Title of Regulation: 18VAC30-20. Regulations Governing the Practice of Audiology and Speech-Language Pathology (amending 18VAC30-20-80, 18VAC30-20-160, 18VAC30-20-170, 18VAC30-20-171, 18VAC30-20-185).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: December 31, 2014.

Effective Date: January 15, 2015.

Agency Contact: Leslie L. Knachel, Executive Director, Board of Audiology and Speech-Language Pathology, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4630, FAX (804) 527-4413, or email leslie.knachel@dhp.virginia.gov.

Basis: 18VAC30-20, Regulations Governing the Practice of Audiology and Speech-Language Pathology, are promulgated under the general authority of § 54.1-2400 of the Code of Virginia. Subdivision 6 of § 54.1-2400 provides the Board of Audiology and Speech-Language Pathology the authority to promulgate regulations to administer the regulatory system.

The specific authority for the board to promulgate regulations for a provisional license in speech-language pathology is found in § 54.1-2604 of the Code of Virginia, which was amended by Chapter 436 of the 2013 Acts of Assembly to require clinical experience for licensure as a speech-language pathologist (SLP) and authorize the board to issue a provisional license to an applicant in speech-language pathology to allow the applicant to obtain clinical experience.

Purpose: If the board continues to grant a full license to SLPs without evidence of clinical competency, the public may be at risk of receiving inadequate or incompetent services. Those services are often provided to young children or elderly stroke victims. The issuance of a provisional license to SLP applicants will allow them to receive clinical supervision for their practice and allow the board to issue full, independent licensure with some assurance of competency to protect the health, safety, and welfare of the public.

Rationale for Using Fast-Track Process: The board expects this regulatory action to be noncontroversial because issuance of and practice with a provisional license is already common for audiologists. The legislation that resulted in Chapter 436 of the 2013 Acts of Assembly was requested by the Speech-Language-Hearing Association of Virginia and is strongly supported by the profession. Additionally, Virginia has been only one of three states not requiring clinical experience for licensure, so these changes will make licensure in the Commonwealth consistent with other states and improve mobility for practitioners.

Substance: The proposed amendments will allow an applicant for reinstatement or licensure by endorsement to meet the requirements for clinical experience by obtaining a provisional license and practicing under supervision for six months. A provisional license will also be available to a person with a graduate degree who is practicing under supervision to complete a clinical fellowship year and qualify for clinical competency certification from the American Speech-Language-Hearing Association (ASHA). Such certification will be required for full licensure in order to ensure minimal clinical competency for licensed speech-language pathologists.

Issues: The primary advantage to the public is assurance of clinical competency for licensed speech-language pathologists. Additionally, a few SLPs, who are currently unable to be licensed by endorsement, may be able to obtain practical experience through a provisional license, which will qualify them for licensure in Virginia. There are no disadvantages to the public.

The credentials review for SLP applicants will be performed by ASHA, so there is an advantage to the Commonwealth in terms of cost-avoidance to the board. There are no disadvantages to the Commonwealth.

The professional association of speech-language pathologists in Virginia is fully supportive of the changes and worked to get authorizing legislation passed in the General Assembly.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 436 of the 2013 Acts of the Assembly, the proposed regulations establish provisional licensing for speech-language pathologists who do not have clinical experience.

Result of Analysis. The benefits likely exceed the costs for all proposed changes. However, there is insufficient data to accurately compare the magnitude of the benefits versus the costs. Detailed analysis of the benefits and costs can be found in the next section.

Estimated Economic Impact. Pursuant to Chapter 436 of the 2013 Acts of the Assembly, the proposed regulations establish provisional licensing for speech-language pathologists who do not have clinical experience. Under the current regulations, clinical experience is not required for full licensure in speech-language pathology. If an applicant has met the educational and examination requirements, he or she may be issued a full license to practice speech-language pathology.

Under the proposed regulations, an applicant who has met the educational and examination requirements, but is lacking clinical experience may be allowed to practice speech-language pathology with a provisional license under the supervision of a licensed practitioner. At the completion of required clinical experience, a provisional license may be upgraded to a full license. According to the Department of Health Professions (DHP), allowing practice of speech-language pathology without supervision could be risky if the practitioner lacks clinical experience. Thus, the proposed provisional licensure is expected to reduce health and safety risks that may be posed by inexperienced speech-language pathologists.

The main costs of the proposed change will be on the applicants. With the proposed changes, applicants who receive a provisional license may be allowed to practice their profession only under the supervision of a fully licensed practitioner. Because of the required supervision, provisional licensees may see a reduction in the pool of potential employers if some employers are unwilling to provide supervision or unwilling to allow their fully licensed staff to provide supervision. There could also be a negative effect on the pay due to the provisional nature of the license. However, DHP is unaware from the 47 other states that require clinical experience for licensure of any evidence indicating that fully licensed persons would not be willing to supervise a provisional licensee. In addition, the Board of Audiology and Speech-Language Pathology will rely on a certification issued by American Speech Language Hearing Association (ASHA) to determine clinical competency. According to DHP, ASHA may charge $286 to $511 to review an applicant's clinical credentials depending on the type of the certificate sought. However, the applicants for provisional license will be required to pay only a $50 application fee instead of $135 for a full license, which represents $85 savings per application.

