# COMAR Title 10 — Maryland Department of Health

## Subtitle 41 — Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists

### Chapter 11 — Speech-Language Pathology Assistants and Audiology Assistants

**Authority:** Health Occupations Article, §§2-205, 2-308, 2-311(c), 2-312(b), 2-314(10) and (11), and 2-319, Annotated Code of Maryland

**Administrative History:** Effective date: April 1, 2002 (29:6 Md. R. 567)

**Administrative History:** Regulation .02 amended effective February 27, 2017 (44:4 Md. R. 255)

**Administrative History:** Regulation .02A amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .03 amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .03A amended effective June 20, 2016 (43:12 Md. R. 667)

**Administrative History:** Regulation .04A amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .05A amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .06D amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .07D amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .08F, G adopted effective June 8, 2015 (42:11 Md. R. 725)

**Administrative History:** Regulation .09E amended as an emergency provision effective January 11, 2008 (35:3 Md. R. 286); amended permanently effective May 19, 2008 (35:10 Md. R. 972)

**Administrative History:** Regulation .10 adopted effective June 20, 2016 (43:12 Md. R. 667)

#### Regulation .01 Definitions.

*COMAR 10.41.11.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Audiology assistant” means an individual who:

    (a) Meets the minimum qualifications established under:

      (i) Health Occupations Article, Title 2, Subtitle 3A, Annotated Code of Maryland; and

      (ii) This chapter;

    (b) Does not work independently; and

    (c) Works under the general supervision of an audiologist licensed under Health Occupations Article, Title 2, Annotated Code of Maryland.

  (2) “Board” means the State Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists and Music Therapists.

  (3) “Continuing education unit (CEU)” means 1 hour of attendance at a Board-approved program as described in COMAR 10.41.03.06.

  (4) “Credit hour” means 1 academic credit hour of an academic course conducted by an accredited academic institution.

  (5) “Delegation agreement” means an agreement between a speech-language pathology assistant or an audiology assistant and a supervising speech-language pathologist or audiologist which identifies the supervising speech-language pathologist or audiologist and the facility at which the speech-language pathology assistant or the audiology assistant will be practicing.

  (6) Direct supervision

    (a) “Direct supervision” means on-site, in-view, observation and guidance by a supervising speech-language pathologist or audiologist while on an assigned activity.

    (b) “Direct supervision” includes the supervising audiologist viewing and communicating with the speech-language pathology assistant or audiology assistant via telecommunication technology to provide clinical services.

    (c) “Direct supervision” does not include reviewing a recorded session at a later time.

  (7) “General supervision” means the supervision of a licensed speech-language pathology assistant or audiology assistant by a licensed speech-language pathologist or audiologist who may or may not be present when the licensed speech-language pathology assistant or audiology assistant assists in the practice of speech-language pathology or audiology.

  (8) “Indirect supervision” means those activities other than direct observation and guidance conducted by a supervising speech-language pathologist or audiologist including, but not limited to:

    (a) Review of charts and records;

    (b) Attendance at meetings; or

    (c) Phone contact.

  (9) “Speech-language pathology assistant” means an individual who:

    (a) Assists the supervising speech-language pathologist clinically in the implementation of treatment and other defined activities; and

    (b) Meets the minimum requirements set forth in this chapter.

  (10) “Supervising speech-language pathologist” means an individual who meets all requirements set forth in this chapter and who:

    (a) Is licensed by the Board; or

    (b) In exempt settings, holds the Certificate of Clinical Competence (CCC) in Speech-Language Pathology from the American Speech-Language Hearing Association (ASHA).

  (11) “Supervision” means both direct and indirect supervision.

#### Regulation .02 Speech-Language Pathology Assistant License Requirements.

*COMAR 10.41.11.02*

A. The Board shall issue a speech-language pathology assistant license to an applicant who:

  (1) Meets the following qualifications:

    (a) Has completed the educational requirements in §C of this regulation;

    (b) Has completed the clinical hours requirements in §D of this regulation;

    (c) Has obtained a limited license as a speech-language pathology assistant from the Board;

    (d) Has completed a period of not less than 9 months of supervised practice as specified in Regulation .03B of this chapter; and

    (e) Submits a competency checklist completed by the supervising speech-language pathologist to the Board; or

  (2) Meets the qualifications for waiver of requirements in Regulation .05 of this chapter.

