Welcome to the 2024 Licensing Board Conference. I'm Christine Seitz, IHS Manager of Government Affairs. Thank you for joining us today. Before we begin, I want to ensure you know that closed captioning is available. To view captioning, click on the arrow to the right of the CC button on your Zoom toolbar and select Show Subtitle. We recognize that you are all incredibly busy, and we appreciate you being here with us today. There's a lot going on in this profession, and the work you do is more important than ever to meet the needs of the hearing aid dispensing professionals and candidates, and most importantly, the clients and patients they serve. So your participation here today is valued, and we really encourage you to speak up. Use this forum to find solutions and ideas and share best practices. Before we begin, let's do a brief tech check. I'm sure we've all got the Zoom basics down at this point. During the healthcare topics and open forum discussions later, you'll be invited to unmute yourself and ask your questions. If you have any questions or comments during the other sessions, we ask that you use the chat feature or raise your Zoom hand, and we'll keep an eye out and call on you to unmute yourself and to ask your questions during the Q&A sessions. Also, we are recording this conference for you. Therefore, it's important that attendees are muted unless speaking to ensure a clear recording. IHS is conducting surveys as part of our ongoing effort to understand the current landscape of hearing aid specialist licensure across the United States and Canada. On the left side of the screen is a comprehensive survey that builds on the 26th licensing survey and will serve as a valuable resource for the profession, licensing board, you, attendees, and the public that your members serve. Please plan to set aside approximately 30 minutes to complete the survey. Not all questions are required. The questions are related to scope of practice, licensure, continuing education requirements, and more. On the right side is a one-question survey about scope of practice. That question is, does your state or province authorize hearing aid specialists to provide serum and management services, tinnitus care, or tympanometry tests, yes or no? You can complete the survey by clicking on the link that Ava has posted in the chat, or you can point your smartphone camera at the QR codes on your screen, inviting you to open a link to the survey. Thank you to all who participate. Answers to these surveys will be provided at a later date. Okay. Now, before we get started, I'd like to introduce IHS staff who are also presenting with me today, Ciara Sharp, Director of Professional Development, and Peter Mihalik, Health Policy and Advocate Director. Now, let's take a moment to hear from you. I'll go through the list of attendees and ask each of you to share your name, the state or province you're representing, and your role, whether that's staff or licensing board. When you are invited to, please unmute yourself and begin your introduction. Claire Kovert-Biby. Claire Kovert-Biby, I'm the Administrator for the Nebraska Board of Hearing Aid Specialists. Welcome, Claire. Next member, I'm sorry, next attendee, Michael Androzzi. Michael Androzzi. Hey, good afternoon, everyone. This is Mike Androzzi. I am the, actually, incoming President of IHS, which starts in January. And also, I serve on the Rhode Island Licensing Board, and we're representing them as well today. So, thank you. Thank you. Michelle Michaels. Michelle Michaels with the State of Arizona Commission for the Deaf and the Hard of Hearing. Great. Thank you so much for being here today. Thank you. Stacey Whitaker. Can you hear me? We can, yeah. I'm Stacey Whitaker with the Nevada Speech and Hearing Board. Great. Great to see you. And then we have Tim Stanton. Tim Stanton with the Kansas Hearing Aid Board. Love Tim. Next is Todd Beyer. Hey, can you hear me? We can. Okay. Yeah, I'm Todd Beyer. I'm from Wisconsin. I am a past President of IHS, and now I am currently a board member for the Wisconsin Hearing and Speech Examining Board. Welcome. Thank you for joining us. Next is Yolanda Morrow. It should be Felicia Wang. I don't know if it's under. I need to change the name, but I'm Felicia Wang with the Mississippi State Department of Health. Hello, Felicia. Sorry. No, no worries. No worries at all. Joseph Chandler. Yes, I'm Joseph Chandler. I'm the Field Manager for Hospitals and Professionals here at Health Licensing in South Carolina. Great. Thank you so much. Oh, we have a new attendee, John Hamm. Hello. Hello. This is Clow. Hope everyone's. Hi, Clow. Board member of North Carolina. Thank you. You're welcome. Okay. I believe that is everybody. So now we'll move on to the agenda. We have a lot to cover today, and we want to leave you with plenty of time to discuss pressing hearing health care topics and participate in an open forum with your colleagues. So let's begin. We'll start by receiving updates from Sierra Sharp on professional development and education, followed by a Q&A with Sierra. Thank you, Christine, and thank you to all of our attendees for being here today, joining us for the licensing board conference. As Christine said, my name is Sierra Sharp. I'm IHS's director of professional development, so I oversee everything related to education and exams on the staff side here at IHS. I'm going to provide you with some updates about the ILE and the practical exam, as well as continuing education. And then at the end, I'll be available to take any questions you have about those topics or any other topics related to education and exams. So as I mentioned, we're going to start with the ILE. So first, we're going to talk about some of the kind of psychometric data and that side of the ILE, and then we'll talk about some of the logistics as we've had some new processes roll out this year that many of you are aware of. So as a reminder to those of you who've been here before, the ILE is the International Licensing Examination for Hearing Health Care Professionals. It's the multiple-choice, computer-based test that IHS creates, maintains, and administers, and we're contracted with 43 U.S. states and five Canadian provinces who use this exam in their licensing process for hearing aid specialists. In 2023, we did a lot of exam maintenance work for a high-stakes psychometric exam like the ILE. It's very important that these processes are completed on a regular basis to ensure that the exam is fair, defensible, reliable, and that it's doing what we want it to do, which is identifying who's qualified to hold a license as a hearing aid specialist. So in 2023, we completed first a job task analysis, which is a process that lets the industry weigh in on the job tasks performed by an entry-level hearing aid specialist. And it tells us which tasks are the most frequent and which tasks are the most critical. All of that information is then synthesized to create the exam blueprint, which tells what's on the exam. So, for example, that 3 to 5 percent of the exam is infection control-type questions. So we build the exam blueprint, and then we do a process called standard setting, which determines the passing score of the exam. So that's an extremely critical decision point that's made in conjunction with a lot of stakeholders to make sure that we're always making the most fair, valid, legally defensible decision about the content of the exam and the passing standard of the exam. As a reminder, the goal of the ILE, as I've said, is to ensure a fair, appropriate, and legally defensible exam