Source: http://register.dls.virginia.gov/details.aspx?id=7179
Timestamp: 2019-04-19 13:05:43+00:00

Document:
Title of Regulation: 18VAC105-20. Regulations Governing the Practice of Optometry (amending 18VAC105-20-5, 18VAC105-20-10, 18VAC105-20-16, 18VAC105-20-20, 18VAC105-20-40, 18VAC105-20-45, 18VAC105-20-46, 18VAC105-20-47, 18VAC105-20-60, 18VAC105-20-70; repealing 18VAC105-20-15).
Statutory Authority: §§ 54.1-2400 and 54.1-3223 of the Code of Virginia.
Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Optometry the authority to promulgate regulations to administer the regulatory system.
Purpose: By updating the current regulations, eliminating any that are unnecessarily burdensome and adding requirements for evidence of continued competency, the board's intent is greater clarity and understanding by applicants and licensees of the applicable rules. Amended regulations will make it less onerous for an applicant who is currently licensed and practicing in another state and wants to become licensed in Virginia. If an applicant has been actively practicing and has a current license, the applicant would not be required to do additional continuing education (CE). If not actively practicing, the board believes some CE is necessary to ensure minimal competency for public health and safety in providing patient care.
Substance: In addition to editorial changes, the board proposes deletion of unnecessary or unenforceable rules, inclusion of a definition for active practice, more specificity about evidence of continued competency required for licensure by endorsement and reinstatement, clarification about the expiration date that may be included on an eyeglass prescription, and a waiver of graduation from an accredited school if an applicant was educated in a foreign country but has been actively practicing in another state.
Issues: The primary advantage to the public is the potential for additional practitioners to become licensed in Virginia if they are licensed in another state and actively practicing without a history of disciplinary action. It is also less onerous to reinstate a lapsed license, which could increase the supply of optometrists available to provide eye care. There are no disadvantages for the public. There are no advantages or disadvantages to the Commonwealth.
Summary of the Proposed Amendments to Regulation. As the result of a periodic review,1 the Board of Optometry (Board) proposes amendments concerning: 1) definitions, 2) requirements for licensure, 3) continuing education (CE), 4) alignment of regulatory text with the Code of Virginia, and 5) clarification.
Result of Analysis. The benefits likely exceed the costs for all proposed changes or are neutral in effect.
Definitions: The Board proposes to define "active clinical practice" as an average of 20 hours per week or 640 hours per year of providing patient care. The term is used in licensing and reinstatement requirements and is currently open to wide interpretation. According to the Department of Health Professions (DHP), the Board's intent is to allow practice hours less than full time but in a quantity sufficient to demonstrate continuing competency to practice. Having a specified definition would be beneficial and reduce the likelihood of confusion or dispute.
Requirements for Licensure. The current regulation requires that applicants for licensure to practice optometry "Be a graduate of a school of optometry accredited by the Accreditation Council on Optometric Education." The Board proposes to add "or other accrediting body deemed by the board to be substantially equivalent" to allow potential recognition of another educational accrediting body if there is one in the future. This may be beneficial if such a situation arises.
The Board proposes to add a provision that would allow it to waive the requirement of graduation from an accredited school of optometry for an applicant who holds a current, unrestricted license in another U.S. jurisdiction and has been engaged in active clinical practice for at least 36 out of the 60 months immediately preceding application for licensure in Virginia. According to DHP, the intent of this amendment is to allow a pathway to licensure for foreign-trained optometrists who have been engaged in active practice in another state. Currently, the regulation requires graduation from an accredited program. The Board believes the requirement of passage of the national examination and active practice for at least 36 months is sufficient evidence of qualification to practice.
The Board proposes to eliminate the requirement that an applicant must complete 32 hours of CE if he has not passed all parts of the examination within the five years prior to application and specify that an applicant who has been licensed in another state and has not been engaged in active practice within the 12 months immediately preceding application complete 20 hours (equivalent of one year) of CE. According to DHP, the Board is trying to make it less onerous for an applicant who is currently licensed and practicing in another state and wants to become licensed in Virginia. If he has been actively practicing and has a current license, the applicant would not be required to do additional CE. If not actively practicing, the Board believes some CE is necessary to ensure minimal competency for providing patient care.
Continuing Education: Other DHP boards have regulations that provide that the board may grant an exemption from all or part of the CE requirement for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters; the Board of Optometry proposes to add this provision for optometrists. To the extent that this proposed provision is applied wisely, it would be beneficial in that it would allow competent optometrists to continue to practice without interruption.
The current regulation states that "A random audit of licensees may be conducted by the board which will require that the licensee provide evidence substantiating participation in required continuing education courses within 14 days of the renewal date." According to DHP, audits are not conducted within 14 days of the renewal date, so the current requirement is not practical. The Board proposes to amend the requirement to the licensee providing evidence substantiating participation in required continuing education courses within 30 days of the audit notification. The proposed requirement is beneficial in that it is much more feasible.