B. Incomplete Applications.

  (1) 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.

  (2) An application is not complete until all required material, including the application fee and supporting documentation, is received by the Board.

  (3) 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.

  (4) An applicant whose application is administratively closed may reapply and submit with the new application proof of compliance with:

    (a) This subtitle; and

    (b) Health Occupations Article, Title 2, Annotated Code of Maryland.

C. Academic Curriculum Requirements.

  (1) A speech-language pathology assistant shall demonstrate completion of one of the following requirements, unless a request for an exception based on extenuating circumstances, with documented continuing education during the previous 5 years is approved by the Board:

    (a) An associate’s degree from an approved program for speech-language pathology assistants at an accredited institution;

    (b) An associate’s degree or higher in an allied health field from an accredited institution with minimum course work that includes at least 3 credit hours in each of the following areas:

      (i) Language acquisition and usage throughout the lifespan;

      (ii) Speech disorders;

      (iii) Anatomy and physiology of speech systems;

      (iv) Language disorders, including pragmatics; and

      (v) Phonology; or

    (c) A baccalaureate degree in speech-language pathology or communication science disorders from an accredited institution.

  (2) The Board shall accept only an official transcript that demonstrates course work completed with a grade of at least a “C” taken for credit.

  (3) Academic course titles which are not self-explanatory shall be substantiated through course descriptions in official school catalogs or bulletins, or by other official means.

  (4) Degrees or course work, or both, received at foreign universities are acceptable only if the course work and clinical practicum hours can be demonstrated, at the applicant’s expense, to meet the requirements of this section.

D. Clinical Hours Requirements.

  (1) A speech-language pathology assistant shall demonstrate at the time of application for licensure:

    (a) Completion of at least 25 hours of clinical observation and 75 hours of clinical assisting experience in an associate’s program; or

    (b) 25 observation and 75 clinical practice hours as a speech-language pathology student in a bachelor’s or master’s program obtained within an educational institution or in one of the educational institution’s cooperating programs.

  (2) Alternative Method for Completion of Clinical Hours.

    (a) If an applicant has not obtained the hours required in §D(1) of this regulation, the applicant may file with the Board a written plan for an alternative method to obtain the hours which shall include:

      (i) A plan for the clinical observation, or clinical assisting experience, or both, designed and signed by the supervising speech-language pathologist;

      (ii) Further information or revisions as requested by the Board;

      (iii) An application for limited licensure; and

      (iv) The fee for limited licensure.

    (b) The plan for obtaining the 75 hours of clinical assistance shall include 100 percent direct supervision by the supervising speech-language pathologist of the speech-language pathologist assistant during any client contact hours.

    (c) The Board shall approve the plan and issue the limited license before any clinical observation or clinical assisting experience may be obtained.

    (d) The limited licensee shall then complete the hours in accordance with the Board-approved plan within 60 days.

    (e) If the Board does not receive proof of successful completion of the hours by the end of 90 days, the limited assistant license is void and the speech-language pathology assistant may reapply.

#### Regulation .03 Speech-Language Pathology Assistant Limited License.

*COMAR 10.41.11.03*

A. The Board shall issue a speech-language pathology assistant license to a limited licensee who:

  (1) Has successfully completed the requirements of the limited licensure period; or

  (2) Meets the qualifications for waiver of requirements in Regulation .05 of this chapter.

B. Supervised Practice Requirements.

  (1) A speech-language pathology assistant shall have a limited license from the Board before beginning supervised practice.

