Existing law, the Speech-Language Pathologists and Audiologists and Hearing Aid Dispensers Licensure Act, regulates the licensure of hearing aid dispensers and dispensing audiologists by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board. The act makes it unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she first, among other duties, provides the purchaser with specified information. Existing law requires a licensed dispensing audiologist to, upon the consummation of a sale of a hearing aid, deliver to the purchaser a written receipt, containing specified information. Existing law makes the violation of these provisions a misdemeanor.

This bill would make it unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless first informing the purchaser of an audio switch, which may be referred to as a telecoil, t-coil, or t-switch, that increases access to a telephone and provides noninvasive access to assistive listening systems that are compliant with the Americans with Disabilities Act of 1990. would, on and after July 1, 2017, require a licensed hearing aid dispenser to, upon the sale of a hearing aid, provide the purchaser with a copy of a consumer hearing aid disclosure that this bill would require the board to develop and make available on its Internet Web site before July 1, 2017. The bill would require a licensed dispensing audiologist to do the same. By creating new requirements, the violation of which would be a crime, this bill would impose a state mandated state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Speech-Language Pathologists and Audiologists and Hearing Aid Dispensers Licensure Act, regulates the licensure of hearing aid dispensers and dispensing audiologists by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board. The act makes it unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she first, among other duties, provides the purchaser with specified information. Existing law requires a licensed dispensing audiologist to, upon the consummation of a sale of a hearing aid, deliver to the purchaser a written receipt, containing specified information. Existing law makes the violation of these provisions a misdemeanor.

This bill would make it unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless first informing the purchaser of an audio switch, which may be referred to as a telecoil, t-coil, or t-switch, that increases access to a telephone and provides noninvasive access to assistive listening systems that are compliant with the Americans with Disabilities Act of 1990. The bill would require a licensed dispensing audiologist to do the same. By creating new requirements, the violation of which would be a crime, this bill would impose a state mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 1950 (Maienschein) - Hearing aids: audio switch

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 1950 would require licensed hearing aid dispensers and licensed dispensing audiologists to provide consumers with a disclosure developed by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board that includes information about a specific technology used in some hearing aids.

Fiscal Impact:

• One-time costs of about $100,000 and ongoing costs of $70,000 for the development of the consumer disclosure, adoption of regulations, and ongoing review of the necessary information in the disclosure by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board (Speech-Language Pathology and Audiology and Hearing Aid Dispensers Fund).
• Potential additional costs of $50,000 to $150,000 per year to respond to consumer complaints and take disciplinary action by the Board (Speech-Language Pathology and Audiology and Hearing Aid Dispensers Fund). There are about 230,000 purchases of hearing aids in the state each year. Of those purchases, a significant portion are for hearing aids that do not include the “telecoil” technology that would be the subject of the consumer disclosure under the bill. When a consumer is dispensed one type of hearing aid (under the professional judgment of the dispenser or audiologist) but also given information about a different type of hearing aid, some number of those consumers will be confused or feel that they have not been well served by the dispenser or audiologist. If even 1% of those consumers make a complaint to the Board, there will be substantial staff costs to process those complaints.
• Unknown impact on public health care programs such as Medi-Cal and CalPERS (various funds). The Medi-Cal program and most CalPERS health plans provide coverage for hearing aids. By providing information to consumers about a specific type of hearing aid technology, the bill may result in some consumers requesting a hearing aid with that technology, rather than a different hearing aid that would have been dispensed absent the consumer notification. To the extent that there is any consumer shift towards telecoil hearing aids under the bill, there could be cost implications for public programs that pay for hearing aids, if telecoil hearing aids are more expensive than the hearing aid a consumer would have been dispensed absent the disclosure.

Background:

Under current law hearing aid dispensers and audiologists are licensed and regulated by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board.

In general, hearing aids are devices that amplify ambient sound and are placed behind the ear, in the ear, or in the ear canal. In addition to amplifying ambient sound, there are technologies on the market to improve the function of hearing aids by working with outside systems. For example, “telecoil” (also referred to as “t-coil” or “t-switch”) technology connects a hearing aid to an outside system that records sound in a room and then broadcasts it to telecoil devises, to improve the hearing experience. For example, a movie theater may be equipped with a telecoil system that transmits the sounds from the movie directly to the hearing aids of those in the theater using the telecoil technology in the hearing aid. There are other technologies that use Bluetooth or FM radio signals to provide similar enhancements to the use of hearing aids.

