Source: https://www.dshs.state.tx.us/vhs/rules.shtm
Timestamp: 2019-04-22 22:14:29+00:00

Document:
The purpose of this subchapter is to implement Texas Health and Safety Code, Chapter 36, concerning the early identification of individuals from birth through 20 years of age who have special senses and communication disorders and who need remedial vision, hearing, speech, or language services.
(1) American Academy of Pediatrics (AAP)--The AAP is a nationally recognized professional organization which issues recommended standards pertaining to the health and well-being of children.
(2) American Association for Pediatric Ophthalmology and Strabismus (AAPOS)--AAPOS is a nationally-recognized professional body which, in conjunction with the AAP, issues recommended vision screening standards. The goals of AAPOS are to advance the quality of children’s eye care, support the training of pediatric ophthalmologists, support research activities in pediatric ophthalmology, and advance the care of adults with strabismus.
(3) American National Standards Institute, Inc. (ANSI)--The national coordinator of standards development and the United States clearinghouse for information on national and international standards.
(4) Audiometer--An electrical device for testing hearing, and for measuring bone and air conduction of sound.
(5) Audiometric calibration equipment--Electro-acoustical equipment used to calibrate audiometers and audiometric testing devices. The term includes frequency counters, voltmeters, and distortion measuring equipment used to calibrate audiometers and audiometric testing devices.
(6) Audiometric testing device--An electro-acoustical generator that provides acoustic energy of a calibrated output.
(7) Biological calibration check--The process of testing a person having a known, stable audiometric curve that does not exceed 25 decibels (dB) hearing level at any frequency between 250 and 6000 Hertz (Hz), and comparing the test results with the subject's known baseline audiogram.
(8) Calibration--The process of comparing an instrument or device with a standard to determine its accuracy and to make the necessary repairs or adjustments to assure that the operating characteristics are within the allowable limits established by a national standard, all in accordance with applicable legal requirements.
(9) Certification--The process by which the Department of State Health Services (department) trains individuals to conduct vision and/or hearing screening or provides training to instructors. The applicable certification is awarded following the successful completion of any of the course scenarios in this paragraph.
(10) dB--The decibel is a unit for expressing the relative intensity of sounds on a scale from zero for the average least perceptible sound to approximately 130 for the average pain level.
(11) Exhaustive calibration--A calibration that tests all settings for both earphones.
(12) Extended recheck--A screen used after the child has failed two sweep-check screens. The screener may perform an extended recheck or initiate a referral for a professional examination, as defined in this section, after the two failed sweep-check screens.
(D) child care homes licensed by DFPS.
(14) Hz--Hertz is a unit of frequency equal to one cycle per second.
(15) Licensed professional--An individual whose legally-defined scope of practice under the license includes knowledge and experience in conducting professional examinations and screenings for vision and/or hearing abnormalities in children, all consistent with this subchapter and Texas Health and Safety Code, Chapter 36. The terms “professional examination” and “screening” are as defined in this section.
(16) Pass/Fail--Allowable documentation of results of vision screening when photoscreening is used for vision screening, in accordance with this subchapter. The documentation of the screening results is in lieu of visual acuity results using “20/20” format.
(17) Photoscreening--A form of pediatric vision screening that uses a special-purpose camera to determine how well a child can see. It is an alternative under this subchapter to visual acuity-based screening with an eye chart for certain children, as specified herein. Other related terms are: autorefractor, objective screening and instrument-based screening. Photoscreening cannot determine exactly how well a child’s visual acuity is developing. Important factors that affect visual acuity such as accommodative ability (focusing ability), binocular vision development, and other eye health issues are not assessed via photoscreening.
(18) Professional examination (also referred to as examination)--A diagnostic evaluation performed by an appropriately licensed professional or by a department-certified individual whose expertise addresses the diagnostic needs of the individual identified as having a possible special senses or communication disorder. A professional examination is one that is done according to the requirements of this subchapter and of the Texas Health and Safety Code, Chapter 36.
(19) Program--The department’s Vision and Hearing Screening Program.
(20) Pure-tone audiometer--A pure-tone audiometer electronically generates pure-tones which are used as signals to test a person’s hearing.