and standard for licensure as an entry-level hearing aid specialist. So there are exams such as the National Board for Certification that's looking at an advanced level, but for the ILE, we're looking at the entry-level. IHS has been laser-focused on improving exam preparation over the last couple of years by beefing up our training and increasing transparency around what's covered on the exam and what the format is of the exam, and making more test preparation resources and information available to people who are preparing to take the exam. So with that, I'm very pleased to share some pass rate data with you today about the ILE. So this slide shows kind of the trajectory from 2018 to 2023. So I would start with the good news, which is that you can see that obviously during the pandemic, 2020 and 2021, we really saw a dip in the number of candidates who were taking the ILE. This is because there were businesses who were tightening their purse strings, businesses who were maybe had periods of shutdown, so they weren't training as many people. It's also because our testing centers were closed during state-mandated situations where non-essential businesses or non-essential services had to be closed. Many of our testing centers are on college campuses, and there were many college campuses that were closed, especially in those early days of the pandemic. So there were a lot of factors that caused our number of candidates to dip in 2020 and 2021. We do tend to look more heavily at the first-time pass rate, which is that second green bar that you're seeing there on your screen. The reason for that is because people who don't pass on their first try are by definition lower ability candidates. And some of them will tend to take the exam many times, which then brings down the overall average for the overall pass rate. So the first-time pass rate really serves for us as a good benchmark for the ability of candidates versus the ILE content. What we know at IHS is that there's a shortage of professionals in the hearing health care field. And we also know that you as licensing boards are tasked with consumer protection and making sure that people are adequately qualified. And so we always want to ensure that the exam is correctly calibrated to that standard I spoke of, of entry-level hearing aid specialists. And this process that we undertook in 2023 from the job task analysis through the standard setting allowed us to reset our alignment and ensure that it's accurate moving forward for the candidates that we have and the industry as it exists in 2024. So this slide is showing the pass rate data so far here in 2024. This data shows the ILE results through the end of September. So it's the first quarter through the end of the third quarter of 2024. So number one, what you can see is that we are on track for the most candidates ever in a year, which is really exciting. That shows us that we're all participating in a growing industry, a growing profession, and we're on track to surpass 1,300 candidates in 2024, which would be a huge increase over our previous high year in 2019, just shy of 1,100 candidates. What we also know is that 656 people have passed the ILE so far in 2024, and last year 717 people passed all year. So we are again on track for the most number of people to pass in a calendar year, the ILE. And what we know is that test takers are becoming more efficient. So the number of exams per person in 2024 has been 1.13. So what that means, quote unquote, is that the average candidate takes the exam 1.13 times, right? Last year, that average was 1.52. So test takers are becoming more efficient. And you can see that in the pretty significant jump in the first time pass rate that now in 2024 we're sitting at 67%. So it seems like doing a bit of a recalibration on the exam was definitely the right thing to do at this point in time. It helps us serve our dual purposes of wanting to grow the profession and ensuring that we're maintaining adequate standards for hearing health care professionals and the consumers that they're serving that you all are tasked with protecting in your roles. And so that, you know, again, that efficiency for the test takers is coming from improved preparation, companies recruiting more qualified applicants, more transparency, which aids the test preparation process, reduced stigma for test taker accommodations. So people are more likely to apply for accommodations for disorders or disabilities they may have that when they get those accommodations, it helps them, you know, succeed on the exam in a way that showcases their true ability. So we're seeing that as a factor as well. And so all of these, you know, factors have combined to create a situation where we have a really healthy candidate pool that are, you know, funneling through the states, becoming licensed, serving more and more consumers, which is so critical as the population in the United States continues to age. So that's my kind of psychometrics information about the ILE at this point. To get more into the logistical side of things, as you all know, an updated score reporting process rolled out in September of this year. And nearly all jurisdictions that are using the ILE opted in for test takers to receive automatic results from IHS. So what they're, those test takers now are receiving an email immediately upon submitting their exam, showing them if they passed or failed and giving them their section level results. So there are five big topic areas on the exam. And so it will show them if they failed, it will say they failed. And then it will show in topic one, you scored a 47 percent. In topic two, you scored an 82 percent, etc. And so that shows them where they need to focus their study efforts before they come take the exam again. So they're getting that in an email automatically when they submit their exam. The candidate response to this, as you can imagine, has been overwhelmingly positive. People are thrilled to have, again, more transparency into their results on the exam. To not have this kind of arduous waiting period of IHS sends their results to the state and then the state sends their results to the candidate, which creates a lot of kind of downtime for even people who pass, right, who could move on to the next stage in their licensing process. It's so helpful for people to, you know, limit the anxiety that they're feeling, to reduce that waiting period and let people be able to move on, you know, in one direction or another, whether they passed or failed. Concurrently with this, we updated the way we're delivering results to you all at the jurisdiction, at the licensing agency. That has been a little bit bumpy, as any new technological rollout sometimes is. My team has been working through any issues as they come up, and we're absolutely committed to getting it right. So if you are having issues, you know, I don't think there's anything outstanding that's not being addressed, but if that happens to be the case for you, please do let me know. Our goals always are to streamline processes for us and for you all, and to protect candidate privacy as we're transmitting these results, you know, and sensitive data back and forth. Moving on to the practical exam. The new IHS practical exam, which we developed over a period of several years, was released over a year ago. It's performing very well, meaning the proctors are having an easy time understanding the exam, administering it in a uniform and fair way. We're hearing feedback from test takers and their trainers that the exam is more aligned with what hearing aid