Another significant benefit will accrue to the speech-language pathologists whose license may have lapsed for more than five years or applicants for licensure by endorsement who have not been actively practicing for three of the past five years. Under the current regulations, these individuals are required to retake the qualifying examination which costs about $115. Under the proposed regulations, they will be allowed to practice with a provisional license without having to retake the exam and may upgrade to a full license after six months. Not having to retake the exam will provide time and travel savings in addition to the savings in exam fee for these individuals.

Businesses and Entities Affected. DHP receives approximately 300 to 350 applications per year for speech language pathology license. One half of the applicants are estimated to lack clinical experience.

Localities Particularly Affected. The proposed regulations apply throughout the Commonwealth.

Projected Impact on Employment. Required supervision for provisional licensees may have a negative impact on the demand for speech-language pathologists with a provisional license. Increased costs due to ASHA review of clinical credentials may provide disincentives to get into this profession. Finally, the elimination of the requirement to retake the exam for those with a lapsed license will make it easier for them to get back into the profession. While the net impact of these opposite effects on demand and supply of speech-language pathologists in the Commonwealth is not known, it probably will be small.

Effects on the Use and Value of Private Property. Required supervision for provisional licensees may increase costs for some employers and have a negative effect on their asset values.

Small Businesses: Costs and Other Effects. Some of the entities hiring speech-language pathologists may be small businesses. As discussed above, required supervision may add to their costs.

Small Businesses: Alternative Method that Minimizes Adverse Impact. There is no known alternative that minimizes potential costs on small businesses while accomplishing the same health and safety goals.

Real Estate Development Costs. No impact on real estate development costs is expected.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Audiology and Speech-Language Pathology concurs with the analysis of the Department of Planning and Budget.

Summary:

Pursuant to changes to § 54.1-2604 of the Code of Virginia by Chapter 436 of the 2013 Acts of Assembly, the amendments (i) require an applicant for full licensure in speech-language pathology to have clinical experience and (ii) add provisional licensure in speech-language pathology for the purpose of allowing applicants to gain the clinical experience.

18VAC30-20-80. Fees.

A. The following fees shall be paid as applicable for licensure:

1. Application for audiology or speech-language pathology license	$135
2. Application for school speech-language pathology license	$70
3. Verification of licensure requests from other states	$20
4. Annual renewal of audiology or speech-language pathology license	$75
5. Late renewal of audiology or speech-language pathology license	$25
6. Annual renewal of school speech-language pathology license	$40
7. Late renewal of school speech-language pathology license	$15
8. Reinstatement of audiology or speech-language pathology license	$135
9. Reinstatement of school speech-language pathology license	$70
10. Duplicate wall certificates	$25
11. Duplicate license	$5
12. Returned check	$35
13. Inactive license renewal for audiology or speech-language pathology	$40
14. Inactive license renewal for school speech-language pathology	$20
15. Approval of a continuing education sponsor	$200
16. Application for provisional license in audiology	$50
17. Renewal of provisional license in audiology	$25

B. Fees shall be made payable to the Treasurer of Virginia and shall not be refunded once submitted.

C. For the renewal of licenses by December 31, 2013, the fees shall be as follows:

1. Annual renewal of audiology or speech-language pathology license	$55
2. Annual renewal of school speech-language pathology license	$30
3. Inactive license renewal for audiology or speech-language pathology	$30
4. Renewal of provisional license in audiology	$20

18VAC30-20-160. Reinstatement of lapsed license.

A. When a license has not been renewed within one year of the expiration date, a person may apply to reinstate his license by submission of a reinstatement application, payment of the reinstatement fee, and submission of documentation of 15 continuing competency hours for each year the license has been lapsed, not to exceed 60 hours obtained during the time the license in Virginia was lapsed.

B. A licensee who does not reinstate within five years as prescribed by subsection A of this section shall either:

1. Reapply for licensure as prescribed by 18VAC30-20-170 and meet the qualifications for licensure in effect at the time of the new application; or

2. Meet the continuing competency requirements specified in subsection A of this section and provide documentation of a current license in another jurisdiction in the United States and evidence of active practice for at least three of the past five years.

C. An applicant for reinstatement in audiology who does not meet one of the requirements of subsection B of this section may qualify for reinstatement by practice under supervision with a provisional license for six months and a recommendation for reinstatement by his supervisor. The board may issue a provisional license to an applicant who can provide evidence of having met the applicable educational qualifications prescribed in 18VAC30-20-170 and passage of the qualifying examination at the time of initial licensure. Provisional licensure shall be practiced under the supervision of a licensed audiologist and in accordance with subsections D and E of 18VAC30-20-171.

D. If the licensee holds licensure in any other state or jurisdiction, he shall provide evidence that no disciplinary action has been taken or is pending. The board reserves the right to deny a request for reinstatement to any licensee who has been determined to have committed an act in violation of 18VAC30-20-280.

Part III
Requirements for Licensure

18VAC30-20-170. Requirements for licensure.