(21) Reporting year--A 12-month period beginning June 1 of each year and ending May 31 of the following year.
(22) Screening--A test or battery of tests for rapidly determining the need for a professional examination.
(23) Screening equipment--An instrument or device used to perform a measurement or measurements for the assessment of sensory abilities.
(24) Sweep-check--A quick hearing screening test using a pure-tone audiometer to determine whether a person can hear the following frequencies: 1000 Hz, 2000 Hz, and 4000 Hz at less than or equal to 25 dB.
(25) Telebinocular instrument--A stereoscopic instrument for screening various eye defects and measuring visual acuity.
(26) Testing equipment--An instrument or device used under this subchapter to perform a measurement or measurements to substantiate or verify the presence or absence of sensory impairment(s).
(27) Tests--Procedures under this subchapter to measure special senses and communication functions.
(28) Visual acuity--The relative ability of the visual organ to resolve detail that is measured and recorded using an internationally recognized, two-figured indicator, such as 20/20.
(a) Screening is required, for individuals who attend a facility, to detect vision disorders. Vision screening conducted under this subchapter by a person who is not a licensed professional, as the term is defined in this subchapter, must be conducted following the national standards set by AAPOS currently found at http://www.aapos.org/terms/conditions/131, as revised, as they apply to age, verbal ability, ability to cooperate with screening, allowable methods of screening in different situations, and referral criteria, with the following exceptions.
(1) For children less than five years of age, refer for a professional examination when there is a difference of two lines between passing acuities in either eye.
(2) For children five years of age and older, refer for a professional examination when screening results indicate visual acuity of less than 20/30 in either eye (rather than 20/32 as listed in the AAPOS standards).
(3) In addition to AAPOS’ recommendation regarding photoscreening for children 42 months to five years of age, photoscreening may be used for any individual (referenced in §37.21 of this title (relating to Purpose) with disabilities who does not respond well to other allowable screening methods. A referral to a professional examination is recommended if the individual fails the photoscreening.
(b) A person who is not a “licensed professional,” as that term is defined in this subchapter, who conducts vision screening must be trained and certified as described in §37.27 of this title (relating to Standards and Requirements for Screening Certification and Instructor Training).
(c) When a screener makes a referral based on the screening results under subsection (a) of this section, that referral shall be to a licensed professional for a professional examination, and not to a specific individual.
(d) The requirements of this section do not apply when the individual is already actively under medical care by an appropriate licensed professional for one or more of the vision problems for which screening is done under this section. In order to claim this exception, the individual under the scenarios described at Texas Family Code, §32.003 or, if the individual is a minor, the individual’s parent, managing conservator or legal guardian, must submit documentation from the licensed professional to the facility. The documentation must be signed and dated by the licensed professional, and must affirmatively state that the individual is under active, ongoing medical care from the licensed professional for specific vision problems as referenced in this subsection.
(a) Screening is required, for individuals who attend a facility, to detect hearing disorders. Hearing screening under this subchapter must be conducted using screening methods and referral criteria, and in compliance with other requirements, as follows.
(b) A person who is not a “licensed professional,” as that term is defined in this subchapter, who conducts hearing screening must be trained and certified as described in §37.27 of this title (relating to Standards and Requirements for Screening Certification and Instructor Training).
(c) A pure-tone audiometer shall be used to conduct a sweep-check screen.
(d) Screening results shall be recorded for each ear at less than or equal to 25 dB for 1000 Hz, 2000 Hz, and 4000 Hz.
(e) A rescreen with another sweep-check is recommended if test results indicate failure to respond to any of the three frequencies in either ear, and it should be conducted no sooner than three weeks but not more than four weeks after the initial screening.
(f) An extended recheck may be conducted or a referral to a professional examination shall be made for all children whose test results indicate failure to respond to any of the three frequencies in either ear on the second sweep-check.
(g) If the extended recheck results in a failure to respond to any frequency in either ear at greater than 25dB, the screener must recommend that a professional examination be immediately conducted.
(h) An extended recheck shall be conducted according to the following procedures.
