This chapter governs individuals holding a license or a limited license as a hearing aid dispenser in the State. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited 2-year post-secondary program” means: A college or university located in the United States whose program has been accredited by a national accrediting association recognized by the: Council for Higher Education Accreditation; or The United State Department of Education; or A college or university located outside of the United States whose program has met the standards for certification of the governing educational body that is regulated by the government of the country where the college or university is located. “Locked, nonproprietary programming software” means software that any provider can render inaccessible to other hearing aid programmers. “Pro bono work” means work provided within the State within the scope of practice of the licensee that is performed without financial reimbursement or direct financial gain. “Proprietary programming software” means software that is: Used to program hearing aids that is supplied by a hearing aid distributor or manufacturer for the exclusive use by affiliated providers; and Locked and inaccessible to nonaffiliated providers. The Board shall forward the necessary form to an individual requesting an application for a license or a limited license as a hearing aid dispenser. The applicant shall provide the Board with the information necessary to satisfy the Board that the requirements are being fulfilled. Failure to complete the forms and to provide the information required may be cause for the application to be rejected by the Board. The applicant shall include with the application: The application fee; Documentation regarding supervision of the limited license, if applicable; An official transcript from the accredited 2-year post-secondary program, as defined in Regulation .01-1B of this chapter, attended by the applicant; and All other required documentation. The application fee covers the cost of administration and is not refundable. The Board shall include in the application for a limited license the following statement: “I do hereby affirm, under penalty of perjury, that I am the holder of a valid unrevoked, unsuspended license issued by the Maryland Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists and that I have read the above excerpts, and that I fully understand my responsibilities as supervisor for the applicant who will work and train under my supervision and for whose technical training and ethical conduct I am to be responsible. I further affirm that I have read the application of the above-named person and that to the best of my knowledge all answers are true and correct.” The holder of a current hearing aid dispenser license who serves as the supervisor for the applicant shall sign the statement quoted in §F of this regulation. False Information. An applicant furnishing false information in the application may be denied the right to the examination. If the applicant has been issued a license before the falsity of the information is discovered by the Board, the licensee may be subject to: Suspension; Revocation; or Prosecution for fraud, perjury, or both. The applicant shall demonstrate oral English competency as follows: Completion of at least 60 credits from an undergraduate college or university where English was the language of instruction throughout the applicant's inclusive dates of attendance; or Achievement of a minimum score of 105, with at least a 26 on Speaking and Listening, on the Test of English as a Foreign Language (TOEFL) within the 2 years preceding license application. Upon approval of an application, the Board shall issue a document authorizing the applicant to practice in this State in accordance with Health Occupations Article, §2-306, Annotated Code of Maryland, and the regulations in this chapter. Incomplete Applications. If an incomplete application is submitted to the Board, the Board shall notify the applicant within 30 days after receipt of an incomplete application of the materials that are required. An application is not complete until all required material, including the application fee and supporting documentation, is received by the Board. If the applicant fails to provide the required documentation within 1 year of receipt of the initial receipt, the Board may administratively close the application. An applicant whose application is administratively closed may reapply and submit with the new application proof of compliance with: This subtitle; and Health Occupations Article, Title 2, Annotated Code of Maryland. An applicant shall file the examination application with the Board at least 30 days before the date of the examination. Except for an applicant who holds a valid license to provide hearing aid dispenser services in another state or an applicant who holds a valid license to practice medicine in this State or any other state, the applicant shall obtain 6 months training under the supervision of a licensed hearing aid dispenser before taking the examination given by the Board. The Board shall: Require that an applicant, who holds a valid license to practice medicine in this State or any other state and intends to sell hearing aids at retail, pass the written and law examinations given by the Board; and Request that an applicant, who holds a valid license to practice medicine in this State or any other state and intends to sell hearing aids at retail, take the practical examination given by the Board to ensure adequate protection to the consumer. The Board shall accept current National Board Certification as a Hearing Instrument Specialist (BC-HIS) instead of the written and practical examinations for licensure, if the applicant: Is currently licensed in good standing in the state from which the applicant is applying; and Has practiced 3 years of the last 5 years before applying