Proposed Law:

AB 1950 would require licensed hearing aid dispensers and licensed dispensing audiologists to provide consumers with a disclosure developed by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board with information about a specific technology used in some hearing aids.

Specific provisions of the bill would:

• After July 1, 2017, require a licensed hearing aid dispenser or a licensed dispensing audiologist, upon the sale of a hearing aid, to provide the purchaser with a copy of a consumer hearing aid disclosure developed by the Board;
• Before July 1, 2017, require the Board to develop a consumer hearing aid disclosure that provides information for the benefit of consumers, including information on telecoil, t-coil, or t-switch.

Staff comments: The only costs that may be incurred by a local agency relate to crimes and infractions. Under the California Constitution, such costs are not reimbursable by the state.

-- END --

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2015 - 2016 Regular

Bill No: Hearing Date: June 27, 2016

Subject:

SUMMARY:

Requires the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board (SLPAHADB) to develop a consumer hearing aid disclosure that includes information on a telecoil, t-coil, or t-switch and, beginning July 1, 2017 and requires a licensed hearing aid dispenser and a licensed dispensing audiologist to provide a purchaser of a hearing aid with a copy of the disclosure at the time of purchase.

Existing law:

1. Establishes the SLPAHADB within the Department of Consumer Affairs and provides the SLPAHADB with licensing, regulatory and disciplinary functions for the professions of speech-language pathology, audiology, and hearing aid dispensing. (Business and Professions Code (BPC) § 2530 et seq.)
2. Defines the obligations of retail sellers of assistive devices and provides warranty/right of return provisions for consumers of assistive devices including exact language to be included in the notice to consumers. (Civil Code (CC) § 1793.02)
3. Provides definitions of assistive devices, hearing aids and hearing aid dispensers:
   
   1. Assistive Device is defined as: “Any instrument, apparatus, or contrivance, including any component or part thereof or accessory thereto, that it used or intended to be used, to assist an individual with a disability in the mitigation or treatment of an injury or disease or to assist or affect or replace the structure or any function of the body or an individual with a disability, except that this term does not include lenses and ophthalmic goods unless they are sold or dispensed to a blind person and unless they are intended to assist the limited vision of the person so disabled.” (CC 1791 § (o))
      
   2. A hearing aid is defined as any wearable instrument or device designed for or offered for the purpose of aiding or compensating for impaired human hearing. (BPC § 2538.10 (d))
      
   3. A hearing aid dispenser is a person engaged in the practice of fitting or selling hearing aids to an individual with impaired hearing. (BPC § 2538.14)
      
   4. A hearing aid dispenser who is the owner, manager, or franchisee at a location where hearing aids are fit or sold, shall be responsible for the adequacy of the fitting or selling of any hearing aid fit and sold by any licensee or licensees at that location. (BPC § 2538.39)
      
4. Provides that the practice of fitting or selling hearing aids includes those practices used for the purpose of selection and adaptation of hearing aids, including direct observation of the ear, testing of hearing in connection with the fitting and selling of hearing aids, taking of ear mold impressions, fitting or sale of hearing aids, and any necessary postfitting counseling. (BPC § 2538.11(a))
   
5. Provides that it is unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she first does all of the following: (BPC § 2538.49)
   
6. Complies with all provisions of state laws and regulations relating to the fitting or selling of hearing aids.
   
7. Conducts a direct observation of the purchaser’s ear canals.
   
8. Informs the purchaser of the address and office hours at which the licensee shall be available for fitting or postfitting adjustments and servicing of the hearing aid or aids sold.
   
9. Requires that a hearing aid dispenser shall, upon the consummation of a sale of a hearing aid, deliver to the purchaser a written receipt, signed by or on behalf of the dispenser, containing all of the following: (BPC § 2538.35)
   
   1. The date of consummation of the sale.
      
10. Specifications as to the make, serial number, and model number of the hearing aid or aids sold.
11. The address of the principal place of business of the dispenser, and the address and office hours at which the dispenser shall be available for fitting or postfitting adjustments and servicing of the hearing aid or aids sold.
    