A. The board may grant a license to an applicant who:

1. Holds a current and unrestricted Certificate of Clinical Competence in the area in which he seeks licensure issued by the American Speech-Language-Hearing Association, certification issued by the American Board of Audiology or any other accrediting body recognized by the board. Verification of currency shall be in the form of a certified letter from a recognized accrediting body issued within six months prior to licensure; and

2. Has passed the qualifying examination from an accrediting body recognized by the board within three years preceding the date of applying for licensure, or has been actively engaged in the respective profession for which he seeks licensure for one of the past three consecutive years preceding the date of application; or

B. The board may grant a license to an applicant for licensure as a speech-language pathologist who:

1. Holds a master's degree or its equivalent as determined by the board or a doctoral degree from a college or university whose speech-language program is accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association or an equivalent accrediting body; and

2. Has passed a qualifying examination from an accrediting body recognized by the board within three years preceding the date of applying for licensure in Virginia or has been actively engaged as a speech-language pathologist for one of the past three consecutive years preceding the date of application.

C. The board may grant a license to an applicant as a school speech-language pathologist who holds a master's degree in speech-language-pathology.

D. C. Any individual who holds an active, renewable license issued by the Virginia Board of Education with a valid endorsement in speech-language pathology on June 30, 2014, shall be deemed qualified to obtain a school speech-language pathologist license from the board until July 1, 2016, or the date of expiration of such person's license issued by the Virginia Board of Education, whichever is later.

18VAC30-20-171. Provisional licensure in audiology.

A. The board may grant a provisional license in audiology to an applicant who submits a completed application and fee with documentation that the applicant:

1. Is a graduate of or is currently enrolled in a doctoral program in audiology at a college or university whose audiology program is accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association or an equivalent accrediting body;

2. Has successfully completed all the didactic coursework required for the doctoral degree as documented by the audiology program; and

3. Has passed a qualifying examination from an accrediting body recognized by the board within three years preceding the date of applying for provisional licensure in Virginia.

B. The board may grant a provisional license in speech-language pathology to an applicant who submits a completed application and fee with documentation that the applicant:

1. Is a graduate of or is currently enrolled in a graduate program in speech-language pathology at a college or university whose program is accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association or an equivalent accrediting body;

2. Has successfully completed all the didactic coursework required for the graduate degree as documented by the speech-language pathology program; and

3. Has passed a qualifying examination from an accrediting body recognized by the board within three years preceding the date of applying for provisional licensure in Virginia.

B. C. A provisional license shall expire 18 months from the date of issuance and may be renewed for an additional six months by submission of a renewal form and payment of a renewal fee. Renewal of a provisional license beyond 24 months shall be for good cause shown as determined by a committee of the board.

C. D. The holder of a provisional license in audiology shall only practice under the supervision of a licensed audiologist and the holder of a provisional license in speech-language pathology shall only practice under the supervision of a licensed speech-language pathologist in order to obtain clinical experience as required for certification by the American Speech-Language-Hearing Association, the American Board of Audiology, or any other accrediting body recognized by the board. The provisional licensee shall be responsible and accountable for the safe performance of those direct patient care tasks to which he has been assigned.

D. E. Licensed audiologists or speech-language pathologists providing supervision shall:

1. Have an active, current license and at least three years of active practice as an audiologist or speech-language pathologist prior to providing supervision;

1. 2. Notify the board electronically or in writing of the intent to provide supervision for a provisional licensee;

2. 3. Document the frequency and nature of the supervision of provisional licensees;

3. 4. Be responsible and accountable for the assignment of patients and tasks based on their assessment and evaluation of the provisional licensee's knowledge and skills; and

4. 5. Monitor clinical performance and intervene if necessary for the safety and protection of the patients.

E. F. The identity of a provisional licensee shall be disclosed to the client prior to treatment and shall be made a part of the client's file.

18VAC30-20-185. Licensure by endorsement.

A. An applicant who has been licensed in another jurisdiction in the United States may apply for licensure in Virginia by submission of a completed application, payment of the application fee, and submission of documentation of 15 continuing competency hours for each year in which he has been licensed in the other jurisdiction, not to exceed 60 hours.

B. An applicant shall either:

1. Meet the qualifications for licensure as prescribed by 18VAC30-20-170; or

2. Provide documentation of a current license in another jurisdiction in the United States and evidence of active practice for at least three of the past five years.

C. An applicant for licensure by endorsement in audiology who does not meet one of the requirements of subsection B of this section may qualify for endorsement by practice under supervision with a provisional license for six months and a recommendation for licensure by his supervisor. The board may issue a provisional license to an applicant who can provide evidence of having met the educational qualifications prescribed in 18VAC30-20-170 and passage of the qualifying examination at the time of initial licensure. Provisional licensure shall be practiced under the supervision of a licensed audiologist and in accordance with subsections D and E of 18VAC30-20-171.

D. An applicant shall provide evidence that no disciplinary action has been taken or is pending against his license in another jurisdiction. The board reserves the right to deny a request for licensure to any applicant who has been determined to have committed an act in violation of 18VAC30-20-280.