specialists do on the job in 2024. So that's a good thing. And the pass rate is very high on the exam, over 90%, which showcases that candidates are prepared. You know, what I keep saying is that one of the great things about a practical exam is that you can tell people exactly what's expected of them and exactly what they're going to be tested on. So you can be completely transparent and let them know, listen, you're going to have to take an ear impression. You're going to be graded on infection control. You're going to be graded on getting it past the second bend. You know, how adept you are at removing it without causing discomfort to the patient, etc. You can tell them all of that and it doesn't actually give away anything because they still have to be able to do all those things properly. So, you know, that's one of the things that we've done to improve the experience for this new exam is, again, increasing transparency, helping people understand what's on the exam. I think that's helping candidates be more prepared. And again, we know people are finding more qualified applicants. You know, people are doing better overall. You know, there's been a huge focus on the industry side, on training, on preparation, on recruitment. And so that's really all paying off and seeing these kind of downstream effects when it comes to the exams. As I switch to the next slide here, you're going to see a poll come up on your screen if you wouldn't mind taking just a quick moment to answer that for me. What we're asking is, what special topics do your laws or rules require around continuing education for hearing aid specialists? And the reason that I'm asking this is because at IHS, we're really focused on what content we are putting out. And so I want to identify any gaps in the content that we're putting out. So we appreciate that you trust IHS to approve continuing education for your licensees. And we did approve, we've approved so far over 780 courses this year that your licensees are able to take advantage of from a variety of course providers, whether it be manufacturers, whether it be IHS ourselves, affiliate chapters, other third party entities who are putting out education to help hearing aid specialists improve their clinical practice, improve their practice management. And I just want to have a nice snapshot of what special topics your laws and rules require, because that allows me to look at it and say, okay, are there any gaps in the education that's being approved that perhaps IHS could fill those gaps? So thank you for completing that. I'm going to ask Ava now to close the poll, and then we'll be able to see the results here on the screen as she does that. Thank you. So we can see that ethics, infection control, preventing medical errors. And I'll check the chat box for a couple of you that checked the other box. Thank you for participating in that. And so with that, I'm going to open the floor for any questions that you may have for me. Again, I'm happy to take questions about anything I've discussed here, or if you have other questions related to education and exams from IHS's perspective. If you do have a question, you can raise your hand, and then we'll be able to unmute you. I see a question from Michael Andreozzi. Hey, Sierra. How you doing, my dear? Hi. I have a question for you. It's also a question and a comment based on the practical exam. I know in Rhode Island this past year, we went to the IHS practical exam so that we're utilizing that as an exam to replace one that we had in place for a long time, which was clearly outdated. One of the things that we ran into in Rhode Island was that some of the practical exam things like real-ear measurement that was not required in our regular or our previous one, and we didn't feel like it was necessary on the practical exam. And we were able to kind of skew that, for lack of a better word. And I just wanted to make other people aware of the fact that if they do have it replaced in their practical exam, the flexibility that IHS has on some of those things that can come up like the example I just used. And I thought you could comment on that. I can. Yeah. Thank you for bringing that forward, Michael. I appreciate it. Yeah. So we are able to be flexible and have individual conversations. So the practical exam has six sections, and they cover matters ranging from real-ear audiometric evaluation, ear impressions, et cetera. So if your state is looking to adopt a new, a modern practical exam, but you potentially have concerns about the content that's covered, I am more than happy to have those conversations, whether it's with the staff, the licensing board, or both, about how we could tailor the exam to fit your jurisdiction. As Michael stated, in Rhode Island, they chose to leave out the real-ear measure section, and instead they replaced it with some state-specific content so that the points on the exam were still lining up and things of that nature, you know, to make the math still hold up. So yes, I'm more than happy to have those conversations if that's applicable to your state. Any other comments or questions on exams or education before we turn it back over to Christine? All right. Well, thank you guys for listening and, again, for being here. You can see that email address there on the screen, education at ihsinfo.org. You can use that to get in touch with me and my team at any time. We are here to help. Have a good day. Great. Thank you, Sierra. During our next session, we'll discuss as a group a few important policy issues to the professions. When you have a question or a comment, we'll ask that you raise your Zoom hand, and we'll keep an eye out and ask you to unmute yourself and to allow you to ask your question. So the first topic today is the employment gap. Some potential questions, like how is your state or province addressing it as it relates to hearing aid specialists and audiologists while maintaining high standards that do not create a barrier to the professions? Some example questions. Are you implementing or expanding temporary or provisional licensing or adopting apprenticeship policies? How are you handling apprenticeship extensions? Conversely, can you share any implementation strategies to retain hearing aid specialists and audiologists in your state? Please share your successes or any setbacks that you dealt with in addressing the employment gap. Now I'd like to open the floor for questions or comments. So let me grab Stace Hodbier. I see you've got your hand up. Yeah, OK. You know, our board in Wisconsin covers both hearing aids and specialists and audiologists. So the audiology compact, I think I'm terming that correctly. That's been working its way through the board approval. And I'm a new member of the board. I've only been on it since April. I think I've attended two meetings. We only meet four times a year. So that's working its way through, as I know many states have already approved it. But for hearing aids and specialists, there's really nothing. I don't see a way that the state or the board would have a role in that, other than just making it easy for candidates to take the test and to get signed up. That is one of the challenges we've had, is communication between the state and the candidates. That's something I'm hoping I can help to improve as a member of the board. Yeah, those are some great comments. And I'm wondering if any conversations are being had with the board and your general assembly or legislative body. I know, obviously, you can't implement legislation. But have they expressed any interest in making any