A. The words and terms "audiologist," "board," "practice of audiology," "practice of speech-language pathology," "speech-language disorders," and "speech-language pathologist" when used in this chapter shall have the meanings ascribed to them in § 54.1-2600 of the Code of Virginia.

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"ABA" means the American Board of Audiology.

"Active practice" means a minimum of 160 hours of professional practice as an audiologist or speech-language pathologist for each 12-month period immediately preceding application for licensure. Active practice may include supervisory, administrative, educational, research, or consultative activities or responsibilities for the delivery of such services.

"ASHA" means the American Speech-Language-Hearing Association.

"Client" means a patient or person receiving services in audiology or speech-language pathology.

"Direct supervision" means the in-view observation and guidance by a licensed speech-language pathologist of a speech-language pathology assistant while such speech-language pathology assistant performs an assigned activity.

"Indirect supervision" means the monitoring or reviewing of activities performed by a speech-language pathology assistant by a licensed speech-language pathologist, excluding observation and guidance provided during the provision of direct services to a student, patient, or client.

"Limited cerumen management" means the identification and removal of cerumen from the cartilaginous outer one-third portion of the external auditory canal in accordance with minimum standards and procedures set forth in this chapter.

"School speech-language pathologist" means a person licensed pursuant to § 54.1-2603 of the Code of Virginia to provide speech-language pathology services solely in public school divisions.

"Supervision" means that the audiologist or speech-language pathologist is responsible for the entire service being rendered or activity being performed, is available for consultation, and is providing regular monitoring and documentation of clinical activities and competencies of the person being supervised.

A. There shall be separate licenses for the practices of audiology and speech-language pathology audiologists, speech-language pathologists, school speech-language pathologists, and speech-language pathology assistants. It is prohibited for any person to practice as an audiologist or a, speech-language pathologist, or speech-language pathology assistant unless the person has been issued the appropriate license.

B. A licensee shall provide a copy of his license upon request.

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

B. Fees shall be nonrefundable.

A. A person seeking a provisional license or licensure as an audiologist, a speech-language pathologist, or a school speech-language pathologist shall submit:

1. A completed and signed application;

2. The applicable fee prescribed in 18VAC30-21-40, or in the case of an application for licensure as an audiologist, a speech-language pathologist, or a school speech-language pathologist issued a provisional license pursuant to 18VAC30-21-70 A, the difference between the provisional licensure fee and the application licensure fee;

3. Verification of the status of the license or certification from each United States jurisdiction in which licensure or certification is held or has ever been held; and

4. A current report from the U.S. Department of Health and Human Services National Practitioner Data Bank.

B. An incomplete application package shall be retained by the board for a period of one year. If an application is not completed within the year, an applicant shall reapply and pay a new application fee.

A. The board may grant an initial license to an applicant for licensure in audiology or speech-language pathology who:

1. Holds a current and unrestricted Certificate of Clinical Competence issued by ASHA; or

2. Submits evidence of the following:

a. Documentation of graduation from a program accredited by the Council on Academic Accreditation of ASHA or an equivalent accrediting body recognized by the board;

b. Passage of the qualifying examination from an accrediting body recognized by the board; and

c. Evidence of six months of practice pursuant to a provisional license as described in 18VAC30-21-70 and submission of recommendation for licensure from the applicant's supervisor during practice as a provisional licensee.

B. 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.

C. The board may refuse to issue a license to any applicant who has been determined to have committed an act in violation of 18VAC30-21-160.

A. An applicant for initial licensure as a speech-language pathology assistant shall submit a completed application and fee along with evidence of meeting the qualification requirements of § 54.1-2620 of the Code of Virginia.

B. The board may refuse to issue a license to any applicant who has been determined to have committed an act in violation of § 54.1-2623 of the Code of Virginia or 18VAC30-21-160.

A. Provisional license to qualify for initial licensure. An applicant for licensure as an audiologist or speech-language pathologist may be issued a provisional license in order to obtain clinical experience for initial licensure in Virginia. The applicant shall submit documentation that the applicant has:

1. Passed the qualifying examination from an accrediting body recognized by the board; and

2. Either:

a. For provisional licensure in audiology, successfully completed all the didactic coursework required for the doctoral degree as documented by a college or university whose audiology program is accredited by the Council on Academic Accreditation of ASHA or an equivalent accrediting body as recognized by the board; or

b. For provisional licensure in speech-language pathology, submission of documentation of graduation or evidence that the applicant successfully completed all the didactic coursework required for a graduate program in speech-language pathology as documented by a college or university whose program is accredited by the Council on Academic Accreditation of ASHA or an equivalent accrediting body as recognized by the board.

B. Provisional license to qualify for endorsement or reentry into practice. An applicant may be issued a provisional license in order to qualify for licensure by endorsement pursuant to 18VAC30-21-80, reactivation of an inactive license pursuant to subsection C of 18VAC30-21-110, or reinstatement of a lapsed license pursuant to subsection B of 18VAC30-21-120.

All provisional licenses shall expire 24 months from the date of issuance and may be renewed for an additional 12 months by submission of a renewal form and payment of a renewal fee. Renewal of a provisional license beyond 36 months shall be for good cause shown.