12. A statement to the effect that the aid or aids delivered to the purchaser are used or reconditioned, as the case may be, if that is the fact.
    
13. The number of the dispenser’s license and the name and license number of any other hearing aid dispenser or temporary licensee who provided any recommendation or consultation regarding the purchase of the hearing aid.
14. The terms of any guarantee or written warranty, required by CC § 1793.02, made to the purchaser with respect to the hearing aid or hearing aids.
    
15. States that it is unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she first does all of the following: (BPC § 2538.49)
16. Complies with all provisions of state laws and regulations relating to the fitting or selling of a hearing aid;
17. Conducts a direct observation of the purchaser's ear canals; and,
18. Informs the purchaser of the address and office hours at which the licensee is available for fitting or post-fitting adjustments and servicing of the hearing aid or aids sold.
19. Requires a licensed audiologist to obtain a dispensing audiologist license in order to sell hearing aids, as specified. (BPC § 2539.1)
20. Permits a hearing aid to be sold by catalog or direct mail provided that:
    (BPC § 2539.2)
    1. The seller is a licensed audiologist and authorized to sell hearing aids;
    2. There is no fitting, selection, or adaptation of the instrument and no advice is given with respect to fitting, selection, or adaptation of the instrument, and no advice is given with respect to the taking of an ear impression for an earmold by the seller; and,
    3. The seller has received a statement which is signed by a physician and surgeon, audiologist, or a licensed hearing aid dispenser to verify proper referral protocols.
21. Requires a licensed audiologist, upon to consummation of a sale of a hearing aid, to deliver to the purchaser a written receipt signed by or on behalf of the licensed audiologist, containing specified information including, but not limited to, the date of the sale, specifications as to the make, serial number, and model number of the hearing aid or aids sold, and a statement to the effect that the aid or aids delivered to the purchaser are used or reconditioned, as the case may be, if that is the fact. (BPC § 2539.4)

This bill:

1. Requires the SLPAHADB, before July 1, 2017, to develop a consumer hearing aid disclosure that provides information for the benefit of hearing aid purchasers, including, but not limited to, information on a telecoil, t-coil, or t-switch and requires SLPAHADB to make the disclosure available on the SLPAHADB website. Authorizes SLPAHADB to solicit and receive public comments during the development of the disclosure and requires that the SLPAHADB update the disclosure as often as it deems necessary.
2. Requires, on and after July 1, 2017, a licensed hearing aid dispenser and a licensed dispensing audiologist, upon the sale of a hearing aid, to provide the purchaser with a copy of the consumer hearing aid disclosure made available by the board pursuant to Item #1), above.

FISCAL EFFECT: This bill is keyed “fiscal” by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated May 18, 2016, this bill will result in estimated costs to the SLPAHADB of approximately $100,000 in fiscal year 2016-17 and $70,000 in fiscal year 2017-18. The analysis notes that ongoing costs related to ensuring the disclosure is updated should be minor.

COMMENTS:

1. Purpose. The Sponsors of this bill are Roger that Consulting and The Hearing Well Club. According to the Author, “telecoils remain a little-known aspect of the hearing aid, but are of great value to the hearing impaired. They can be found in most hearing aids and cochlear implants and can help improve a person’s ability to hear in noisy environments. With the price of hearing aids reaching thousands of dollars, it is critical that we educate consumers on how best to use their hearing aids in the most efficient way.”
2. Background. According to the U.S. Department of Health and Human Services’ National Institute on Deafness and Other Communication Disorders, a hearing aid is an electronic device that makes some sounds louder. There are three different styles of hearing aids: behind-the-ear, in-the-ear, and canal aid. These hearing aids are composed of three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier, which then increases the power of the signals and sends them to the ear through a speaker.