Under the current regulation CE course providers are directed to submit certificates of course completion and to ensure that all required information is included. The Board proposes to amend the regulatory text to place the burden on the licensee to ensure that the certificate of completion he receives from the CE provider includes the information necessary to receive credit from the Board for meeting regulatory requirements.
Chapter 89 of the 2016 Acts of Assembly amended Code of Virginia § 54.1-3219 to specify that at least 10 hours (of CE) be obtained through real-time, interactive activities, including in-person or electronic presentations. In order to practically meet this statutory requirement, the Board proposes to require that CE certificates include whether the course was in real-time and interactive activities, including in-person or electronic presentations.
Projected Impact on Employment. The proposals to make it less onerous for optometrists to become licensed or maintain licensure in the Commonwealth may moderately increase the number of employed optometrists.
Agency's Response to Economic Impact Analysis: The Board of Optometry concurs with the economic impact analysis of the Department of Planning and Budget.
In addition to editorial changes, the proposed amendments (i) delete unnecessary or unenforceable rules, (ii) add a limitation on the number of times an applicant can take and fail the licensing examination before additional education is necessary, (iii) add specificity about evidence of continued competency required for licensure by endorsement and reinstatement, (iv) clarify the expiration date that may be included on an eyeglass prescription, and (v) waive requirement of graduation from an accredited school if an applicant was educated in a foreign country but has been actively practicing in another state.
"Active clinical practice" means as an average of 20 hours per week or 640 hours per year of providing patient care.
"Adnexa" is defined as the conjoined, subordinate, or immediately associated anatomic parts of the human eye, including eyelids and eyebrows.
"TMOD" means the treatment and management of ocular disease portion of the NBEO examination.
18VAC105-20-10. Licensure by examination Requirements for licensure.
4. Sign a statement attesting that the applicant has read, understands, and will comply with the statutes and regulations governing the practice of optometry in Virginia.
B. Applicants who passed the National Board Examination prior to May 1985 shall apply for licensure by endorsement as provided for in 18VAC105-20-15. The board may waive the requirement of graduation from an accredited school of optometry for an applicant who holds a current, unrestricted license in another United States jurisdiction and has been engaged in active clinical practice for 36 out of the 60 months immediately preceding application for licensure in Virginia.
C. Required examinations. 1. For the purpose of § 54.1-3211 of the Code of Virginia, the board adopts all parts of the NBEO examination as its written examination for licensure. After July 1, 1997, the board shall require passage as determined by the board of Parts I, II, and III of the NBEO examination, including passage of TMOD.
2. As part of the application for licensure, an applicant must sign a statement attesting that he has read, understands, and will comply with the statutes and regulations governing the practice of optometry in Virginia.
1. The applicant shall attest that he the applicant is not a respondent in a pending or unresolved malpractice claim; and.
d. The applicant has not committed any act that would constitute a violation of § 54.1-3204 or 54.1-3215 of the Code of Virginia.
E. 3. An applicant who completed all parts of the board-approved examination more than five years prior to the date of the board's receipt of his application for licensure may be required to take up to 32 hours of board-approved continuing education licensed in another jurisdiction who has not been engaged in active practice within the 12 months immediately preceding application for licensure in Virginia shall be required to complete 20 hours of continuing education as specified in 18VAC105-20-70.
4. In the case of a federal service optometrist, the commanding officer shall also verify that the applicant is in good standing.
1. The applicant has successfully passed the examination required for licensure in optometry in any jurisdiction of the United States at the time of initial licensure.
2. The applicant has been engaged in active clinical practice for at least 36 months out of the last 60 months immediately preceding application.
3. The applicant is not a respondent in a pending or unresolved malpractice claim.
4. The applicant is currently licensed in another jurisdiction of the United States.
e. The applicant has graduated from an accredited school or college of optometry.
B. The applicant shall also provide proof of competency in the use of diagnostic pharmaceutical agents (DPAs) that shall consist of a report from the national board of passing scores on all sections of Parts I and II of the NBEO examination taken in May 1985 or thereafter. If the applicant does not qualify through examination, he shall provide other proof of meeting the requirements for the use of DPA as provided in §§ 54.1-3220 and 54.1-3221 of the Code of Virginia.
C. As part of the application for licensure, an applicant must sign a statement attesting that he has read, understands, and will comply with the statutes and regulations governing the practice of optometry in Virginia.
D. In the case of a federal service optometrist, the commanding officer shall also verify that the applicant is in good standing and provide proof of credentialing and quality assurance review to satisfy compliance with applicable requirements of subsection A of this section.
