Title of Regulation: 18VAC30-21. Regulations Governing Audiology and Speech-Language Pathology (amending 18VAC30-21-100).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: February 19, 2020.

Effective Date: March 5, 2020.

Agency Contact: Leslie L. Knachel, Executive Director, Board of Audiology and Speech-Language Pathology, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 597-4130, or email audbd@dhp.virginia.gov.

Basis: Regulations Governing Audiology and Speech-Language Pathology (18VAC30-21) is promulgated under the general authority of Chapter 24 of Title 54.1 of the Code of Virginia. Section 54.1-2400 provides the Board of Audiology and Speech-Language Pathology the authority to promulgate regulations to administer the regulatory system. General authority for a continuing competency requirement for renewal of licensure is found in § 54.1-103 of the Code of Virginia.

Purpose: The purpose of the amendment is to increase access to continuing education (CE). To the extent audiologists or speech-language pathologists can more readily obtain CE at less cost to licensees, the public health and safety is better protected.

Rationale for Using Fast-Track Rulemaking Process: Adding another approved provider of continuing education benefits some licensees who receive in-service training from a health care organization accredited by DNV GL Healthcare, therefore such amendment is not expected to be controversial.

Substance: 18VAC30-21-100 is amended to add DNV GL Healthcare as a recognized accrediting body for health care organizations that are approved to provide CE for licensees. In addition, the name of the Joint Commission on Accreditation of Healthcare Organizations is amended to reflect a change in the name of that entity to "The Joint Commission."

Issues: The primary advantage of this change is additional opportunities to obtain CE through employers of some licensees. There are no disadvantages to the public. There are no advantages and disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. In response to a petition for rulemaking, the Board of Audiology and Speech-Language Pathology (Board) proposes to establish that health care organizations accredited by DNV GL Healthcare are approved sources of continuing education.

Background. Regulations Governing Audiology and Speech-Language Pathology (Regulation) require that in order to renew an active license, a licensee shall complete at least 10 contact hours of continuing education prior to the renewal date each year. The current regulation specifies that the continuing education must be activities, programs, or courses related to audiology or speech-language pathology, depending on the license held, and offered or approved by one of the following accredited sponsors or organizations sanctioned by the profession:

1. The Speech-Language-Hearing Association of Virginia or a similar state speech-language-hearing association of another state;

2. The American Academy of Audiology;

3. The American Speech-Language-Hearing Association;

4. The Accreditation Council on Continuing Medical Education of the American Medical Association offering Category I continuing medical education;

5. Local, state, or federal government agencies;

6. Colleges and universities;

7. International Association of Continuing Education and Training; or

8. Health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations has changed its name to The Joint Commission. The Board proposes to amend that entity's name in the regulation to reflect that change. Also, the Board proposes to state in the regulation that health care organizations accredited by DNV GL Healthcare are also approved sources of continuing education.

Starting in 2008, the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) has granted accreditation deeming authority to DNV GL Healthcare as an option to accreditation by The Joint Commission for participation in Medicare. On February 26, 2019, a petition for rulemaking² was submitted to the Board to "recognize health care organizations accredited by DNV-GL Healthcare for approval of continuing education." Twenty-two hospital systems nationally, including the Riverside and Sentara health systems in Virginia, are now accredited by DNV GL rather than The Joint Commission.³

Estimated Benefits and Costs. To the extent that accreditation from DNV GL signifies as much competence to provide quality continuing education pertaining to audiologists and speech-language pathologists as does accreditation from The Joint Commission, the proposed amendment appears to be beneficial. Audiologists and speech language pathologists would have additional sources of quality continuing education available. This would be particularly convenient, and perhaps lower cost, for licensees who are employees of a health care organization accredited by DNV GL. Such individuals could potentially newly have training provided by their employer qualify for continuing education. If these licensees would otherwise have obtained these hours of continuing education from other sources, these other sources may encounter reduced demand for their services, potentially resulting in reduced revenue.

Businesses and Other Entities Affected. The proposed amendments potentially affect the 542 licensed audiologists and 4,351 licensed speech-language pathologists in the Commonwealth, and their employers.⁴ Licensees who are employees of a health care organization accredited by DNV GL would be particularly affected. There are two health care organizations accredited by DNV GL in Virginia. Providers of continuing education to audiologists and speech-language pathologists would also potentially be affected. Data for the number of providers of continuing education to audiologists and speech-language pathologists is not available.⁵ The proposal would not increase implementation or compliance costs.

Localities⁶ Affected.⁷ The proposed amendments apply statewide. Employees of health care organizations accredited by DNV GL would be particularly affected. The two Virginia health care organizations currently accredited by DNV GL have locations in the Cities of Chesapeake, Franklin, Hampton, Newport News, Norfolk, Portsmouth, Suffolk, Virginia Beach, and Williamsburg and the Counties of Accomack, Essex, Gloucester, Hanover, Isle of Wight, King William, Lancaster, Mathews, Middlesex, New Kent, Northampton, Northumberland, Richmond, Sussex, and York. The proposed amendments do not introduce costs for local governments.

