assistant (SLPA) for speech-language pathologists shall

meet the following requirements:

     (1) Hold a bachelor's degree from an accredited college or university and have successfully

completed no less than eighteen (18) hours of graduate credit in the areas of speech-language

pathology to include the following:

     (i) Normal processes in speech, language and hearing three (3) hours;

     (ii) Disorders of speech, language and hearing nine (9) hours;

     (iii) Equipment, materials, procedures and data collection used in assessment and/or

management of speech, language and hearing disorders six (6) hours; and

     (iv) Completion of twenty-five percent (25%) of those practicum hours required for

professional personnel by the American Speech-Language-Hearing Association.

     (2) A speech-language pathology assistant (SLPA) shall be registered at the department

and be required to re-register every two (2) years.

     (b) Support personnel for audiologists (audiometric aide) or audiology assistants must meet

the following requirements:

     (1) Hold a high school diploma;

     (2) Receive intensive on-the-job training in accordance with the American Speech-

Language-Hearing Association (ASHA) or American Academy of Audiology (AAA) guidelines

for support personnel by the supervising licensed audiologist prior to providing services. Any

subsequent supervising licensed audiologist may require retraining of an audiometric aide or

audiology assistants under his/her supervision.

     (3) Audiometric aides or audiology assistants shall be registered at the department and be

required to re-register every two (2) years.

     5-48.2-9. Supervision and responsibility.

     (a) A supervising professional must be a speech-language pathologist or audiologist who

is licensed under the act and this chapter, has attained and maintained their certificate of clinical

competency and who has been actively working in the field for twenty-four (24) months after

completion of the postgraduate professional experience, and must be responsible for the acts and

performances, patient screening, and specific tasks assigned by the licensee to the speech-language

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pathology assistant (SLPA)/audiometric aide or audiology assistant.

     (1) A licensee who supervises support personnel must:

     (i) Utilize the services of only those who meet the minimum requirements enumerated

under this chapter;

     (ii) Ensure that the support personnel are assigned only those duties and responsibilities for

which the person has been specifically trained and which the assistant is qualified to perform;

     (iii) Ensure that persons who will be receiving services from support personnel, or the

person's legal representative, are informed that services are being rendered by support personnel;

     (iv) Provide supervision of the support personnel (other than newborn hearing screeners

and school hearing screeners); and

     (v) Complete of a minimum of two (2) hours of professional development in clinical

instruction/supervision.

     (b) A speech-language pathologist supervisor may only supervise one full-time equivalent

speech-language pathology assistant (SLPA) support personnel and an audiologist supervisor may

only supervise three (3) full-time equivalent audiometric aides or audiology assistants unless

otherwise approved by the board.

     (c) Observations of support audiometric aides must be completed and documented as to

date, amount of time, and accuracy and efficacy of service according to the following: Direct on-

site observations of the first ten (10) hours of direct client contact; and five percent (5%) of all

clinical sessions after the first ten (10) hours for every forty (40) consecutive hours worked; and

Indirect supervision (e.g. home, interactive television, audio/video review or patient record review)

of five percent (5%) of each forty (40) consecutive hours worked.

     5-48.2-10. Supervision of the support personnel -- newborn hearing screeners and

school hearing screeners.

     (a) Hospital-based newborn hearing screeners and school-based hearing screeners shall be

trained by a licensed audiologist working in the newborn hearing or school screening program

according to training guidelines established by the programs.

     (b) Supervision shall include a method of evaluation and documenting the competency of

each screener upon completion of the initial training and at least annually thereafter by a licensed

audiologist working in the newborn hearing or school screening program.

     (c) Observations of a speech-language pathology assistant (SLPA) pathology support

personnel must be completed and documented as to date, amount of time, and accuracy and efficacy

of service according to the following:

     (1) Direct on-site observations of the first ten (10) hours of direct client contact; and ten

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percent (10%) of clinical sessions after the first ten (10) hours of each forty (40) consecutive hours

worked; and

     (2) Indirect supervision (e.g. phone, interactive television, audio/video review) of ten

percent (10%) of each forty (40) consecutive hours worked.

     (d) Supervisors must observe all provisions of the ASHA policy regarding support

personnel unless a specific policy is addressed in this chapter, including, but not limited to, that the

licensee must maintain records which document the frequency and type of supervision of support

personnel, such records to be available for audit upon request by the board.

     5-48.2-11. Continuing education requirements.

     (a) On or before the thirtieth day of June of even years, every person licensed to practice

speech-language pathology and/or audiology within Rhode Island shall complete not less than

twenty (20) clock hours of continuing education within the preceding two (2) years and be able to

present satisfactory evidence of completion to the department.

     (1) Course descriptions, proof of attendance, or other documentation of completion shall

be retained by the licensee for a minimum of four (4) years and is subject to random audit by the

department.

     (2) Activities approved by the board for continuing education credit are those sponsored

by the American Speech-Language Hearing Association (ASHA), the American Academy of

Audiology (AAA), a state department of education, other International Association for Continuing

Education and Training (IACET)-authorized providers, and/or continuing medical education units

(CMEs) from the Accreditation Council for Continuing Medical Education (ACCME). Approved

activities may include conferences, seminars, self-study programs, courses, or workshops

sponsored by the organizations noted above, or course work from an accredited institution.

     (b) Those persons holding licensure in both speech-language pathology and audiology must

have completed and have evidence of completion of not less than thirty (30) clock hours of

continuing education within the preceding two (2) years.

     (c) Continuing education hours may not be carried over from one renewal period to the

next.

     (d) Continuing education hours must be in accordance with the American-Speech-

Language-Hearing Association's requirements including at least two (2) hours in cultural

competency, cultural humility, culturally responsive practice or diversity, equity, and inclusion

(DEI) and at least one hour in the area of ethics.

     (1) If the licensee is acting as a clinical supervisor a minimum of two (2) hours of

professional development in clinical instruction/supervision is required.

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     (e) Speech-language pathologists or audiologists initially licensed by examination after the

July 1 renewal date shall be exempt from the continuing education requirements stated in this

section until the date of the next renewal cycle (i.e., June 30 of the second year following its

issuance).

     (f) The board, at its discretion, may extend, reduce, or waive for a person the requirement

for continuing education for hardship or other extenuating circumstances as the board deems

appropriate.

     5-48.2-12. Rules governing the dispensing and/or selling of hearing aids.

     An audiologist who engages in the dispensing and/or selling of hearing aids shall comply

with any and all federal and state laws and regulations governing the sale of hearing aids.

     5-48.2-13. Rules governing practices and procedures.

     All hearings and reviews required under the provisions of the act shall be held in

accordance with the provisions of the rules and regulations regarding practices and procedures

before the department of health.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PROFESSIONAL LICENSING AND

REGULATION OF SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS

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     This act would establish prevailing standards and procedures for licensing speech-language

pathologists and audiologists in Rhode Island.

     This act would take effect upon passage.

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