Certain hearing aids also include a telecoil, which is a small copper wire located inside the hearing aid that expands functionality. The telecoil functions as a way to increase the clarity of sounds and connects the listener directly to the sounds source while eliminating most background noise. Telecoils pair with Hearing Assistive Technology (HAT), which is becoming increasingly available in public spaces. HAT typically comes in two forms: the hearing loop and an infrared system. The hearing loop is a wire that circles a room and transmits sound electro-magnetically, and then the electromagnetic signal is picked up by the telecoil in the hearing aid. To use a hearing loop, the user flips a t-switch on the hearing aid. The infrared system uses invisible light beams to carry sound from the source to a personal receiver- this receiver can be a neckloop or a behind the ear silhouette inductor - in which the telecoil then picks up sounds from the receiver via the attachment. According to the Hearing Loss Association of America, pairing telecoils with HAT creates a way to bridge the physical space between the listener and the sound source.

1. Arguments in Support. Supporters state that while hearing aids are a necessity for users, sometimes they are not enough, as problems such as background noise may occur. Supporters note that the use of a telecoil remedies loss of clarity due to background noise. According to supporters, telecoils can improve clarity on the telephone. Supporters believe that “when spending up to $4,000 per hearing aid, consumers should be informed about the universal and versatile features of telecoils.” According to supporters of this bill, Californians with hearing loss will be
   
   able to make an informed decision about what features they want and need in their hearing aids, including telecoil.
   
2. Arguments in Opposition. The California Academy of Audiology (CAA) is opposed to this bill, noting that the type of device that is the focus of this bill has many enthusiastic users but may not be the best type of device for all patients. According to CAA, today’s hearing aids can use audio switches for activating t-coils but there are also more modern items like streamers. CAA states t-coils create an additional cost and would thus increase the cost of hearing aids and notes that the bill does not acknowledge that physicians also dispense hearing aids. CAA proposes amending the bill to strike the current provisions and instead require the SLPAHADB could produce a consumer fact sheet on its website outlining current hearing aid options, including the types of devices available to consumers like those with t-coils or audio switches.

Hearing Healthcare Providers (HHP) writes “we have seen technology move away from traditional copper wire telecoils. The telecoil posited in this bill has been in use since the 1970’s and requires high amounts of energy to operate.” HHP believes that the creation of an additional document for HHP members, small business with small budgets, payrolls and office staff, requires them to print at their own cost is another cost to bear. HHP states that it would be willing to include a link to a document like that proposed in this bill on the written purchase order every patient receives or proposes the same fact sheet production and posting by SLPAHADB as CAA above.

SLPAHADB notes that the Federal Trade Commission requires that a patient-education insert be included with all new hearing aids at the time of sale. According to SLPAHADB, this insert fully describes the function of the hearing aid telecoil. SLPAHADB writes that this bill would create a duplication of information that is already mandated by the federal government and adds that emphasizing telecoil over other technologies to all hearing aid purchasers is not appropriate, as telecoils are just one of many hearing aid features available to consumers.

1. Should the Legislature Mandate Information About One Specific Technology? This bill intends to increase awareness about one technological component of hearing aids. Typically, consumer outreach and public information provided by a licensing board to licensees and the public is broad and comprehensive, offering information that can assist practitioners in their work while at the same time informing patients of issues impacting a particular practice. In the case of SLPAHADB, the hope would be that the board is providing information to its licensees, as well as hearing impaired patients, to ensure that licensees are performing services that utilize the most appropriate and available means of serving their patients. It is unclear how adding a consumer information sheet specific to one technology, telecoils, will assist in the delivery of services to hearing impaired patients. Additionally, the delivery of material that could be for a different type of technology than that received by the patient may lead consumers to question the judgment of a licensee and could have the unintended consequence of driving decisions about the most appropriate type of hearing aid away from the licensed audiologist.

SUPPORT AND OPPOSITION:

Support:

Hearing Loss Association of America

Hearing Loss Association of America California State Association

Hearing Loss Association of America Chapters throughout the state, including the

Central Coast Chapter, Diablo Valley Chapter, Long Beach/Lakewood Chapter, Mission Viejo Chapter, San Diego Chapter and Santa Barbara Chapter

Hearing Well Club

Roger That Consulting

Numerous individuals

Opposition:

California Academy of Audiology

Hearing Healthcare Providers California

Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board

-- END --

Date of Hearing: May 18, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1950

Author:(Maienschein) – As Amended Ver:April 25, 2016

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires licensed professionals dispensing hearing aids, upon the sale of a hearing aid, to provide the purchaser with a copy of a consumer hearing aid disclosure made available by the Speech Language Pathology Audiology and Hearing Aids Dispensers Board (Board).