changes to allowing out-of-state hearing aid specialists or audiologists to move to your state and not have to go through the entire process all over again, and so forth? Well, we use the ILE, as most states do. And that certainly makes it easier if they're looking for reciprocity. Because if they've passed the ILE, they get credit for that. But that's really about the extent of my knowledge on it. OK. Let me see if maybe, Stacey, if you had anything to add that's going on in your state, if you guys are looking into any apprenticeship programs or expanding it. I believe we have a very successful apprentice program in place. I can tell you our numbers aren't outrageous. They've always been relatively slow. But it is neat to see people succeed through the program. The only thing we have going is some pretty substantial legislative proposed changes that we'll go through. We have a bill that will be presented this legislative session, which is in effect now and will go through the beginning of June. So we're pretty stable at this point. But again, no major changes. OK. Thank you. And how about, I believe, Felicia, you're from Mississippi. Yolanda, it's mentioned, I mean listed as Yolanda. Is there anything you'd like to add on how your state is addressing the employment gap? And also, feel free to mention any ways that you're looking to retain. And I know that a lot of some retention issues are via legislation. But I'm wondering also if staff or board members are having conversations with their elected officials, you know, kind of providing guidance. Yeah. So I know that we do, you know, we do license the hearing aid dealers. We do use the written exam and the practical and things like that. We actually don't have a lot of individuals that are residents of Mississippi that do apply for our license. They actually do come from out of state. And I assume, I don't know if they wind up staying in state or if they transfer, because as soon as we get, you know, someone that passes. And I just really hate it because we've had our proctor, you know, state that, you know, it's kind of hard to find good employees in Mississippi. And I don't know if that's a Mississippi thing or, you know, whatever the case may be. But a lot of them do wind up saying they're no longer working in Mississippi or they're no longer working. We have the employment in, you know, that they were licensed or doing their temporary supervision ad and things like that. So I don't know as far as what we can do in order to, you know, retain the individuals in Mississippi. I mean, we do have all of our older, you know, ones that have been here for years and years, but it's like the newer ones. They come, take the exam. And I don't know, maybe if it's easier, which it shouldn't be because we do use, like I said, all of the IHS materials, you know, as far as getting licensing in Mississippi. But that's our issue. Well, thank you. Does anybody else have anything you'd like to add about the employment gap, how your, you know, your board is looking into maybe changing some regs about it or having conversations with elected officials, being a little proactive? If not, we can move on to the next topic, which is related to the employment gap, but specifically the reciprocity. Reciprocity agreements are between states or provinces can help hearing aid specialists and audiologists looking to relocate to your state or province, and more importantly, increase access to hearing health care. For example, some questions and comments you might want to make on is please share your successful stories on reciprocity agreements and their impact on workforce mobility and access to care or alternative policies to the agreements that have been effective, increasing access to hearing health care, and how does your state overcome any challenges in implementing reciprocity agreements or policies? And now I'd just like to open the floor for any questions or comments about it. Hey, Claire. I actually have some information from the prior topic, if that's OK to share. Oh, absolutely. Thank you. Yeah. So is this entity or any of the state boards familiar with the Health Care Regulatory Research Institute and their Cross Professions Minimum Dataset Toolkit for gathering state health workforce data? If not, I'm not. It is sponsored by several different entities and like NBCOT and FSBPT and NCBSN, if you're familiar with any of those. But it gives you kind of a roadmap for states to gather data to help you plan for workforce. So anyways, I just thought I would highlight that for everyone. Yeah, that's that's excellent. Thank you so much. Claire, if I could just, if I could just unmute her one more time, I'm sorry. Claire, can you repeat the name of that study or of that resource? I'm sorry. Yeah, absolutely. So what I'm going to do is I'm going to put a link in the chat. Oh, perfect. And it's HRRI's Cross Professional Minimum Dataset Toolkit. So feel free to look at it. It may not be for everyone. Certainly, Nebraska has not been able to implement it yet, but it's very interesting to consider and to look at the questions that are being asked and what is being proposed. Excellent. Thank you so much for sharing that. We really appreciate it. And then our next hand up is Michael Andreozzi. Yes. And I was talking about reciprocity specifically. I know in the state of Rhode Island, we've had candidates who are licensed in other states that wanted to become licensed in the state of Rhode Island who had experience, who had passed state license exams, obviously, in different states. It's happened on a couple of occasions. We've always granted reciprocity based on the fact that if they had taken the ILE exam, that we felt that the standard was exactly the same in our state, obviously, for them to be licensed. The only thing that we required them to do is to become familiar with the local state laws that related to issues that are more statewide. We gave them information on those types of things, and we'd sat with that candidate and make sure that they had a test based on the state piece of it. And once they got past that, they were allowed to practice in our state as a licensed person. We just felt like the impact they would have and the challenges we're having right now with the resources of not having enough licensed people across the country that we should not prevent it from happening. So that was our guidance on that. So that's how we handle it in Rhode Island. Great. Thank you so much for sharing that. Let me ask another board member to get your thoughts on your state's abilities and interest in allowing other individuals who are licensed in one state to then practice in your state, either through a reciprocity or an official reciprocity agreement with another state or something similar to the interstate compact that the audiologists and speech language pathologists have. I'm going to put Klohem on the spot. In North Carolina, I'm wondering if that is... Hi, Christine. Yes, we do have reciprocity. I remember we were doing legislation, it may have been even a decade ago, and it's something along the lines. I'd have to go back and look at the statute specifically, but someone who is in good standing, has three years of experience in another state, it seems to me that they have to come in and pass our rules and regs. But other than that, I think it's pretty simple for them to come in and practice in North Carolina. Don't hold me 100 percent of that, but it's something along those lines. Thank you. Okay, let's start our next topic, which is mixed boards. Now, this topic is for attendees