C. 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. The provisional licensee shall be responsible and accountable for the safe performance of those direct client care tasks to which the provisional licensee has been assigned.

D. 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;

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

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

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

E. 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.

A. An applicant for licensure in audiology or speech-language pathology who has been licensed in another United States jurisdiction may apply for licensure in Virginia in accordance with application requirements in 18VAC30-21-50 and shall submit documentation of current active and unrestricted licensure in another United States jurisdiction and either:

1. Evidence of one year of active practice over the past three years; or

2. Evidence of six months of practice pursuant to a provisional license as described in 18VAC30-21-70 and submission of recommendation for licensure from the applicant's supervisor during practice as a provisional licensee.

B. The board may refuse to issue a license to any applicant who has been determined to have committed an act in violation of § 54.1-2623 of the Code of Virginia or 18VAC30-21-160.

A. In order to To renew an active license as an audiologist, speech-language pathologist, or school speech-language pathologist, a licensee shall complete at least 10 hours of continuing education prior to the renewal date each year.

B. To renew an active license as a speech-language pathology assistant, a licensee shall complete at least 5 hours of continuing education prior to the renewal date each year.

C. One hour of the 10 continuing education 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. D. 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 a board-recognized, accredited sponsor or organization.

C. E. If the licensee is dually licensed by the 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. F. A licensee shall be exempt from the continuing education requirements for the first renewal following the date of initial licensure in Virginia under pursuant to 18VAC30-21-60 or 18VAC30-21-61.

E. G. 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. H. 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. I. 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. J. The board may periodically conduct an audit for compliance with continuing education requirements. Licensees selected for an audit conducted by the board shall provide all supporting documentation within 30 days of receiving notification of the audit.

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

A. An audiologist, speech-language pathologist, or school speech-language pathologist, or speech-language pathology assistant who holds a current, unrestricted license in Virginia may, upon a request on the renewal application and submission of the required fee, be issued an inactive license. The holder of an inactive license shall not be required to maintain continuing education requirements and shall not be entitled to perform any act requiring a license issued by the board to practice audiology or speech-language pathology in Virginia.

B. A licensee whose license has been inactive or has lapsed and who requests reactivation or reinstatement of an active license shall file an application, pay the prescribed fee, which, for reactivation of an inactive license, shall be the difference between the inactive and active renewal fees for the current year, and provide documentation of:

1. Either:

a. Current certification issued by ASHA or ABA; or

b. Completion of 10 continuing education hours equal to the requirement for the number of years in which the license has been inactive, not to exceed 30 contact hours for audiologists, speech-language pathologists, or school speech-language pathologists and not to exceed 15 contact hours for speech-language pathology assistants; and

2. A current report from the U.S. Department of Health and Human Services National Practitioner Data Bank.

C. The board may deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-2623 of the Code of Virginia or 18VAC30-21-160.

A. Responsibility of a licensee.

1. A. A licensed audiologist who supervises unlicensed assistants shall document such supervision, shall be held fully responsible for their performance and activities, and shall ensure that they perform only those activities that do not constitute the practice of audiology and that are commensurate with their level of training.

2. B. A licensed speech-language pathologist who supervises unlicensed speech-language pathology assistants shall document such supervision, shall be held fully responsible for their performance and activities, and shall ensure that they speech-language pathology assistants only perform only those activities that do not constitute the practice of speech-language pathology activities that fall within the statutory scope of practice of a speech-language pathology assistant included in § 54.1-2621 of the Code of Virginia and that are commensurate with their the speech-language pathology assistant's level of training.

a. A speech-language pathologist shall not supervise an assistant without the speech-language pathologist's knowledge and consent by the assistant and the licensee documented prior to assumption of supervisory responsibilities.

b. The frequency in which the speech-language pathologist personally delivers treatment or services to a client who is receiving some services from an assistant shall be up to the professional judgment of the speech-language pathologist and shall be determined by the treatment needs of the client, the type of services being provided, and the setting in which the client is being served, but shall occur at least every 30 days.

3. C. The identity of the unlicensed any assistant shall be disclosed to the client prior to treatment and shall be made a part of the client's file.

B. Qualifications of a speech-language pathologist assistant.

1. A person acting as a speech-language pathologist assistant shall have:

a. A bachelor's degree or associate's degree and documented training by a licensed speech-language pathologist in topics related to the client population to be served; or

b. Employment as a speech-language pathologist assistant in a United States jurisdiction within the last five years preceding July 27, 2016.

2. A speech-language pathologist supervising an assistant shall be responsible for determining that the knowledge, skills, and clinical experience of the assistant are sufficient to ensure competency to perform all tasks to which the assistant is assigned. The speech-language pathologist shall document competency after training and direct observation of the assistant's performance of such tasks, and a record of skills and competencies shall be maintained.

C. Scope of practice of a speech-language pathologist assistant. After demonstration and documentation of competency for the duties to be assigned, an assistant shall only engage in those duties planned, designed, and supervised by a licensed speech-language pathologist, to include the following:

1. Assist with speech, language, and hearing screenings without clinical interpretation of results.

2. Assist during assessment of a client exclusive of administration or interpretation.

3. Perform activities for each session that are routine and do not require professional judgment, in accordance with a plan developed and directed by the speech-language pathologist who retains the professional responsibility for the client.