It also requires the Board to develop the disclosure, which provides information for the benefit of hearing aid purchasers, including, but not limited to, information on a telecoil, t-coil, or t-switch.

FISCAL EFFECT:

Estimated costs to the Board are approximately $100,000 in fiscal year 2016-17 and $70,000 in fiscal year 2017-18. Ongoing costs related to ensuring the disclosure is updated should be minor (Speech-Language Pathology and Audiology and Hearing Aid Dispensers Fund).

COMMENTS:

1. Purpose. This bill aims to increase awareness about "telecoils" or "t-coils" which are used in assisted hearing devices. According to the author, telecoils remain a little-known aspect of the hearing aid, but are of great value to the hearing impaired. They can be found in most hearing aids and can help improve a person’s ability to hear in noisy environments.
2. Background. The Board is charged with the regulation of the practices of speech-language pathology, audiology, and hearing aid dispensing. Licensed audiologists and hearing aid dispensers are permitted to dispense hearing aids if they meet the appropriate requirements. A hearing aid is small electronic device that a person wears in or behind the ear. According to the American Academy of Audiology, a telecoil is a small copper coil that is an option on most hearing aids. They are also known as t-coils and were originally used to boost the magnetic signals from the telephone handset. The telecoil is activated by a t-switch on the hearing aid. All landline and some cell phones are designed to be used with a telecoil. Some other states have enacted similar legislation requiring consumer disclosure about telecoils.
3. Support. Hearing Well Club, a co-sponsor of this bill along with "Roger That Consulting," writes in support that the majority of their members have not learned about telecoils from their hearing health care providers.
4. Opposition. Providers of hearing care opposes this bill, citing lack of necessity as well as their expertise in hearing loss treatment and various types of amplification devices that will allow patients to be as communicatively functional as possible in their daily lives.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Rudy Salas, Chair

ABPCA Bill Id:AB 1950

Author:(Maienschein) – As Introduced Ver:February 12, 2016

SUBJECT: Hearing aids: audio switch.

SUMMARY: States that it is unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she informs the purchaser of an audio switch, which may be referred to as a telecoil, t-coil, or t-switch, that increases access to a telephone and provides noninvasive access to assistive listening systems that are compliant with the American with Disabilities Act and requires a licensed dispensing audiologist, prior to fitting or selling a hearing aid, to inform the purchaser of an audio switch, as specified.

EXISTING LAW:

1. Establishes the Speech Language Pathology Audiology and Hearing Aids Dispensers Board (SLPAHADB) within the Department of Consumer Affairs, to regulate the practice of audiology and hearing aid dispensing. (BPC Section 2530 et seq.)
2. Defines the "practice of fitting or selling hearing aids" to mean those practices used for the purpose of selection and adaptation of hearing aids, including direct observation of the ear, testing of hearing in connection with the fitting and selling of hearing aids, taking of ear molds impressions, fitting and selling of hearing aids, and any necessary post-fitting consulting, but does not include the act of concluding the transaction by a retail clerk. (Business and Professions Code (BPC) Section 2538.11(a))
3. Defines a "hearing aid dispenser" as a person engaged in the practice of fitting or selling hearing aids to an individual with impaired hearing. (BPC Section 2538.14)
4. Defines a "hearing aid" as any wearable instrument or device designed for, or offered for, the purpose of aiding or compensating for an impaired human hearing." (BPC Section 2538.10(d))
5. Requires a licensed hearing aid dispenser, upon the consummation of a sale of a hearing aid, to deliver to the purchaser a written receipt, signed by or on behalf of the licensee, containing specified information, including, but not limited to, the date of the sale, specifications as the make, serial number, and model number of the hearing aid or aids sold, the licensee's license number, and the name and license of any other hearing aid dispenser or temporary license who provided any recommendation or consultation regarding the purchase of the hearing aid. (BPC 2538.35)
6. States that it is unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid unless he or she first does all of the following: (BPC Section 2538.49)
   1. Complies with all provisions of state laws and regulations relating to the fitting or selling of a hearing aid;
   2. Conducts a direct observation of the purchaser's ear canals; and,
   3. Informs the purchaser of the address and office hours at which the licensee is available for fitting or post-fitting adjustments and servicing of the hearing aid or aids sold.
7. Requires a licensed audiologist to obtain a dispensing audiologist license in order to sell hearing aids, as specified. (BPC Section 2539.1)
8. Permits a hearing aid to be sold by catalog or direct mail provided that:
   1. The seller is a licensed audiologist and authorized to sell hearing aids;
   2. There is no fitting, selection, or adaptation of the instrument and no advice is given with respect to fitting, selection, or adaptation of the instrument, and no advice is given with respect to the taking of an ear impression for an earmold by the seller; and,
   3. The seller has received a statement which is signed by a physician and surgeon, audiologist, or a licensed hearing aid dispenser to verify proper referral protocols. (BPC Section 2539.2)
9. Requires a licensed audiologist, upon to consummation of a sale of a hearing aid, to deliver to the purchaser a written receipt signed by or on behalf of the licensed audiologist, containing specified information including, but not limited to, the date of the sale, specifications as to the make, serial number, and model number of the hearing aid or aids sold, and a statement to the effect that the aid or aids delivered to the purchaser are used or reconditioned, as the case may be, if that is the fact. (BPC Section 2539.4)