with mixed boards, but it's also, if not, if you're not from a mixed board, generally speaking, what strategies are in place to manage and avoid any conflicts of interest? Like what policies or procedures are in place that ensure transparency and fairness? How does your state ensure ethical practices by both board members and those that they oversee? And more states I've seen, some states are now transitioning from either eliminating the board's responsibility and not passing, but transferring that to either another overarching board. I think I've seen that in Nevada. There's a bill that's out there. And then I've seen in some other states like Iowa that have moved the responsibilities to a department. Just kind of want to get your thoughts on some of those ideas. And I'm happy now to open the floor for, again, questions or comments about strategies that are in place to manage and avoid conflicts of interest. Well, Ham, I see your hand raised. Are you specifically asking where we have, you know, audiologists, combined boards of audiology and hearing aid specialists, or you want to just know in general, like, thoughts on the subject? It depends. Like if you are from a board that is joint, then let me hear about your thoughts on that. But if you're not from a board that is joint or mixed, then just generally speaking, what are your thoughts? Well, interestingly, North Carolina, we were joint. And then we, in some ways, we still are joint because in 2011, we exempted the AUDs and kind of came up with this unique approach where we are separate yet equal in North Carolina. So if you have an AUD in North Carolina, we deem you minimally competent. We didn't create any hierarchy. It's separate yet equal. There was even a treaty that was signed by the Hearing Aid Professional Association and the AAA at the time. But we still have master's degree audiologists under our board. And we really had no issues whatsoever. I mean, I think prior to that there was some challenges, and that's one of the reasons we kind of came up, and I think it primarily had to do with the fact that once the AUD became an option for audiologists, they felt that they had enough clinical training to be minimally competent and wanted to just operate under their own licensure law, and we thought that was a fair and reasonable compromise. And so that's the position we took in North Carolina, separate yet equal as it relates to the scope of fitting hearing aids, and it's worked pretty well. So if there are people out there maybe who have contentious boards for whatever reason potentially, and there's the opportunity to separate and do it in a way where you kind of follow that model, that would be great, and if you're working well together and you're great colleagues and it's happy and harmonious, then stay the course would be my thought. Great. Thank you for your feedback. I hate to pick on you, Stacey, but Stacey, if I remember correctly, you're a joint board where you have audiologists and hearing aid dispensers on the same board, and you guys have done a great job of, you know, keeping the peace, so to speak, but just if you don't mind sharing some of your expertise on that. Yeah, so our boards, the hearing aid board was a separate entity up until 2015, and we merged the hearing aid specialists with our speech and audiology board. It's run very smoothly. I mean, I can't really say anything negative about it. I think it just, it was a great transition, and I feel like the professions work very well together. As far as mixed boards, we are independent licensing boards in Nevada, but as you mentioned, there is a bill that has been put forth in the Nevada legislation that will create basically an umbrella type licensing board situation under business and industry, and they are proposing to put in our category, it would be called the vision speech and mobility professions, and it would constitute our board with dispensing opticians, optometry, and podiatry, so we are anxiously awaiting to see what happens with this bill. Yes, yes, we noticed that the other day, and we'll just monitor it, not to put up any red flags or scare tactics or anything like that. We always monitor bills, obviously, that would either eliminate a board or transfer powers. We just want to make sure that the powers are totally transferred to ensure that there's no hiccups in the licensing process, and then I'm just curious about, like, is there an onboarding process that you engage in or provide with your new members to just ensure that, you know, meetings are, open meetings are met under the statute requirements and so forth? I mean, right now, as an independent licensing board, we certainly are compliant with the Nevada open meeting law. We have set statutory guidelines that we have to follow. You know, it's just, it varies state by state as to how the boards are structured, and we're learning that as we go, that we're, we are one of the few states that has independent licensing boards. So, we're just, yeah, we're, we're a little uneasy, but we're just, you know, we're trying to see what this will mean and how it will unfold. And feel free to reach out to IHS with any questions, concerns, or anything. We're always here to help you out, and thank you for all the work you've done, and we'll mention one of your proposals later on. Okay, wonderful, thank you. You're welcome. And we have another hand, Todd Byer. Yeah, so, Wisconsin, we have a mixed board, and the wisdom of the, of the people that put it together, we have audiologists, hearing and speech specialists, and speech language pathologists all covered under our board. And the wisdom I was talking about, there's two, the board consists of two speech pathologists, two audiologists, three hearing instrument specialists, and two public members, one that must be a hearing aid wearer. And they intentionally gave hearing instrument specialists three seats to help level the board a little bit, if you will, for fear of that the audiologists and the speech pathologists could gang up against the hearing instrument specialists. In general, things have gone really, really well over the years. We did have a little bit of a dust-up last year when we were able to add Saruman management to the hearing instrument specialists scope of practice. From what I was told, there was some other members on the board, oh, and I forgot the otolaryngology members. So there is also a, a surgeon that has a seat on the board as well. And there were some people that weren't too happy about the expansion of the scope for hearing instrument specialists. But that was before I was on the board. So now we're, we're in the process of developing the rules to allow the hearing instrument specialists to do the Saruman management. And the two meetings that I've attended so far, things are very, have been very cordial and everybody's working together to, to achieve the goal. Fantastic. And as you're working on, on developing curriculum and what have you for your Saruman management or Saruman removal, feel free to reach out to us. We're more than happy to connect you with other states that have authorized it like North Carolina and Tennessee previously. Yep. Okay. Thanks. You're welcome. Claire, I saw that you had your hand up, but you took it down. I just want to make sure that that's still the case before we move on to the next topic. I was just going to mention that Nebraska had introduced last legislative session that proposed to eliminate the board of hearing instrument specialists and move the regulation of hearing instrument specialist licensure under the