Projected Impact on Employment. The proposed amendments are not likely to substantially affect total employment.

Effects on the Use and Value of Private Property. The proposal to establish that health care organizations accredited by DNV GL Healthcare are approved sources of continuing education would likely increase the number of sources of qualifying continuing education for audiologists and speech-language pathologists, potentially reducing the cost of obtaining such continuing education. To the extent that these costs are incurred or partially incurred by firms that employ audiologists and speech-language pathologists, this may moderately increase the net value of such firms.

The proposal may also result in some private providers of continuing education facing additional competition for their services, potentially moderately reducing revenue. This may moderately reduce the net value of such continuing education providers.

The proposed amendments do not affect real estate development costs.

Adverse Effect on Small Businesses:⁸

Types and Estimated Number of Small Businesses Affected. The proposal to establish that health care organizations accredited by DNV GL Healthcare are approved sources of continuing education potentially may moderately reduce demand for services from some small providers of continuing education to audiologists and speech-language pathologists. Data is not available to estimate the number of such small businesses.

Costs and Other Effects. The proposed amendments do not increase costs. Some small providers of continuing education may encounter reduced demand for their services and consequently reduced revenue.

Alternative Method that Minimizes Adverse Impact. The proposal to establish that health care organizations accredited by DNV GL Healthcare are approved sources of continuing education creates benefit for licensed audiologists and licensed speech-language pathologists. The benefit cannot be achieved without the resulting potential loss of business for some small continuing education providers.

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²See https://townhall.virginia.gov/l/viewpetition.cfm?petitionid=293

³Source: Department of Health Professions

⁴The Department of Health Professions licenses individual audiologists and speech-language pathologists, but not their employers. Consequently, the number of licensed individuals is available, but the number of employers is not.

⁵The Department of Health Professions does not license providers of continuing education and thus does not collect associated data.

⁶"Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁷ § 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

⁸Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Agency's Response to Economic Impact Analysis: While the Board of Audiology and Speech-Language Pathology concurs with the analysis of the Department of Planning and Budget on amendment to 18VAC30-21, Regulations Governing Audiology and Speech-Language Pathology, the board strongly disagrees with the determination that the action needs to be referred to the Joint Commission on Administrative Rules (JCAR). The economic impact analysis acknowledges that the proposed action provides additional, less costly opportunities for licensees of the board to obtain continuing education. The board has adopted a less restrictive, less burdensome regulation, so the referral to JCAR is unwarranted.

Summary:

The amendment adds DNV GL Healthcare as a recognized accrediting body for health care organizations that are approved to provide continuing education for licensees. The amendment is in response to a petition for rulemaking.

18VAC30-21-100. Continuing education requirements for renewal of an active license.

A. In order to renew an active license, a licensee shall complete at least 10 contact hours of continuing education prior to the renewal date each year. Up to 10 contact hours of continuing education in excess of the number required for renewal may be transferred or credited to the next renewal year. One hour of the 10 hours required for annual renewal may be satisfied through delivery of professional services, without compensation, to low-income individuals receiving health services through a local health department or a free clinic organized in whole or primarily for the delivery of those services. One hour of continuing education may be credited for three hours of providing such volunteer services, as documented by the health department or free clinic.

B. Continuing education shall be activities, programs, or courses related to audiology or speech-language pathology, depending on the license held, and offered or approved by one of the following accredited sponsors or organizations sanctioned by the profession:

1. The Speech-Language-Hearing Association of Virginia or a similar state speech-language-hearing association of another state;

2. The American Academy of Audiology;

3. The American Speech-Language-Hearing Association;

4. The Accreditation Council on Continuing Medical Education of the American Medical Association offering Category I continuing medical education;

5. Local, state, or federal government agencies;

6. Colleges and universities;

7. International Association of Continuing Education and Training; or

8. Health care organizations accredited by the The Joint Commission on Accreditation of Healthcare Organizations or DNV GL Healthcare.

C. If the licensee is dually licensed by this board as an audiologist and speech-language pathologist, a total of no more than 15 hours of continuing education are required for renewal of both licenses with a minimum of 7.5 contact hours in each profession.

D. A licensee shall be exempt from the continuing education requirements for the first renewal following the date of initial licensure in Virginia under 18VAC30-21-60.

E. The licensee shall retain all continuing education documentation for a period of three years following the renewal of an active license. Documentation from the sponsor or organization shall include the title of the course, the name of the sponsoring organization, the date of the course, and the number of hours credited.

F. The board may grant an extension of the deadline for continuing education requirements, for up to one year, for good cause shown upon a written request from the licensee prior to the renewal date of each year.

G. The board may grant an exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

H. The board shall periodically conduct an audit for compliance with continuing education requirements. Licensees selected for an audit conducted by the board shall complete the Continuing Education Form and provide all supporting documentation within 30 days of receiving notification of the audit.

I. Failure to comply with these requirements may subject the licensee to disciplinary action by the board.