(1) Beginning with the right ear, present the tone at 40 dB hearing level (HL) and at 1000 Hz for two to three seconds. If no response is obtained, record "greater than 40 dB."
(2) If the child responds at 40 dB, lower the intensity to 30 dB HL and present the tone again.
(3) Lower the HL in 10 dB increments until no response is obtained, or until 20 dB is reached. If a response is obtained at 20 dB, record "20 dB."
(4) If no response is obtained, increase the HL dial in 5 dB increments until a response is obtained. Record the dB results obtained at 1000 Hz for the right ear.
(5) Repeat steps in paragraphs (1) - (4) of this subsection at 40 dB HL for 2000 Hz and 4000 Hz.
(6) Repeat steps in paragraphs (1) - (5) of this subsection for the left ear.
(i) When a screener makes a referral based on the screening results under subsection (a) of this section, that referral shall be to a licensed professional for a professional examination, and not to a specific individual.
(j) The requirements of this section do not apply when the individual is already actively under medical care by an appropriate licensed professional for one or more of the hearing problems for which screening is done under this section. In order to claim this exception, the individual under the scenarios described at Texas Family Code, §32.003 or, if the individual is a minor, the individual’s parent, managing conservator or legal guardian, must submit documentation from the licensed professional to the facility. The documentation must be signed and dated by the licensed professional, and must affirmatively state that the individual is under active, ongoing medical care from the licensed professional for specific hearing problems as referenced in this subsection.
§37.25. Facility Requirements; Department Activities.
(a) The chief administrator of each facility shall ensure that each individual admitted to the facility complies with the screening requirements of this subchapter (including ensuring that any screening done is performed by a properly certified screener), according to the following schedule.
(1) Children four years of age or older, who are enrolled in any facility for the first time, must be screened for possible vision and hearing problems within 120 calendar days of enrollment. If a child is enrolled within 60 days of the date a facility closes for the Summer, the child’s vision and hearing must be tested within 120 days of the beginning of the following school year.
(2) Children enrolled in pre-kindergarten and kindergarten must be screened each year within 120 days of enrollment.
(3) Children enrolled in the first, third, fifth, and seventh grades must receive vision and hearing screening in each of those grade years (can be done at any time during each of those years).
(4) Except for children enrolled in pre-kindergarten, kindergarten or first grade, a facility shall exempt any child from screening as required by paragraphs (1) - (3) of this subsection if the child’s parent, managing conservator, or legal guardian, or the individual under the scenarios described at Texas Family Code, §32.003, submits a record to the facility showing that a professional examination was properly conducted during the grade year in question or during the previous year. The record must be submitted to the facility during the grade year in which the screening would otherwise be required.
(5) Children enrolled in a facility who turn four years of age after September 1 of that year are exempt from screening until the following September.
(6) Upon written request pre-approved by the department, the screening of vision and hearing performed at a facility may occur on an even-year schedule (i.e., pre-kindergarten, kindergarten, and first, second, fourth, and sixth grades instead of pre-kindergarten, kindergarten, and first, third, fifth, and seventh grades). Any department approval will include conditions so that children do not miss necessary screening during the transition.
(b) A child’s parent, managing conservator, or legal guardian, or the individual under the scenarios described at Texas Family Code, §32.003, may execute an affidavit stating that a person, other than the individual secured by the facility to conduct screenings at the facility, shall conduct the screening (or that a licensed professional shall conduct an examination) as soon as is feasible. The facility may admit the child on a provisional basis for up to 60 days, or may deny admission until the screening record(s) are provided to the facility.
(c) A facility shall not require a child to be screened if the child’s parent, managing conservator, or legal guardian, or the individual under the scenarios described at Texas Family Code, §32.003, submits to the facility, on or before the date vision or hearing screening is scheduled, an affidavit in lieu of the screening record(s) stating that the vision or hearing screening conflicts with the tenets and practices of a church or religious denomination of which the affiant is an adherent or member.
(d) Only individuals who have completed high school may serve as volunteer assistants during vision and/or hearing screenings. It is the responsibility of the certified screener to determine how any volunteer assistant(s) will be used during the screening process, consistent with all state and federal confidentiality requirements.