for a license in this State. Before taking the Hearing Aid Dispensing Examination, a candidate shall provide the Board with a certificate of completion of the International Hearing Society course entitled “Distance Learning for the Professional in Hearing Health Sciences”. The Board shall select the site for the examination. An applicant may not be examined by an examiner by whom the applicant is employed or with whom the applicant has a contractual relationship. The Board shall ensure that the content and scope of the examination is in accordance with Health Occupations Article, §2-304, Annotated Code of Maryland. The Board shall provide the applicant with up-to-date information as to study or reference material which would be beneficial in preparing for the examination. The Board shall treat cheating or dishonesty by an applicant as grounds for failure. At the time of the examination, the Board shall provide each applicant with an identification number to be used on the examination papers. The Board shall ensure that the examination consists of a written part and a practical part. The written examination shall utilize the most recent competency model licensing examination from the Education Division of the International Hearing Society. The Board shall ensure that the practical part of the examination tests proficiency in: Pure tone audiometry, including testing and recording of air and bone conduction; Speech audiometry, including speech reception and speech discrimination testing; Masking methodology; Choice and adaptation of hearing aids; Testing of hearing aids; Maintenance and basic repair of hearing aids; Taking of ear mold impressions; and Other techniques and procedures that may be required to fit hearing aids. Nothing in the examination shall imply that the applicant shall possess the degree of medical competence normally expected of physicians. Passing Score. Written Examination. The Board shall determine the passing score for the written examination. If a candidate does not earn a passing score on the written examination, the candidate shall have to retake the entire written examination. Practical Examination. An applicant shall obtain a score of at least 80 percent on the practical examination. If the licensee's limited license has not expired and the licensee passed the examination within the past 2 years, the Board shall accept prior passage of the written examination, the practical examination, or both. The holder of a limited license shall be familiar with and shall avoid committing any of the acts regarded as unethical practices set forth in COMAR 10.41.02. On obtaining a limited license, the holder of a limited license shall engage in the practice of fitting and dispensing hearing aids for 20 consecutive days under the direct and continuous supervision of a licensee. The licensee shall provide direct supervision subsequently for a minimum of 40 hours per month for at least 6 months. The supervising hearing aid dispenser shall be immediately available and physically on-site. Supervision shall include training in those areas of the examination outlined in Regulation .05 of this chapter. The limited licensee shall maintain documentation of supervision and training and shall submit the documentation to the Board upon request. A licensee who supervises an applicant for a limited license shall assume full responsibility for the ethical conduct of the limited licensee. Termination of Supervision. The supervising licensee may terminate the supervisory responsibility by discharging the limited licensee and returning the license to the Board, together with a letter explaining fully the circumstances under which the limited licensee was separated from the employment of the supervisor. If the limited license cannot be returned, the supervising licensee shall include a full explanation in the letter. A limited license expires on the first anniversary of its effective date. The Board may renew the limited license once for an additional 1-year term if the limited licensee: Takes but fails the examination; or Does not take the examination for a reason acceptable to the Board. If a limited licensee fails to receive a full license within 2 years after the initial limited license was issued, the individual shall wait a minimum of 1 year before the individual may apply for another limited license. The supervisor of a limited licensee: Shall hold a valid license issued by the Maryland Board; Shall conduct all required direct and continuous supervision as defined in §B of this regulation, at a Maryland hearing aid dispensing practice only; Shall be actively involved in the dispensing of hearing aids; Shall have been in practice for a minimum of 2 years after passing the Board examination; Shall supervise not more than three limited licensees at one time; and May not have been formally disciplined by the Board within the previous 5 years. The licensee or holder of a limited license who is engaged in the fitting and dispensing of hearing aids shall use appropriate testing procedures for a hearing aid fitting. The licensee or holder of a limited license shall perform the following minimum testing procedures on each client evaluated prior to the fitting of a hearing aid or hearing aids: Pure tone air conduction thresholds at 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz, 6,000 Hz, and 8,000 Hz, including masking as needed, if the threshold between the ears differs, at any frequency, by: 40 decibels when using supra aural headphones; 60 decibels when using insert earphones, properly inserted; or Inter-octave frequencies that shall be tested if there is a difference of 15dB or greater between octave frequencies as specified under §B(1)(a) and (b) of this regulation; Pure tone bone conduction thresholds, including masking as needed, at 500 Hz, 1000 Hz, 2000 Hz, and 4000Hz; and Word recognition scores obtained using recorded word lists or monitored