THIS BILL:

1. States that is unlawful for a licensed hearing aid dispenser to fit or sell a hearing aid without first informing the purchaser of an audio switch, which may be referred to as a telecoil, t-coil, or t-switch, that increases access to a telephone and provides noninvasive access to assistive listening systems that are compliant with the Disabilities Act of 1990, as specified.
2. Requires a licensed dispensing audiologist, prior to fitting or selling a hearing aid, to inform the purchaser of an audio switch, which may be referred to as a telecoil, t-coil, or t-switch, that increases access to a telephone and providers noninvasive access to assistive listing systems that are compliant with the Americans with Disabilities Act of 1990, as specified.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill aims to increase awareness about "telecoils" or "t-coils" which are used in assisted hearing devices. This bill is sponsored by The Hearing Well Club and Roger that Consulting. According to the author, "Telecoils remain a little-known aspect of the hearing aid, but are of great value to the hearing impaired. They can be found in most hearing aids and cochlear implants and can help improve a person’s ability to hear in noisy environments. Currently, California has no laws regarding telecoils. However, multiple states have passed telecoil legislation including Arizona, Florida, New York, Utah, and Rhode Island. [This bill] would require audiologists and hearing aid dispensers to educate consumers about the benefits of telecoil hearing aids and how to effectively use the telecoils they purchase. With the price of hearing aids reaching thousands of dollars, it is critical that we educate consumers on how best to use their hearing aids in the most efficient way."

Background. Licensed Audiologists and Hearing Aid Dispensers. The SLPAHADB is charged with the regulation of the practices of speech-language pathology, audiology, and hearing aid dispensing in California by licensing those who meet minimum standards of competency. Although the SLPAHADB regulates four distinct professions, only licensed audiologists and hearing aid dispensers are permitted to dispense hearing aids if they meet the appropriate requirements.

There are approximately 1,500 licensed audiologists in the state. In order to be licensed as an audiologist, an individual must hold a doctoral degree or equivalent in audiology from an accredited educational institution, or prior to January 1, 2008, hold a master’s degree or equivalent in audiology, completed 300 hours of supervised clinical practicum in three different clinical settings, completed an externship, and passed the national audiology exam. If an audiologist seeks to dispense hearing aids, they must take and pass the California hearing aid dispensers written and practical licensing examinations.

There are approximately 900 licensed hearing aid dispensers in California. In order to be licensed as a hearing aid dispenser, applicants must be at least 18 years of age, be a high school graduate or equivalency, and pass the California hearing aid written and practical examinations.