(a) Individuals conducting screenings under this subchapter must comply with the following recordkeeping and reporting requirements.
(1) Individuals conducting screenings at the facility (and those other than licensed professionals conducting screenings outside of the facility) shall document in each child’s screening record the specific screening conducted, the date the screening was conducted, observations made during the screening, and the final results of the screening. The individual shall also ensure that the following are included in the documentation: the name of the child, age or birthdate of the child, and whether the child is wearing corrective lenses during the vision screening. The documentation required under this subsection must also be signed and dated by the person who conducted the screening.
(2) Individuals using photoscreening for vision screening must comply with the recordkeeping and reporting requirements detailed at §37.27(b)(2) of this title (relating to Standards and Requirements for Screening Certification and Instructor training). Additionally, prior to conducting photoscreening at a facility, the individual must submit copies of these same documents to that facility in addition to the documents which must be submitted under subsection (b)(3) of this section.
(3) Individuals using a telebinocular instrument for vision screening must comply with the recordkeeping and reporting requirements detailed at §37.27(b)(3) of this title. Additionally, prior to conducting telebinocular screening at a facility, the individual must submit copies of these same documents to that facility.
(4) Individuals conducting screenings at a facility (and those other than licensed professionals conducting screening outside of the facility) shall submit the documentation referenced in paragraph (1) of this subsection to the facility at the time of that screening.
(5) Individuals must submit documentation to the department related to certifications and refresher courses, as specified in §37.27 of this title.
(b) Facilities must comply with the following recordkeeping and reporting requirements.
(1) Each facility shall maintain vision and hearing screening records under this section onsite for at least two years.
(2) A facility must maintain screening records regarding any individual claiming the exemptions found in §37.23(d) of this title (relating to Vision Screening) and/or §37.24(j) of this title (relating to Hearing Screening) for at least two years.
(3) A facility shall maintain the records it receives from screeners under subsection (a)(2) of this section, related to the use of photoscreening for vision screening at the facility for at least two years.
(4) An individual’s screening records may be transferred among facilities without the consent of the individual under the scenarios described at Texas Family Code, §32.003 or, if the individual is a minor, the minor’s parent, managing conservator, or legal guardian, pursuant to Texas Health and Safety Code, §36.006(c).
(5) The recordkeeping required in this section must be made available to the department in a timely manner upon request. The department may, directly or through its authorized representative, enter a facility and inspect records maintained relating to vision and hearing screening.
(6) On or before June 30 of each year, each facility shall submit to the department a complete and accurate annual report on the vision and hearing screening status of its aggregate population screened during the reporting year. Facilities shall report in the manner specified by the department (currently found at http://chrstx.dshs.state.tx.us/CHRS/login.aspx). Facilities are required to report on the following categories.
(A) For hearing screening--The total number screened: the number who failed; the number referred for professional examination; the number transferred out of the facility prior to the facility receiving the professional examination results; professional examination results indicating none of the disorders present which are screened for under this section; professional examination results indicating a disorder(s) which is screened for under this section; and referral for a professional examination with no indication that a professional examination was ever done.
(B) For vision screening--The total number screened; the total number screened with correction (e.g. glasses or contacts); the total number screened with photoscreening; the number who failed; the number referred for professional examination; the number transferred out of the facility prior to the facility receiving the professional examination results; professional examination results indicating none of the disorders present which are screened for under this section; professional examination results indicating a disorder(s) which is screened for under this section; and referral for a professional examination with no indication that a professional examination was ever done. The “total number screened” includes the number screened with telebinocular screening.
(c) There are additional recordkeeping requirements in §37.28(f) and (g) of this title (relating to Hearing Screening Equipment Standards and Requirements) for individuals or entities who own and/or use audiometers and audiometric screening equipment.
(d) For all submissions to the department under this subchapter, use the following contact information (unless otherwise specified): Vision, Hearing and Spinal Screening Program, Department of State Health Services, Mail Code 1978, P.O. Box 149347, Austin, Texas 78714-9347.
§37.27. Standards and Requirements for Screening Certification and Instructor Training.