E. An optometrist previously licensed in Virginia is not eligible for licensure by endorsement but may apply for reinstatement of licensure under 18VAC105-20-60.
18VAC105-20-16. Requirements for TPA certification.
2. Take and pass Submit a passing score on the TPA certification examination, which shall be Treatment and Management of Ocular Disease (TMOD) of the NBEO TMOD or, if be TPA-certified by a state examination, provide evidence of comparability to the NBEO examination that is an examination satisfactory to the board.
B. A candidate for certification by the board who fails the examination as required in subdivision A 2 of this section, following three attempts, shall complete additional postgraduate training as determined by the board to be eligible for TPA certification.
1. Use in connection with the optometrist's name wherever it appears relating to the practice of optometry one of the following: the word "optometrist," the abbreviation "O.D.," or the words "doctor of optometry."
2. Disclose to Notify the board of any disciplinary action taken by a regulatory body in another jurisdiction.
3. Post in an area of the optometric office which is conspicuous to the public, a chart or directory listing the names of all optometrists practicing at that particular location.
4. Maintain patient records, perform procedures or make recommendations during any eye examination, contact lens examination or treatment as necessary to protect the health and welfare of the patient and consistent with requirements of 18VAC105-20-45.
5. Notify patients in the event the practice is to be terminated or relocated, giving a reasonable time period within which the patient or an authorized representative can request in writing that the records or copies be sent to any other like-regulated provider of the patient's choice or destroyed in compliance with requirements of § 54.1-2405 of the Code of Virginia on the transfer of patient records in conjunction with closure, sale, or relocation of practice.
6. Ensure his access to the practice location during hours in which the practice is closed in order to be able to properly evaluate and treat a patient in an emergency.
7. Provide for continuity of care in the event of an absence from the practice or, in the event the optometrist chooses to terminate the practitioner-patient relationship or make his services unavailable, document notice to the patient that allows for a reasonable time to obtain the services of another practitioner.
8. Comply with the provisions of § 32.1-127.1:03 of the Code of Virginia related to the confidentiality and disclosure of patient records and related to the provision of patient records to another practitioner or to the patient or his personal representative.
9. Treat or prescribe based on a bona fide practitioner-patient relationship consistent with criteria set forth in § 54.1-3303 of the Code of Virginia. A licensee shall not prescribe a controlled substance to himself or a family member other than Schedule VI as defined in § 54.1-3455 of the Code of Virginia. When treating or prescribing for self or family, the practitioner shall maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.
10. Comply with provisions of statute or regulation, state or federal, relating to the diversion, distribution, dispensing, prescribing, or administration of controlled substances as defined in § 54.1-3401 of the Code of Virginia.
11. Not enter into a relationship with a patient that constitutes a professional boundary violation in which the practitioner uses his professional position to take advantage of the vulnerability of a patient or his family to include, but not be limited to, actions that result in personal gain at the expense of the patient, a nontherapeutic personal involvement, or sexual conduct with a patient. The determination of when a person is a patient is made on a case-by-case basis with consideration given to the nature, extent, and context of the professional relationship between the practitioner and the person. The fact that a person is not actively receiving treatment or professional services from a practitioner is not determinative of this issue. The consent to, initiation of, or participation in sexual behavior or involvement with a practitioner by a patient does not change the nature of the conduct nor negate the prohibition.
12. Cooperate with the board or its representatives in providing information or records as requested or required pursuant to an investigation or the enforcement of a statute or regulation.
13. Not practice with an expired or unregistered professional designation.
14. Not violate or cooperate with others in violating any of the provisions of Chapters 1 (§ 54.1-100 et seq.), 24 (§ 54.1-2400 et seq.) or 32 (§ 54.1-3200 et seq.) of Title 54.1 of the Code of Virginia or regulations of the board.
d. A recommendation for an appropriate treatment or management plan, including any necessary follow up.
e. Directions for the wear, care, and handling of lenses.
c. Such further instructions as necessary for the individual patient.
4. In addition, the record of any examination shall include the signature of the attending optometrist and, if indicated, refraction of the patient.
1. Sufficient information for complete and accurate filling of an established contact lens prescription shall include but not be limited to (i) the power, (ii) the material or manufacturer or both, (iii) the base curve or appropriate designation, (iv) the diameter when appropriate, and (v) medically appropriate expiration date.
2. An optometrist shall provide a patient with a copy of the patient's contact lens prescription at the end of the contact lens fitting, even if the patient does not ask for it. An optometrist may first require all fees to be paid, but only if he requires immediate payment from patients whose eye examinations reveal no need for corrective eye products.
3. An optometrist shall provide or verify the prescription to anyone who is designated to act on behalf of the patient, including contact lens sellers.
4. An optometrist shall not require patients to buy contact lens lenses, pay additional fees, or sign a waiver or release in exchange for a copy of the contact lens prescription.