board of audiology, speech, language, pathology, excuse me, speech, language, pathology. The concern was lack of representation of hearing instrument specialists on the audiology speech, language, pathology licensure board. Ultimately the bill did not go anywhere, but we do anticipate seeing similar legislation being introduced either this session or in future sessions. Okay. Good to know. And likewise with everybody on this call, if there's anything that you need help with us on your legislative proposals or bills that have been proposed by other entities, we're here to help out in any way that we can. Okay. Well, thank you all for the discussions on hearing healthcare topics. For our next session, I'll provide an update on U.S. state trends and Peter will discuss how the 2024 U.S. federal election could potentially impact your state. Following the release of the October 2022 FDA's OTC prescription hearing aid rule, IHS is working diligently alongside IHS members, stakeholders, representatives, and board staff like some of you on this meeting today to codify these changes through legislative proposals of regulatory guidance. As you see in the map on the screen, this includes efforts in 15 states that have passed legislation and five that have issued regulatory guidance to secure the key phrase, order the use of language. Currently we are in discussions with New Jersey and Michigan to authorize both hearing aid dispensers and audiologists again to order the use of prescription hearing aids. It's important that all 50 states authorize them to order the use of prescription hearing aids since licensure of prescription medical devices, now reclassified as prescription hearing aids, falls under state jurisdiction. The lack of the phrase order the use of in statute governing licensing hearing aid providers could create ambiguity compared to existing terms like selecting and sale. Parity is needed for both hearing aid specialists and audiologists to order the use of prescription hearing aids and we are very happy to assist you with this technical change. State trends. Recent trends for hearing aid specialists show an effort to clarify their scope of practice and ensure access to care. States, as we mentioned or you heard of previously today, include Nebraska's Department of Health and Human Services. They've expressed support for cerumen removal and tinnitus care. They sent a letter to the UNICAMERL mentioning this. The Nevada Speech Language Pathology and Audiology and Hearing Aid Dispensing Board also voted last, well this year, to clarify cerumen removal and tinnitus care and they hope to introduce legislation next year to do so with other changes as well. Additionally, the oversight boards in New Mexico and West Virginia withdrew proposals that would have prohibited hearing aid specialists from providing tinnitus and cerumen management care services and in New Mexico they also were prohibiting servicing children but again those were withdrawn. This follows actions late last year and earlier this year in Wisconsin and South Dakota where both cerumen removal was clarified to be within a hearing aid specialist scope of practice. As you see these trends highlight the ongoing efforts to balance regulatory oversight with the needs to provide patients with safe, comprehensive, streamlined hearing health care. Some other issues that we do monitor too are taxation bills, insurance, worker compensation, and vocational. We just want to ensure that hearing aid specialists are in there as well. And now Peter Mihalik will provide you with how the 2024 U.S. federal elections may impact your state. Good afternoon everybody. Thank you for joining us this afternoon. I'm just here to provide a brief update on the federal elections from November. Obviously the last state, well last race was called just a few days ago leaving Republicans in control of the U.S. House of Representatives 220 to 215. The Republicans won control of the Senate. It's now 53 to 47 and obviously President Trump is returning to the White House starting on January 20th. What does that mean for you particularly and what does that mean for some of the other initiatives at IHS? There's been talk of VA reform which I know has been a big topic since I joined here at IHS in August as far as including hearing aid specialists in the VA system. Some of the other things that have popped up though that are probably more in line with what you're looking for are things affecting like FDA rules governing OTC hearing aids or other potential avenues involving Medicare or Medicaid expansion. Those things are probably unlikely to happen. I know there's been a lot of talk here in D.C. about making America healthy again is the acronym but nothing pertaining to hearing aid specialists exactly has been sort of discussed as of yet. I am working with IHS's contract lobbying team to ensure that we're part of those conversations if they do occur but nothing sort of really solid has occurred where the point where it might be affecting anything involving some of the things trickling down to the state level that Christine was talking about in the slides before. So we'll keep an eye out for things here at the federal level but as far as impact to you specifically it's probably very limited but if that does change you'll be the first to know. So thank you and Christine back to you. Great thank you Peter. We're happy to answer any questions that you have on federal or state legislative issues and again feel free to raise your hand via Zoom. Well again any of the states that haven't already codified their FDA OTC language we're more than happy to help out and any other proposals that you're thinking of doing and any proactive pieces of legislation we're here as a resource and are more than happy to help you and seeing no questions for the government affairs team we will move on to the open forum. When you have a question or comment we ask that you raise your Zoom hand and we'll keep an eye out and call on you to unmute yourself and to ask questions. Here are some examples of what we could discuss during the open forum like what's happening in your state or province that you'd like to share with your colleagues? What questions do you have others in your role? Are you noticing any regulatory trends or issues? Are there any best practices that you'd like to share among each other? And what policies or legislation are you working on with your legislative body to make hearing aids and hearing health care more accessible to underserved populations? And if you thought of any additional questions for Ciara, Peter, or me you could ask those now. This open forum is a great opportunity to share experiences and learn from each other and we look forward to this discussion and now I'd like to open the floor for questions or comments and anything that you would like to discuss amongst yourselves. Stacey, oh sorry, Blam, you have your hand up. Yeah, I do. I was just curious, in North Carolina we have, as we have an apprentice who's trying to get licensed, we have what's called personal supervision and then direct supervision and personal supervision is when that you literally, as the sponsor, must be in the room with the apprentice whenever they're with a patient and they're with a patient and then once they pass rules and regs, the practicum, and the simulator, then they can be, go under what's called direct supervision, which means, you know, the sponsor has to be in the building but doesn't have to be in the room. And generally you have one sponsor and I'm wondering if there are any states out