(a) Individuals who conduct vision and/or hearing screening must be certified under this section unless the screening is conducted by a licensed professional. There are two options for obtaining this certification: a certificate issued directly by the department; or a certificate issued by an instructor who has been trained and authorized by the department to issue certificates. There is no cost to taking the course in either scenario.
(1) The department offers certification courses, and issues certificates to those who successfully complete them. To be eligible to take the department’s certification course, an individual must be a high school graduate and sign a written statement to that effect at the beginning of the course. Individuals who successfully complete the course, including passing the associated tests, will be issued a certificate by the department.
(2) The department trains instructors who themselves give certification courses, as described in this section. The eligibility requirement to attend such a course is the same as is described at paragraph (1) of this subsection. Individuals who successfully complete the course, including passing the associated tests, will be issued a certificate signed by the authorized instructor. It will have the same validity, and is subject to the same restrictions, as a certificate issued under paragraph (1) of this subsection.
(b) Screening certificates issued under this section are subject to the following requirements.
(1) Individuals who receive a certificate are authorized to conduct vision and/or hearing screening (as applicable to the course taken, and as listed on the certificate) in accordance with this subchapter. Certified screeners are required to comply with this subchapter, and failure to do so is grounds for the modification, suspension and/or revocation of the certification as provided in this section.
(2) Individuals using a photoscreener for vision screening must have successfully completed instrument-specific training (including passing all associated tests) in accordance with manufacturer guidelines and must have a full understanding of the pass/fail referral criteria in accordance with AAPOS standards. Individuals conducting photoscreening must also have a current screening certificate under subsection (a)(1) or (2) of this section. Documentation of the photoscreening training must be submitted to the instructor upon attendance at a certification class and include the date and location the training was taken, and the name, affiliation and contact information of the instructor. The individual must successfully complete instrument-specific refresher training (including passing any associated tests) every five years. Such refresher training must be completed during the fifth year of certification from the date the preceding certificate was issued.
(3) Individuals using a telebinocular instrument for vision screening must be familiar with the instrument in accordance with manufacturer guidelines and must have a full understanding of the pass/fail referral criteria. Individuals conducting telebinocular screening must also have a current screening certificate under subsection (a)(1) or (2) of this section.
(4) Screening certification under this section allows the individual to screen children for vision and/or hearing problems (as applicable to the course taken, and as listed on the certificate) under this subchapter for a period of five years, with renewals processed as described in paragraph (5) of this subsection.
(5) Screening certification may be renewed by attending a department-approved refresher training course (either offered directly by the department or by an instructor authorized under this section). The refresher training course must be completed during the fifth year of certification from the date the preceding certificate was issued. Once a refresher training course is successfully completed, the five-year cycle begins again. If certification is not renewed within the required time period, the individual must attend the basic certification training course (i.e., a refresher course will not be sufficient).
(6) When the department receives information from any source that indicates a screener has not been following the requirements of this subchapter, the department may modify, suspend, or revoke the certification. The department will send a notice to the affected individual as part of any such action being taken.
(7) The affected individual has 20 days after receiving the notice, referenced in this paragraph, to request a hearing on the proposed action. It is a rebuttable presumption that a notice is received five days after the date of the notice. Unless the notice letter specifies an alternative method, a request for a hearing shall be made in writing, and mailed or hand-delivered to the program at the address specified in §37.26(d) of this title (relating to Recordkeeping and Reporting). If an individual who is offered the opportunity for a hearing does not request a hearing within the prescribed time for making such a request, the individual is deemed to have waived the hearing and the action may be taken.
(8) Appeals and administrative hearings will be conducted in accordance with the department’s fair hearing rules, at §§1.51 - 1.55 of this title (relating to Fair Hearing Procedures).
(c) Individuals who successfully complete a department instructor training course, including all associated testing, are authorized to conduct screening trainings and issue screening certificates to individuals who successfully complete the screening training (including all associated testing), subject to the requirements of this section. Instructors may not charge any kind of fees for their activities under this section.
(C) be an audiologist, speech pathologist, optometrist, ophthalmologist or a registered nurse and must have the applicable Texas license, current and in good standing under Texas law.