Under current law, dispensing audiologists and hearing aid dispensers are required to provide specified information to a person at the finalization of the sale. Both licensed dispensing audiologists and hearing aid dispensers are required to provide the purchaser with a written receipt that contains specified information including the date of sale, the hearing aid specifications, address and principal place of business, and the address and office hours where the dispenser will be available for fitting or post-fitting adjustments and servicing of the hearing aid, a statement about the hearing aids being used or reconditioned if they are, the audiologist or hearing aid dispenser's license number, and the terms of a written warranty. There are not specific requirements for either dispensing audiologists or hearing aid dispensers to provide to the consumer any types of specified information about certain products or types of hearing aid equipment.

For licensed hearing aid dispensers, BPC Section 2538.49 specifies that it is unlawful for a hearing aid dispenser to fit or sell a hearing aid unless he or she complies with all state laws and regulations related to the fitting and selling of a hearing aid, conducts a direct observation of the purchaser's ear canal, and informs the purchaser of the address and office hours at which the licensee is available for fitting or post-fitting of the hearing aid sold. This bill would require a hearing aid dispenser to inform a purchaser about telecoils when selling or fitting a hearing aid and states that it is unlawful for a hearing aid dispenser to fit or sell without providing such notification. This bill also requires audiologists to provide the same notification to a consumer; however, it does not make it unlawful if a dispensing audiologist fails to comply with the provisions of this bill.

Hearing Aids and the Telecoil. According to the Hearing Health Foundation, from 2000 to 2015, the number of Americans with hearing loss doubled, and globally that number increased by 44%. Those statistics also note that one in five teens, one in five adults, and three in five veterans returning from war are impacted by hearing loss.

A hearing aid is small electronic device that a person wears in or behind the ear. According to the National Institute on Deafness and Other Communication Disorders, there are three different styles of hearing aids: 1) behind-the-ear, which are used by people of all ages for mild to profound hearing loss; 2) in-the-ear, which fits completely inside the outer ear and used for mild to severe hearing loss, (usually not worn in children because the casings need to be replaced as often as the ear grows); and 3) in the canal which is used for mild to moderately sever hearing loss. According to the American Academy of Audiology, a telecoil is a small copper coil that is an option on most hearing aids and is built into cochlear implant processors. They are also known as t-coils and were originally used to boost the magnetic signals from the telephone handset. The telecoil is activated by a t-switch on the hearing aid or cochlear implant. All landline and some cell phones are designed by law to be used with a telecoil.

The Hearing Loss Association of America provides information about telecoils that references when individuals would use a telecoil, "hearing assistive technology combined with a telecoil can improve your understanding of dialogue at work, in a meeting, in the classroom, theatres, places of worship, tour buses, and other places. Some places use telecoils at home with the TV while keeping the TV while keeping the TV volume for the comfort of others. Many public places are equipped with hearing assistive technology."

According to a Federal Communications Commissions' consumer guide, The Federal Hearing Aid Compatibility Act of 1988 (HAC Act) requires that the Federal Communications Commission ensure that all telephones manufactured or imported for use in the United States after August 1989, and all “essential” telephones, are hearing aid-compatible. Essential telephones are defined as “coin-operated telephones, telephones provided for emergency use and other telephones frequently needed for use by persons using such hearing aids.” Essential phones might include workplace phones, phones in confined settings (like hospitals and nursing homes), and phones in hotel and motel rooms. The initial act specifically exempted wireless telephones, but in 2003, the FCC established rules for the hearing aid compatibility of digital wireless phones.

The author notes that telecoils remain a little-known aspect of the hearing aid, but are of great value to those with hearing impairment. They can be found in most hearing aids and cochlear implants and can help improve a person’s ability to hear in noisy environments. According to information provided by the author "with the price of hearing aids reaching thousands of dollars, it is critical that we educate consumers on how best to use their hearing aids in the most efficient way."

The American Audiology Association and the Hearing Loss Association of America recommend that to get a telecoil, a consumer should ask their audiologist or hearing instrument specialist when purchasing a hearing aid, but they further note that there might be an increased cost to the hearing aid. Further, the Hearing Loss Association states, "don’t assume that your hearing aid will automatically come with a telecoil, or that it will be recommended... Today, approximately 71[%] of all hearing aids dispensed in the United States, have telecoils. Yet few consumers are told about them and know how to use them.”

Other States. There are at least five other states which have enacted some form of legislation which requires consumer disclosure about telecoils, including: 1) Arizona, 2) Florida, 3) New York, and 4) Utah. Other states such as New Mexico have proposed legislation that would require some form of disclosure.