  (2) The Board shall issue a limited license to practice as a speech-language pathology assistant to an applicant who:

    (a) Is of good moral character;

    (b) Meets the qualifications indicated in Regulation .02A of this chapter and:

      (i) Has completed the requirements of Regulation .02D(1) of this chapter; or

      (ii) Has submitted a plan approved by the Board as provided in Regulation .02D(2) of this chapter;

    (c) Submits the completed application and fee to the Board; and

    (d) Submits a delegation agreement to the Board for each supervising speech-language pathologist.

  (3) During the period of limited licensure, the speech-language pathology assistant shall:

    (a) Practice only under the supervision of:

      (i) A fully licensed speech-language pathologist; or

      (ii) An individual who holds a Certificate of Clinical Competence in speech-language pathology from the American Speech-Language-Hearing Association;

    (b) Demonstrate completion, within the first 60 days, under direct supervision as documented by the supervising speech-language pathologist of:

      (i) At least 25 hours of clinical observation earned during the educational training or on the job, or both; and

      (ii) A cumulative total of 75 hours of clinical assistance earned during the educational training or on the job, or both; and

    (c) Practice a minimum of 9 months under a limited license.

  (4) The limited license shall expire 12 months after its effective date.

  (5) The supervising speech-language pathologist shall ensure that the speech-language pathology assistant demonstrates successful completion of the Board’s competency skills checklist.

  (6) The speech-language pathology assistant shall submit the completed competency skills checklist to the Board at least 60 days before the limited license expiration date.

#### Regulation .04 Audiology Assistant License Requirements.

*COMAR 10.41.11.04*

A. The Board shall issue an audiology assistant license to an applicant who:

  (1) Meets the following qualifications:

    (a) Holds a high school diploma or equivalent degree such as a GED from an accredited institution;

    (b) Is of good moral character;

    (c) Demonstrates oral competency;

    (d) Submits a criminal history records check in accordance with Health Occupations Article, §2-303.1, Annotated Code of Maryland;

    (e) Submits an application to the Board on the form that the Board requires; and

    (f) Pays the application fee set by the Board; or

  (2) Meets the qualifications for waiver of requirements in Regulation .05 of this chapter.

B. Incomplete Applications.

  (1) 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.

  (2) An application is not complete until all required material, including the application fee and supporting documentation, is received by the Board.

  (3) 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.

  (4) An applicant whose application is administratively closed may reapply and submit with the new application proof of compliance with:

    (a) This subtitle; and

    (b) Health Occupations Article, Title 2, Annotated Code of Maryland.

C. Academic Curriculum Requirement. An audiology assistant shall provide proof of completion of a high school diploma or higher.

D. An audiology assistant:

  (1) May not work independently; and

  (2) Works under the general supervision of a licensed audiologist.

#### Regulation .05 Waiver of Requirements.

*COMAR 10.41.11.05*

A. The Board may waive the qualifications required for a license to practice as a speech-language pathology assistant or an audiology assistant under this chapter for an individual who:

  (1) Is of good moral character;

  (2) Pays the application fee required by the Board under COMAR 10.41.01;

  (3) Has been working as:

    (a) A speech-language pathology assistant prior to October 1, 2007; or

    (b) An audiology assistant prior to October 1, 2022;

  (4) Has completed the educational requirements in Regulations .02C and .04C of this chapter;

  (5) Possesses sufficient qualifications which have been documented by a supervising speech-language pathologist, through completion of the speech-language pathology assistant competency skills checklist; and

  (6) Completes a delegation agreement for each supervising speech-language pathologist.

B. The Board may waive any of the qualifications required for a license to practice as a speech-language pathology assistant or an audiology assistant under this chapter for an individual who:

  (1) Holds a valid certification as a speech-language pathology assistant or an audiology assistant from the American Speech-Language-Hearing Association;

  (2) Holds a valid license, certification, or registration as a speech language pathology assistant or an audiology assistant in another state whose qualifications for a speech-language pathology assistant or an audiology assistant are equivalent to the qualifications for a speech-language pathology assistant or an audiology assistant in this State; or

  (3) Qualifies under the waiver of requirements provided in §A of this regulation.

