BILL ANALYSIS Ó
AB 1950
Page 1
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Rudy Salas, Chair
AB 1950
(Maienschein) - As Introduced 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,
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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)
a) Complies with all provisions of state laws and
regulations relating to the fitting or selling of a hearing
aid;
b) Conducts a direct observation of the purchaser's ear
canals; and,
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c) 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:
a) The seller is a licensed audiologist and authorized to
sell hearing aids;
b) 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,
c) 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
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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
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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
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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
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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
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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
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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."
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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.
2)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
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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
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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