there listening that have the ability to have a second or a secondary sponsor. For example, the sponsor goes to Europe for a month and then the apprentice, you know, has no way of operating if the sponsor is not in place. But if there's another licensed person in the practice, you know, and this is just something I'm thinking about proposing in North Carolina, but I'm just wondering if there's a precedence for that. Stacey, I see you're been unmuted. Yeah, I was just gonna share with you that we allow, so we have a two-year apprentice program. They can take up to three years to complete it if need be. After one year, the sponsor can request from the board that their apprentice is now authorized to work without direct supervision. So, again, they have to document it with the board and then that apprentice can work without direct supervision after the first year. And then we also allow apprentices to have up to two sponsors in the event that somebody is not on site, then they can certainly work with it with somebody else. Perfect. And how does that, can you, how does that work? Do they just list two immediately? Is there one that's primary and secondary? Or is it just they have the ability to list two sponsors? I mean, how do you... They have the ability to list two. And in our database, we have a sponsor field where we track the sponsor with their apprentice. And Stacey, you're with what state? Nevada. Okay, very good. Thank you very much. That's very helpful. You're welcome. Yeah, thank you both, Will and Stacey. Todd Beyer, I see you have your hand up. Yes, I'm aware of a case where the sponsor was out on sick leave and the state was contacted and they were able to temporarily approve a second sponsor. And also something fairly new is one sponsor can have up to three candidates now in Wisconsin. Direct supervision is still required. So they can't, you know, all three of the candidates can't be seeing clients at the same time, but they can have up to three candidates underneath one sponsor as well, which has allowed for some more flexibility and allowed people to train up more specialists at once. So for example, you know, they might have a certain day each week where that candidate is seeing clients and the rest of the days are study days or doing other, completing other objectives as well toward licensure. Yeah, I've seen that something similar in the state of California. It's more of a, you'll have to ask for permission to have additionals. They might be making some changes in that regards, but thank you so much for your feedback, Todd. And then I'm just going to ask Felicia, if there's anything that you wanted to ask your colleagues or anything that you wanted to bring to their attention that's going on in your state. Okay, and how about Michelle Michaels, is there anything that you would like to share amongst the group in this open forum session that's going on in your state or any questions that you have for colleagues? Hi, I have nothing to offer at this time. Thank you so much. All right, thank you. And I see that Tammy, Tammy has just joined us. Tammy, why don't you go ahead and introduce yourself and we're in the open forum session. If there's anything that you'd like to ask your colleagues or have any questions or concerns, here's a perfect opportunity to address them. Okay, I'm trying to get all logged in here. Yeah, take your time. Technology, right? Yeah. Okay, I think the only thing that I was wanting to address was actually the International Hearing Society practical exam. Okay. I'm having requests about how often the exam is offered. In our state, I'm in Illinois, and it seems to me that a lot of people are offering the test, you know, putting in dates and offering it almost unlimited for that date. And I don't know if that's possible or how anybody would be doing that with the IHS practical. That's a great question through Sierra. Feel free to... Yeah, I'm... Hi, Tammy. I'm here. I hear the question. This varies so much from state to state, so I would love to hear from some of our other folks on the line, whether it's the IHS practical or a practical that your state is running. Maybe how long does the exam take? How many times a year are you offering it? Are you offering it to how many candidates are taking it at each exam date? I think gets at some of the logistical questions that Tammy is considering here. So if anybody would like to unmute, I think this could be a really helpful discussion for Tammy. I think... I don't know for sure how the controls look on your side to our attendees, but if you're not able to unmute yourself, you could raise your hand, and then we can unmute you, I believe. Todd, thank you. Yeah. Hi, Tammy. I'm your neighbor to the north from Wisconsin, and our practical exams are offered only four times a year. Typically, we have between 10 and 15 individuals at each exam date, and if... I think, yeah, I think that answers your question. I'm not sure. Yeah. When you have 10 to 15 people, Todd, are they... Do you have 10 to 15 proctors, and everybody's testing at the same time, or do you have people signed up in time slots, or how does that work? No. What they do, they just get everybody in a room, and they... Usually, we have about six, maybe seven or eight proctors, always trying to use two for each candidate, and then they just... They bring them into the room one at a time, so they're there for a while. Everybody hasn't done it once. In Wisconsin, the ear mold portion, right now, is a 30-minute exam, and that includes taking an ear impression, and then also recommending an appropriate hearing aid, so we lay out about six audiograms face down on the table. They pick one randomly, and it's just an audiogram, no case history, and they need to recommend an appropriate hearing aid fitting. As far as canal length, vent, matrix, it's a little outdated. We just... The board just started a committee to develop a new practical exam. We're going to look at the IHS exam. Then, the other practical exam is the audiometric, where the state provides an individual with a hearing loss, and the candidate comes in, sets up their audiometer, all the equipment that they need. They're allowed 50 minutes to do a complete exam, including case history, pure tone, air, and bone speech, and then recommend or then identify type and degree of hearing loss. Okay. I understand that, and I think that that's what I'm up against, is that we are giving the IHS exam, which can't be given that way. Can you say more about the challenges that you're encountering, Tammy? Are you finding that you're running out of time? Is it that... I think what I hear Todd saying is they're in maybe one big room, and there's three stations, so there's... Depending on how many proctors you have, maybe there's three people testing at a time. Do you feel like that's untenable based on either the exam or the space? Can you tell us more about the challenges that you're facing? Well, the thing that... I like the IHS practical exam, the new exam. I think it's modern, it's updated, not like the one we were using prior, but we have two proctors. Illinois does a kind of a first-come, first-served with exams. For example, last month I did five exam dates because I had applicants who wanted to take the exam. I don't... I'm supposed to do it four times a quarter. I do it probably 17 times a quarter because I'm doing it based on desire. You know, if I have somebody who's applying for the exam, then I try and get them set in an exam to try and keep them, you know, moving forward to get their license. But I am getting a little bit