live voice. Presentation level shall be at least 40dB above speech recognition threshold or at least 5dB above the threshold at 2000Hz, or both, if within level of tolerance. The use of speech stimuli, such as speech in noise testing, is recommended before and after the fitting of the hearing aid. The use of probe microphone measurements are recommended to verify the audibility of speech at 50dB, 65dB, and 80dB input levels as well as MPO measurements to avoid damage to the peripheral auditory system and check comfort of the hearing aid users. The hearing aid dispenser shall: Maintain and retain all test results as part of a client’s record. Part or all of the tests may be performed by an otologist or clinical audiologist, but the test may not be more than 6 months old for the use of a hearing device fitting; and Provide to the client a copy of all: Test results; Recommendations; and Referrals. During the 2-year renewal, a hearing aid dispenser shall furnish evidence that each audiometer in use has been calibrated within the previous 12-month period. Before fitting or selling a hearing aid to a potential client, the licensee shall refer the client to a physician, preferably one specializing in the diseases of the ear, if the licensee determines that the client has any of the following conditions: Visible, congenital, or traumatic deformity of the ear; Acute drainage from the ear within the previous 90 days; Sudden or rapidly progressive hearing loss within the previous 90 days; Acute or chronic dizziness; Pain, discomfort, foreign body/material, or active drainage in the ear; Air-bone gap in excess of 15 decibels on more than one frequency; Evidence of congenital or traumatic deformity of the ear, not previously evaluated; Unilateral or asymmetrical hearing loss with a difference of greater than 15dB pure tone average between ears, or asymmetry greater than 15dB at 2 or more frequencies; or Visible evidence of cerumen (ear wax) accumulation or a foreign body in the ear canal. A licensee shall display the license conspicuously in the office or place of employment of the licensee. A licensee shall notify the Board in writing of: The address of each place where the licensee provides hearing aid services; and A change of address within 30 days after the change. If a licensee has more than one place of business, the licensee shall specify on each notice required under this regulation the place to which the Board should mail its notices and other correspondence to the licensee. A licensee shall deliver to an individual supplied with a hearing aid, a receipt containing: The licensee's signature; The address of the licensee's regular place of practice; The licensee's license number; Specifications as to the amount charged; Other terms of the sale, stated clearly; and The manufacturer, model, and serial number of the hearing aid provided. If a hearing aid is not new, the licensee shall ensure that the receipt is clearly marked “used” or “reconditioned” and state the terms of any guarantee. A licensee applying for renewal of a license shall have successfully completed, within the 2-year licensing period, a total of 30 hours of Board-approved continuing education programs. Of the 30 hours, the licensee shall complete: 26 or more hours of instruction directly relating to the practice of fitting hearing aids, including the: Science of hearing and hearing disorders; Structure and function of hearing aids; and Psychology of the hearing impaired; Not more than: 4 hours of instruction directly relating to managerial aspects of the practice of fitting hearing aids, including: Good business principles; and Customer management principles; or 5 hours of continuing education credit in a single continuing education cycle by attending regularly scheduled Board meetings where 1 hour of an open session at a Board meeting equals 1 hour of continuing education credit; A minimum of 1 CEU in the area of cultural competency; and A minimum of 1 CEU in the area of ethics. It is recommended that a licensee applying for the renewal of a license successfully complete, within the 2-year licensing period as a part of required 30 hours of Board-approved continuing education programs a minimum of 2 CEUs in the area of supervision. A licensee who fails to complete the continuing education requirements within the time frame specified under COMAR 10.41.03.06 may be subject to: Informal or formal discipline for failure to meet the requirements; and A monetary fine not to exceed $250. Pro Bono Work. CEUs may be earned for pro bono work at the rate of 1 Maryland CEU for every 8 hours of Board-approved CEU activity up to a maximum of 3 CEU credits in any single 2-year period. The licensee shall obtain approval from the Board for all pro bono work. The licensee shall provide the Board a written description of the proposed work not later than 60 days before beginning pro bono work. The description shall include: The place where the pro bono work will take place; The type of work to be performed; The number of hours of actual work to be performed for which the licensee desires CEU credit; A description of how the work will enhance the licensee's ongoing education; and A statement guaranteeing that the licensee will not receive any financial gain from the work provided. The licensee shall submit a written statement to the Board from the facility verifying the number of pro bono work hours completed. CEU credit may not be granted for work that did not receive prior approval from the Board. First-Time Renewal of License. Continuing education units shall be prorated for: Licensees holding a full license for at least 6 months but less than 2 years during the renewal cycle; Newly licensed individuals; and Individuals seeking reinstatement. The Board shall waive all continuing education requirements for a licensee obtaining full licensure within the last 6 months of the renewal cycle. Miscellaneous. Continuing