(2) Department authorization for instructors to conduct trainings is valid for five years from the date certification was issued. The individual must successfully complete a department-approved instructor training refresher course (including passing any associated tests) and submit documentation of successful completion to the department within 30 days of completion of the course. Such refresher training must be completed during the fifth year of certification from the date the preceding certificate was issued. Failure to comply with these requirements, by the deadline given, means that the individual must then attend the basic instructor training course (i.e., a refresher course will not be sufficient).
(3) Once authorized by the department to conduct trainings, instructors must do so using training materials obtained from the department.
(4) All proposed screening training sessions must be approved by the department at least 15 working days prior to the training session. The instructor must provide all information sought by the department, by the deadlines given.
(5) Instructors in good standing under this section may teach screening refresher courses as described in subsection (b)(5) of this section. Such refresher courses are subject to the same requirements under this section as those pertaining to initial screening courses.
(6) When a department-authorized instructor issues a certificate of vision and/or hearing screening, the instructor has 14 days to submit the attendance sheets, evaluations and the tear-off portion of the department’s certification, and the photoscreening certificate, if applicable, to the department. These original documents should be submitted to the program at the address found at §37.26(d) of this title. The instructor should maintain a copy.
(7) When the department receives information from any source that indicates a screening instructor has not been following the requirements of this subchapter, the department may modify, suspend, or revoke the certification. The department will send a notice to the affected individual as part of any such action being taken.
(8) The affected individual has 20 days after receiving the notice, referenced in paragraph (7) of this subsection, to request a hearing on the proposed action. It is a rebuttable presumption that a notice is received five days after the date of the notice. Unless the notice letter specifies an alternative method, a request for a hearing shall be made in writing, and mailed or hand-delivered to the program at the address specified in §37.26(d) of this title. If an individual who is offered the opportunity for a hearing does not request a hearing within the prescribed time for making such a request, the individual is deemed to have waived the hearing and the action may be taken.
(9) Appeals and administrative hearings will be conducted in accordance with the department’s fair hearing rules at §§1.51 - 1.55 of this title.
§37.28. Hearing Screening Equipment Standards and Requirements.
(a) Except as otherwise specifically provided, the sections in this subchapter apply to all persons and entities (e.g., calibration companies, facilities) who receive, possess, acquire, transfer, own, or use audiometers, audiometric testing devices, and audiometric calibration equipment, and to all audiometers used for audiometric screening and hearing threshold tests, all audiometric testing devices, and all audiometric calibration equipment used in the State of Texas.
(b) Each individual and entity using any of the equipment referenced in subsection (a) of this section must be registered with the department, in the manner prescribed by the department (see information at http://www.dshs.state.tx.us/vhs/audio.shtm). Registration information must be updated in a timely manner to keep it current.
(c) Equipment referenced in subsection (a) of this section shall meet the appropriate current ANSI standards, or the manufacturer's specifications if no ANSI standards apply, and all other applicable federal and state standard(s) and/or regulation(s) for such equipment.
(d) Individuals must be trained by or undergo training approved by the department in the proper use of this equipment, as detailed in §37.27 of this title (relating to Standards and Requirements for Screening Certification and Instructor Training).
(e) Individuals and entities who perform calibration services on the equipment referenced in subsection (a) of this section shall register with the department, and must update that registration in a timely manner to keep it current, in a manner prescribed by the department (see information at http://www.dshs.texas.gov/vhs/audio.shtm).
(f) Only calibration firms shall perform periodic electronic calibrations and exhaustive electronic calibrations. Calibration firms shall provide notification to the owner of the audiometer being calibrated that the audiometer has been calibrated. The notification may be in the form of a decal or sticker affixed to the audiometer, or in hard copy documentation that must be maintained by the owner and be made readily available to the department or its representative upon request.
(g) Upon reasonable notice, each individual or entity using audiometric screening equipment shall make available to the department, in a timely manner, records maintained pursuant to this subchapter. Calibration forms and records for all equipment referenced in subsection (a) of this section, including monthly biological calibration data, shall be maintained for inspection by the department for three years.
(2) equipment limited to nonhuman use.

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