of feedback from some of the companies in Illinois saying, we don't give it often enough or we don't post it anywhere, but for me, posting it would just mean that, you know, I would run out of space. I started asking, and I think what, you know, what was covered for Wisconsin is that they're not giving the ILE, I mean the IHS practical, sorry. It takes two and a half hours or we give them two and a half hours to do that exam. And to have them all in one big room, I feel like they would... it would be distracting. I've already had examinees who wanted to be in a more quiet environment for the test, so I can't imagine having them in a big room where there's lots of motion and things going on. And just the way the exam is, you're signing an affidavit that you're not divulging any information and, you know, I would almost want them all in different rooms. We don't have the facility to put them in a different room for each section, all six sections of the exam. Sure. We do two proctors with our examinees. We feel that's best. So we're doing two exams a day, one in the morning, one in the afternoon, to accommodate that two and a half hour period with still giving the proctors lunch breaks. So, so yeah, I guess the challenge is that we can't do it on a, in a big room and accommodate a lot of people in one day. Yeah, and we don't do it in a big room. Each, each individual, whether it's audiometric or the ear mold portion, they're all, we have a series of small little offices. Yeah. Okay. So each, each exam is done in a, in a room with just the candidate, the subject and the two examiners. But what's the total? You said 50 minutes for the audiological portion of the exam and 15 for the ear mold. So 30 minutes for the ear mold. 30 minutes for the ear mold. Sorry. Yeah. Yeah, yeah. I was just about to call on you, Kyle. So, so I, so in North Carolina, this is something you might consider that I think works really well for the practicum. It's 30 minutes. So we have a two-day process, right? They go up, they do the simulator and rules and regs. And I guess they would do the, the ILE if that was part of it. You know, we have A, B and A, B, C and D. So some people are just doing A, B and C, but the practicum is, say it's a Friday, Saturday, when you bring a model, they do it by appointment. So they have every 30 minutes, right? Where you, you know, someone's going back with their model. So, you know, I'm, I'm driving to Raleigh from, from Wilmington, North Carolina. It's two and a half hours. You know, I have a 1030 appointment as the model, you know, and they start at say, whatever, eight o'clock and go through the day. That, that might be a way to make it more manageable. I mean, in some ways more time, but it's not as chaotic. Just something to consider. Thank you, Klau. I'd like to call on Stacey, if you wouldn't mind, because I was, as Tammy was describing that she offers the exam on demand, and of course made me think, Stacey, of what you all do in Nevada and how you're also offering on demand, but in a little bit of a different way. Would you mind sharing how you handle it in Nevada? Yeah, we actually schedule the exams on an individual basis. So as soon as we have a candidate ready, I reach out to, we have four proctors, two in the Vegas area and two here in Northern Nevada. And I just try and match the availability of the candidate with one of our proctors. So we usually have them booked within a week or two of their request. It's a one-on-one exam. The proctors are gracious enough to hold off some of their time during the week to do the practical. And again, it's just, it's worked very successfully. And I feel like we're moving candidates through the process very quickly. And this is great. You know, thank you, Stacey, for sharing that. Tammy, I chuckled a little bit to myself when you said that, you know, companies are telling you that you're not offering enough because there are some states where they only do one practical exam date a year. So to think that you're doing multiple a month and still getting complaints that you're not doing enough is, those people don't know how good they have it, really, to be in Illinois where you're offering it that frequently. But I hope that hearing some of these different ways that, you know, in North Carolina, Wisconsin, Nevada, that they're handling it, and Nevada is using the IHS practical exam, that that can, you know, help you as you try to navigate these. I'm also happy, personally, to continue having the conversation with you about, you know, brainstorming the ways that we could handle that to help you move your candidates through the process more efficiently, which is always the goal. But it also sounds like you're doing a really great job moving people through quickly if you're doing 17 exam dates a quarter, two people a day. So you're moving 34 people through a quarter. That's more than a lot of states move through in a whole year. So thank you for bringing the topic forth. I'm going to turn my video off now and turn it back to Christine until I am called upon again. Thank you, everybody. I could also, just out of curiosity, I've seen some states also are going through the regulatory process. You know, some states like Texas require their regulations to be updated every four years. Is that something your states are looking into doing the same, or is it just a case-by- case, or when statute is enacted, that sets the clock, so to speak, of updating your regulations? I'm curious what's going on in your states in regards to regulations. I think, Clow, Ham, I think you had discussed earlier in this presentation that your board might be looking just into the regs. Yeah, I think we're doing a rules review right now, just going through the process to make sure everything is still relevant. And so we're just working that process. Thanks. Okay. Any other questions or topics you all would like to talk, and any questions that you'd like to ask each other? What legislation you're working with your legislative body on that you want to get accomplished? You know, how can IHS help you, just generally speaking? We're here, more than happy to answer any questions today, and you've got our contact information. And if there's no other questions or comments in the open forum section, we'll give you back your time. And thank you so much for joining us today. We hope this was a valuable experience. Again, we really enjoy hearing from you and encourage you to use IHS as a resource in the work that you're doing. You can contact our teams at the emails listed on the screen at any time, and we're more than happy to help you with whatever we can do, and whatever your issues and needs are. We also ask that you please complete the session evaluation. You can do that by clicking on the link that Ava's posted in the chat, or you can put your smartphone camera at the QR code on the screen, which will invite you to open a link to the survey. This is very important for us to let you know what was helpful for you, and how we can best assist you in going forward, and how we can continue to improve this conference. We're going to go ahead and keep this on the screen for a little bit, and then close the conference. And happy holidays to everyone, and thank you so much for taking the time out of your busy schedule to be with us today.

Licensing Board Conference

hearing aid dispensing

state licensure

professional challenges

Zoom accessibility

scope of practice

International Licensing Examination

psychometric analysis

reciprocity agreements

professional development

apprenticeship programs