ARGUMENTS IN SUPPORT:

The Hearing Well Club writes in support, "the majority of members of the Hearing Well Club have not learned about telecoils from their hearing health care providers. Some members, after learning about telecoil use at club meetings, are very upset to learn that their hearing aids could have had a telecoil included but did not as they were not informed about it. Most hearing aids cannot be retrofit after manufacture. Hearing aids are a major investment that can cost from $1,500 to $4,000 each. The buyer has a right to know and understand all of the benefits and features available to them (including telecoils) before they buy. While 80% of hearing aids come with a telecoil, it serves no purpose if buyers are not aware that they have one.

[This bill], once passed, will ensure hearing aid buyers the power of choice which has so far been absent in California."

ARGUMENTS IN OPPOSITION:

The California Academy of Audiology writes in opposition, "The California Academy of Audiology, representing state licensed audiologists, is writing to express its opposition to [this bill] as the bill is currently written, requiring audiologists to inform a patient seeking hearing assistance of one particular aspect of a hearing aid, an audio switch or telecoil (t-coil). As you know, an audio switch is used to improve speech understanding on the telephone and to allow hearing aid wearers to access spoken information in larger venues that have electromagnetic induction loop system. Audiologists are trained to assess the hearing and communicative needs of patients with hearing loss. In addition, audiologists recommend appropriate treatments for hearing loss, including the various types of amplification devices that will allow patients to be as communicatively functional as possible in their daily lives. The primary purpose of [this bill] is to encourage consumers to avail themselves of t-coils in their hearing aids so that they can access information more easily via looped environments and on the telephone. This type of device has many enthusiastic users, but it may not be the best type of device for all patients."

POLICY ISSUES FOR CONSIDERATION:

1. This bill requires hearing aid dispensers and dispensing audiologists provide information to purchasers about telecoils which increase access to a telephone. While purchasers of hearing aids may need additional information about telecoils, there may be other pertinent information about hearing aids that should be disclosed to consumers either at the time of purchase or preceding the sale of a hearing aid.

In order to provide an effective consumer disclosure that includes information about telecoils and other relevant information, the author may wish to consider requiring the SLPAHADB to create and make available on its Internet website, a consumer disclosure document which can be provided to consumers with information which may benefit hearing aid purchasers including information on topics such as telecoils, testing, operation of a hearing aid, care of a hearing aid, among others.

1. This bill would make it unlawful for a hearing aid dispenser or dispensing audiologist to fit or sell a hearing aid if they fail to inform a purchaser about telecoils. Although disclosure of such information may be extremely valuable to the purchaser, the author may wish to instead require that information about telecoils be provided to the purchaser at time of sale, when other required information is required to be provided to the seller including, the date of the sale, specifications as to the make and model number, and warranty information.

AMENDMENTS:

Add Assembly Member Mullin and Assembly Member Harper as a coauthor.

In order to address the policy issues raised above, the author should amend the bill as follows:

Delete the current contents and insert the following:

On or before July 1, 2017, the Board shall develop, and make available on its website, a consumer hearing aid disclosure. The consumer hearing aid disclosure shall include information determined by the Board including, but not limited to, information on a telecoil, t-coil, or t-switch.

In developing the consumer hearing aid disclosure, the Board may consult with stakeholders. The board shall update or revise the consumer hearing aid disclosure as it deems necessary.

On and after July 1, 2017, a licensee shall upon the consummation of a sale of a hearing aid provide to the purchaser a copy of the consumer hearing aid disclosure.

REGISTERED SUPPORT:

Roger That Consulting (sponsor)

The Hearing Well Club (sponsor)

Hearing Loss Association of America, Diablo Valley Chapter

Hearing Loss Association of America, Long Beach/Lakewood Chapter

Hearing Loss Association of America, Mission Viejo Chapter

Hearing Loss Association of America, San Diego Chapter

Hearing Loss Association of American, Santa Barbara Chapter

REGISTERED OPPOSITION:

California Academy of Audiology

Hearing Healthcare Providers

Analysis Prepared by: Elissa Silva / B. & P. / (916) 319-3301