5. An optometrist shall not disclaim liability or responsibility for the accuracy of an eye examination.
1. A licensed optometrist shall provide a written prescription for spectacle lenses immediately after the eye examination is completed. He may first require all fees to be paid, but only if he requires immediate payment from patients whose eye examinations reveal no need for corrective eye products.
2. An optometrist shall not require patients to buy ophthalmic goods, pay additional fees, or sign a waiver or release in exchange for a copy of the spectacle prescription.
3. An optometrist shall not disclaim liability or responsibility for the accuracy of an eye examination.
2. Records that are required by contractual obligation or federal law to be maintained for a longer period of time.
F. Practitioners shall post information or in some manner inform all patients concerning the time frame for record retention and destruction. Patient records shall only be destroyed in a manner that protects patient confidentiality.
G. For the purpose of prescribing spectacles, eyeglasses, lenses, or contact lenses to a patient, a licensee shall establish a bona fide provider-patient relationship in accordance with requirements of § 54.1-2400.01:2 of the Code of Virginia.
18VAC105-20-46. Treatment guidelines for TPA-certified optometrists.
A. TPA-certified optometrists may treat diseases and abnormal conditions of the human eye and its adnexa that may be treated with medically appropriate pharmaceutical agents as referenced in 18VAC105-20-47. The adnexa is defined as conjoined, subordinate or immediately associated anatomic parts of the human eye, including eyelids and eyebrows.
1. Glaucoma (excluding the treatment of congenital and infantile glaucoma). Treatment of angle closure shall follow the definition and protocol prescribed in subsection C of this section.
2. Ocular-related post-operative care in cooperation with patient's surgeon.
3. Ocular trauma to the above tissues as in subsection A of this section.
5. Anaphylactic shock (limited to the administration of intramuscular epinephrine).
5. Proper topical medications as appropriate may also be administered by the optometrist.
D. An oral Schedule VI immunosuppressive agent shall only be used when (i) the condition fails to appropriately respond to any other treatment regimen; (ii) such agent is prescribed in consultation with a physician; and (iii) treatment with such agent includes monitoring of systemic effects.
1. Oral analgesics - Schedule II controlled substances consisting of hydrocodone in combination with acetaminophen and Schedule III, IV and VI narcotic and nonnarcotic agents.
B. Schedule I, II and V drugs and Schedule II drugs with the exception of controlled substances consisting of hydrocodone in combination with acetaminophen are excluded from the list of therapeutic pharmaceutical agents.
A. Every person authorized by the board to practice optometry shall, on or before December 31 of 2018, submit a completed renewal form and pay the prescribed annual licensure fee. Beginning with calendar year 2020, the renewal of licensure deadline shall be March 31 of each year. For calendar year 2019, no renewal is required.
C. The license of every person who does not complete the renewal form and submit the renewal fee each year may be renewed for up to one year by paying the prescribed renewal fee and late fee, provided the requirements of 18VAC105-20-70 have been met. After the renewal deadline, a license that has not been renewed is lapsed. Practicing optometry in Virginia with a lapsed license may subject the licensee to disciplinary action and additional fines by the board.
B. Each licensee shall attest to fulfillment of continuing education hours on the required annual renewal form. All continuing education shall be completed prior to the renewal deadline unless an extension or waiver has been granted by the Continuing Education Committee. A request for an extension or waiver shall be received prior to the renewal deadline each year.
C. All continuing education courses shall be offered by an approved sponsor or accrediting body listed in subsection G H of this section. Courses that are not approved by a board-recognized sponsor in advance shall not be accepted for continuing education credit. For those courses that have a post-test requirement, credit will only be given if the optometrist receives a passing grade as indicated on the certificate.
D. Licensees shall maintain continuing education documentation for a period of not less than three years. A random audit of licensees may be conducted by the board which will require that the licensee provide evidence substantiating participation in required continuing education courses within 14 30 days of the renewal date audit notification.
E. Documentation of hours shall clearly indicate the name of the continuing education provider and its affiliation with an approved sponsor or accrediting body as listed in subsection G H of this section. Documents that do not have the required information shall not be accepted by the board for determining compliance. Correspondence courses shall be credited according to the date on which the post-test was graded as indicated on the continuing education certificate.
1. Provide a certificate of attendance that shows the The date, location, presenter or lecturer, content hours of the course and contact information of the provider or sponsor for verification. The certificate of attendance shall be based on verification by the sponsor of the attendee's presence throughout the course, either provided by a post-test or by a designated monitor.
2. Maintain documentation about the course and attendance for at least three years following its completion. Whether the course was in real-time and interactive, including in-person or electronic presentations.
VA.R. Doc. No. R17-5114; Filed October 4, 2018, 3:25 p.m.

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