education units may not be carried over from one renewal period to the next renewal period. If the licensee presents evidence to the Board that failure to obtain the required continuing education units was due to circumstances beyond the licensee’s control, the Board may grant an extension of time to obtain the required continuing education units. If the Board grants an extension of time as provided for in §E(2) of this regulation, the Board may require the licensee to obtain, as additional continuing education, not more than twice the number of missing credits in order to renew the license. The Board may reduce or waive the continuing education requirements for an individual under extenuating circumstances as determined by the Board. A licensee shall undergo a new criminal records history check as set forth in Health Occupations Article, §2-303.1, Annotated Code of Maryland, every three renewal cycles or every 6 years. A licensee who has failed to renew a license to practice in this State by March 3 of the year in which the license is due to be renewed is prohibited from practicing in this State. If the Board determines that a licensee has practiced in this State after the license has expired, the Board may: Order the licensee to immediately cease and desist practice in this State until the license has been reinstated by the Board; and Take action as follows against a licensee for unprofessional conduct if it determines that the licensee practiced in this State after the license has expired: Issue a nonpublic consent agreement in which the licensee agrees to make an anonymous donation of $250 to a charitable institution and to perform 40 hours of Board-approved pro bono services; Provide the licensee with a settlement conference; or Charge the licensee with unprofessional conduct as provided in Health Occupations Article, §2-314(10), Annotated Code of Maryland, for practicing without a license. A licensee shall notify the Board in writing of a change of: Mailing address within 30 days after the change; Name within 30 days after the change; or Email address within 30 days after the change if the licensee has previously submitted an email address to the Board. A licensee who fails to comply with requirements of this regulation may be subject to disciplinary action. To the extent not inconsistent with federal law, a licensee shall, before the consummation of a sale of a hearing aid that uses proprietary programming software or locked, nonproprietary programming software, provide the purchaser with a written notice that: States, “The hearing aid being purchased uses proprietary or locked programming software and can only be serviced or programmed at specific facilities or locations.”; Shall be signed by the purchaser before the sale; and Includes a copy that is kept and maintained by the licensee. To the extent not inconsistent with federal law, a licensee shall, upon the consummation of a sale of a hearing aid, deliver to the purchaser a written receipt, signed by or on behalf of the licensee, containing all of the following: The date of consummation of the sale; Specifications as to the make, serial number, and model number of the hearing aid or aids sold; The address of the principal place of business of the licensee, and the address and office hours at which the licensee shall be available for fitting or post-fitting adjustments and servicing of the hearing aid or aids sold; A statement to the effect that the aid or aids delivered to the purchaser are used or reconditioned, as the case may be, if that is the fact; The number of the licensee’s license and the name and license number of any other hearing aid dispenser, temporary licensee, or trainee licensee, who provided any recommendation or consultation regarding the purchase of the hearing aid; and The terms of any guarantee or written warranty, as required by federal law or regulations, made to the purchaser with respect to the hearing aid or hearing aids. Health Occupations Article, §§2-101(d), 2-205, 2-302.1, 2-304, 2-308, 2-310.1, 2-311(c), 2-311 — 2-314.8, 2-314(10) and (11), and 2-314.9, Annotated Code of Maryland Effective date: February 10, 1997 (24:3 Md. R. 188) Regulation .01-1 adopted effective March 23, 2009 (36:6 Md. R. 492) Regulation .01-1 amended effective April 29, 2013 (40:8 Md. R. 724) Regulation .02 amended effective October 13, 2003 (30:20 Md. R. 1448) Regulation .02D amended effective April 29, 2013 (40:8 Md. R. 724); June 20, 2016 (43:12 Md. R. 667) Regulation .02I adopted effective October 20, 2008 (35:21 Md. R. 1824) Regulation .02J adopted effective June 20, 2016 (43:12 Md. R. 667) Regulation .02K adopted effective February 27, 2017 (44:4 Md. R. 255) Regulation .03 amended effective October 28, 2002 (29:21 Md. R. 1646) Regulation .03D adopted effective October 13, 2003 (30:20 Md. R. 1448) Regulation .03E adopted effective October 20, 2008 (35:21 Md. R. 1824) Regulation .04F amended effective October 13, 2003 (30:20 Md. R. 1448) Regulation .05B, C amended effective October 20, 2008 (35:21 Md. R. 1824) Regulation .05E amended effective October 28, 2002 (29:21 Md. R. 1646); October 13, 2003 (30:20 Md. R. 1448) Regulation .06 amended effective October 13, 2003 (30:20 Md. R. 1448) Regulation .06I amended effective October 20, 2008 (35:21 Md. R. 1824) Regulation .07 repealed effective October 13, 2003 (30:20 Md. R. 1448) Regulation .10A amended effective October 13, 2003 (30:20 Md. R. 1448) Regulation .11 amended effective March 23, 2009 (36:6 Md. R. 492); June 8, 2015 (42:11 Md. R. 725) Regulation .11A amended effective May 30, 2011 (38:11 Md. R. 671); January 7, 2013 (39:26 Md. R. 1665) Regulation .11C amended effective October 28, 2013 (40:21 Md. R. 1775) Regulation .11D adopted effective October 28, 2013 (40:21 Md. R. 1775) Regulation .12 adopted effective June 8, 2015 (42:11 Md. R. 725) Regulation .13 adopted effective June 20, 2016 (43:12 Md. R. 667)