#### Regulation .06 Speech-Language Pathology Assistant Scope of Practice.

*COMAR 10.41.11.06*

A. A speech-language pathology assistant may provide only services which assist the direct services provided by a supervising speech-language pathologist, and not services which are alternatives to direct services.

B. Activities within the scope of practice of a speech-language pathology assistant or an audiology assistant shall include the following:

  (1) Engaging only in those duties planned, designed, and supervised by a supervising speech-language pathologist or audiologist;

  (2) Following treatment plans or protocols developed by the supervising speech-language pathologist or audiologist who maintains professional responsibility for the plans of care;

  (3) Adhering at all times to the code of ethics of the Board;

  (4) Identifying the licensee as a speech-language pathology assistant or an audiology assistant to consumers and co-professionals;

  (5) Following specified screening protocols developed by the supervising speech-language pathologist or audiologist when conducting speech-language or audiology screenings; and

  (6) Reporting documented evidence of treatment and non-interpretive data regarding the client’s performance to the supervising speech-language pathologist or audiologist.

C. Activities within the scope of practice of a speech-language pathology assistant or an audiology assistant may include the following:

  (1) Performing preparation of materials;

  (2) Scheduling activities;

  (3) Preparing charts, records, graphs, and other clerical duties;

  (4) Performing checks and maintenance of equipment;

  (5) Participating with the supervising speech-language pathologist or audiologist in research projects, in-service training, and public relations programs;

  (6) Assisting the speech-language pathologists or audiologists during patient assessments; and

  (7) Assisting the audiologists with basic diagnostic tests, such as audiometry and tympanometry.

D. Activities not within the scope of practice of a speech-language pathology assistant or an audiology assistant include:

  (1) Performing or interpreting the results of diagnostic evaluations;

  (2) Participating in parent conferences, case conferences, or interdisciplinary team meetings without the presence of the supervising speech-language pathologist or audiologist, or other licensed speech-language pathologist or audiologist designated by the supervising speech-language pathologist or audiologist;

  (3) Providing client or family counseling;

  (4) Selecting clients for services;

  (5) Discharging a client from services;

  (6) Making referral recommendations;

  (7) Disclosing clinical or confidential information either orally or in writing to anyone other than the supervising speech-language pathologist or audiologist; or

  (8) Providing specialized treatment that requires advanced knowledge and training.

E. Audiology assistants may not perform any task:

  (1) Without the express knowledge and approval of the supervising audiologist; and

  (2) That may be prohibited by state or federal law.

#### Regulation .07 Supervisor Responsibilities.

*COMAR 10.41.11.07*

A. A supervising speech-language pathologist or audiologist is responsible for the direction of all client services provided by a speech-language pathology assistant or an audiology assistant.

B. A licensed full-time (35 hours or more a week) speech-language pathologist or audiologist may not supervise more than the equivalent of two full-time (35 hours or more a week) speech-language pathology assistants or audiology assistants.

C. A licensed part-time (less than 35 hours a week) speech-language pathologist or audiologist may not supervise more than the equivalent of one full-time (35 hours a week) speech-language pathology assistant or audiology assistant.

D. A supervising speech-language pathologist or audiologist shall:

  (1) Have a minimum of 3 years work experience (2 years since receipt of full license or ASHA-CCC) as a speech-language pathologist or audiologist;

  (2) Maintain on-going contact with all clients seen by a speech-language pathology assistant or an audiology assistant by participating in:

    (a) Not less than one session every 2 weeks of in-person contact per client if the client is being seen three times per week or more; or

    (b) Not less than one session per month of in-person contact per client if the client is being seen two times per week or less;

  (3) Provide supervision of the speech-language pathology assistant or the audiology assistant that is a combination of direct on-site activities and indirect activities;

  (4) Be on-site to supervise the speech-language pathology assistant during the first 2 hours of treatment for each client and then at least 1 direct hour of supervision during each subsequent month;

  (5) Provide general supervision to the audiology assistant and continuous availability by phone or telehealth technologies;

  (6) Conduct and maintain performance evaluations of the speech language pathology assistant or the audiology assistant within the first 3 months, and at least annually thereafter, that are cosigned by both the supervising speech-language pathologist or audiologist and the speech-language pathology assistant or the audiology assistant;

  (7) Provide a copy of the signed performance evaluation to the speech-language pathology assistant or the audiology assistant;

  (8) Maintain documentation of client contact and supervisory activities of the speech-language pathology assistant or the audiology assistant; and

  (9) Have the authority to combine in-person client contact and on-site supervision of the speech-language pathology assistant or the audiology assistant when appropriate.