4. Document a client's performance and report information to the supervising speech-language pathologist.

5. Assist with programming augmentative and alternative communication devices and assist the client in repetitive use of such devices.

6. Sign or initial informal treatment notes and, upon request, co-sign formal documents with the supervising speech-language pathologist.

7. Engage in the following activities:

a. Preparing materials;

b. Scheduling appointments and activities;

c. Preparing charts, records, or graphs and performing other clerical duties;

d. Performing checks and maintenance of equipment; and

e. Assisting a client with transitioning to and from therapy sessions.

8. Perform duties not otherwise restricted to the practice of speech-language pathology.

D. A speech-language pathologist assistant shall not engage in the practice of speech-language pathology, including the following:

1. Represent himself as a speech-language pathologist.

2. Perform standardized or nonstandardized diagnostic tests or formal or informal evaluations.

3. Perform procedures that require a professional level of clinical acumen and technical skill.

4. Tabulate or interpret results and observations of feeding and swallowing evaluations or screenings performed by a speech-language pathologist.

5. Participate in formal conferences or meetings without the presence of the supervising speech-language pathologist.

6. Provide interpretative information to the client, the family of the client, or others regarding the client's status or service.

7. Write, develop, or modify a client's treatment plan.

8. Assist in or provide services as specified in subsection C of this section unless directed by the supervising speech-language pathologist.

9. Sign any formal documents in lieu of the supervising speech-language pathologist.

10. Select a client for service or discharge a client from service.

11. Make a decision on the need for additional services or make referrals for service.

12. Disclose clinical or confidential information either orally or in writing to anyone other than the supervising speech-language pathologist, unless mandated by law or authorized by the supervising speech-language pathologist.

13. Develop or determine the swallowing or feeding strategies or precautions for a client or provide feeding or swallowing treatment.

E. D. Supervision of an assistant in a speech-language pathology assistant.

1. The practice of an assistant shall only be supervised by a speech-language pathologist who retains full legal and ethical responsibility for the client. A speech-language pathologist shall only supervise the equivalent of two full-time assistants.

2. The speech-language pathologist shall provide the level of supervision to the speech-language pathologist assistant necessary to ensure quality of care to include onsite supervision of at least two client sessions for each assistant being supervised every 30 days to directly observe and evaluate the performance of the assistant. The speech-language pathologist shall document such onsite observation and evaluation in the client record for each session.

The board may refuse to issue a license to any applicant, suspend a license for a stated period of time or indefinitely, reprimand a licensee or place his license on probation with such terms and conditions and for such time as it may designate, impose a monetary penalty, or revoke a license for any of the following:

1. Guarantee of the results of any speech, voice, language, or hearing consultative or therapeutic procedure or exploitation of clients by accepting them for treatment when benefit cannot reasonably be expected to occur or by continuing treatment unnecessarily;

2. Diagnosis or treatment of speech, voice, language, and hearing disorders solely by written correspondence, provided this shall not preclude:

a. Follow-up by written correspondence or electronic communication concerning individuals previously seen; or

b. Providing clients with general information of an educational nature;

3. Failure to comply with provisions of § 32.1-127.1:03 of the Code of Virginia related to the confidentiality and disclosure of client records or related to provision of client records to another practitioner or to the client or his personal representative;

4. Engaging or attempting to engage in a relationship with a client that constitutes a professional boundary violation in which the practitioner uses his professional position to take advantage of the vulnerability of a client or a client's family, including sexual misconduct with a client or a member of the client's family or other conduct that results or could result in personal gain at the expense of the client;

5. Incompetence or negligence in the practice of the profession;

6. Failure to comply with applicable state and federal statutes or regulations specifying the consultations and examinations required prior to the fitting of a new or replacement prosthetic aid for any communicatively impaired person;

7. Failure to refer a client to an appropriate health care practitioner when there is evidence of an impairment for which assessment, evaluation, care, or treatment might be necessary;

8. Failure to supervise persons who assist in the practice of audiology or speech-language pathology as well as failure to disclose the use and identity of unlicensed or licensed assistants;

9. Conviction of a felony or a misdemeanor involving moral turpitude;

10. Violating or cooperating with others in violating any of the provisions of Chapter 1 (§ 54.1-100 et seq.), 24 (§ 54.1-2400 et seq.), or 26 (§ 54.1-2600 et seq.) of Title 54 of the Code of Virginia or the regulations of the board;

11. Publishing or causing to be published in any manner an advertisement relating to his professional practice that is false, deceptive, or misleading;

12. Inability to practice with skill and safety;

13. Fraud, deceit, or misrepresentation in provision of documentation or information to the board or in the practice of audiology or speech-language pathology;

14. Aiding and abetting unlicensed activity; or

15. Revocation, suspension, restriction, or any other discipline of a license or certificate to practice or surrender of license or certificate while an investigation or administrative proceedings are pending in another regulatory agency in Virginia or another jurisdiction.