#### Regulation .08 Licensee Responsibilities.

*COMAR 10.41.11.08*

A. A licensee shall notify the Board in writing of a change of:

  (1) Mailing address within 30 days after the change;

  (2) Name within 30 days after the change; or

  (3) Email address within 30 days after the change if the licensee has previously submitted an email address to the Board.

B. A licensee who fails to comply with the requirements of this regulation may be subject to disciplinary action.

#### Regulation .09 License Renewal.

*COMAR 10.41.11.09*

A. A speech-language pathology assistant or an audiology assistant license expires on the date set by the Board, unless it is renewed for an additional term as provided in this regulation.

B. A license may not be renewed for a term longer than 2 years.

C. At least 1 month before the license expires, the Board shall notify the speech-language pathology assistant or the audiology assistant of the date the license expires and the procedures for renewing the license.

D. The speech-language pathology assistant or the audiology assistant is responsible for renewing licensure.

E. The speech-language pathology assistant or the audiology assistant may apply to renew the license for another term if the speech-language pathology assistant or the audiology assistant:

  (1) Is otherwise entitled to be licensed;

  (2) Pays the renewal fee set by the Board; and

  (3) Submits to the Board:

    (a) A renewal application on the form the Board requires;

    (b) Satisfactory evidence of compliance with any continuing education requirements under Regulation .10 of this chapter; and

    (c) A delegation agreement for each supervising speech-language pathologist or audiologist.

F. A speech-language pathology assistant or an audiology assistant 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.

G. A licensee who has failed to renew a license to practice in this State by June 30 of the year in which the license is due to be renewed is prohibited from practicing in this State.

H. If the Board determines that a licensee has practiced in this State after the license has expired, the Board may:

  (1) Order the licensee to immediately cease and desist practice in this State until the license has been reinstated by the Board; and

  (2) 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:

    (a) Issue a nonpublic consent agreement in which the licensee agrees to make an anonymous donation of $100 to a charitable institution and to perform 40 hours of Board-approved pro bono services;

    (b) Provide the licensee with a settlement conference; or

    (c) Charge the licensee with unprofessional conduct as provided in Health Occupations Article, §2314(10), Annotated Code of Maryland, for practicing without a license.

#### Regulation .10 Continuing Education Requirements.

*COMAR 10.41.11.10*

A. A speech-language pathology assistant or an audiology assistant shall obtain CEUs as a means of staying current in the field.

B. The speech-language pathology assistant or the audiology assistant shall earn a minimum of ten CEUs as a condition of renewal as follows:

  (1) Five CEUs in the area of clinical practice; and

  (2) Five CEUs in work-related areas that may include the recommended completion of:

    (a) A minimum of 1 CEU in the area of cultural competency;

    (b) A minimum of 1 CEU in the area of ethics; and

    (c) Related training that does not include annual training requirements for:

      (i) Job orientation;

      (ii) Job maintenance; or

      (iii) Other general information related to health care.

C. The speech-language pathology assistant or the audiology assistant shall retain records documenting completion of CEUs.

D. At the time of license renewal, the Board shall audit 25 percent of the speech-language pathology assistants or the audiology assistants for compliance with the continuing education requirement.

E. If the speech-language pathology assistant or the audiology assistant is audited by the Board, the speech-language pathology assistant or the audiology assistant shall submit to the Board the following:

  (1) A copy of the most recent performance evaluation;

  (2) An application for license renewal; and

  (3) Documentation of earned CEUs completed within the 2 years immediately preceding the license expiration date.