TITLE 25. HEALTH SERVICES
PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 37. MATERNAL AND INFANT HEALTH SERVICES
SUBCHAPTER
C.
The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to §37.21, concerning Purpose; §37.22, concerning Definitions; §37.23, concerning Vision Screening; §37.24, concerning Hearing Screening; §37.25, concerning Facility Requirements; Department Activities; §37.26, concerning Recordkeeping and Reporting; §37.27, concerning Standards and Requirements for Screening Certification and Instructor Training; and §37.28, concerning Hearing Screening Equipment Standards and Requirements.
BACKGROUND AND PURPOSE
The proposal is necessary to comply with House Bill (HB) 1297, 88th Legislature, Regular Session, 2023, which allows electronic eye charts for childhood vision screenings in public and private schools, licensed childcare centers, and licensed childcare homes. The proposed amendments define electronic eye charts and permit their use for visual acuity screenings. The proposal also includes edits to improve clarity and readability, defines terms, adds referral requirements from training materials, removes unnecessary procedural steps and details, removes a photoscreener training requirement, ends audiometer registration, requires facilities and certificate holders to comply with the program's policy and procedures manuals, adds an optional hearing screen for children with disabilities or for those who do not pass their initial hearing screening, and clarifies who may become a certified screener or external instructor.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §37.21 edits language for clarity and readability.
The proposed amendment to §37.22 adds definitions for: electronic eye chart to comply with HB 1297; instrument-based vision screeners, which is a general term for certain vision screening equipment; optotypes, which are the standardized figures or letters used for visual acuity screening; otoacoustic emissions (OAE) testing, which is a hearing screen that tests vibrations of the inner ear in response to sounds emitted by a probe; screener, which refers to a person who conducts screenings; and vision disorder, which is a broad term for many eye problems. The proposal updates the definitions of "biological calibration checks," "calibration," "exhaustive calibration," "licensed professional," and "visual acuity," and replaces the definitions of "certification" with "certificate" and "photoscreening" with "photoscreener." The proposal edits definitions for clarity and readability. The proposal also updates a reference to the Texas Health and Safety Code.
The proposed amendment to §37.23 adds electronic eye charts for visual acuity screenings to comply with HB 1297. The proposal adds the requirement for children aged four years and younger to be referred for a professional eye examination if either eye cannot identify the majority of optotypes on the 20/40 visual acuity line. The proposal adds an example of a two-line difference on a visual acuity chart. The proposal specifies that screener training and certification is required only for screeners who screen children in facilities and not in other locations. The proposal adds a referral form to the vision screening referral process that is in the training manual.
The proposed amendment to §37.24 edits language for clarity and readability. The proposal removes step-by-step instructions for conducting an extended recheck and makes the extended recheck optional, allowing screeners greater discretion when referring a child for further evaluation. The proposal specifies screener training and certification is required only for screeners who screen children in facilities and not in other locations. The proposal adds a referral form to the hearing screening referral process. The proposal allows screeners to determine when a follow-up screen should be conducted. The proposal adds otoacoustic emissions (OAE) testing as an optional screen for children with disabilities.
The proposed amendment to §37.25 replaces wording and updates the rule title to include of State Health Services (DSHS) , "Facility Requirements; Department of State Health Services (DSHS) Activities." The proposal changes the screening timeline from any time in the school year to within 120 calendar days of enrollment to allow for early intervention. The proposal adds that an affidavit for screening exemption must be submitted on or before the day the screening is scheduled. The proposal adds that facilities must verify a screener has a valid DSHS screening certificate prior to screening. The proposal adds that DSHS will notify facilities and school districts when external instructors do not comply with the rules and the external instructor manual. The proposal also explains consequences for repeated non-compliance, which may include cancellation of the instructor's certificate.
The proposed amendment to §37.26 adds electronic eye charts to recordkeeping and reporting requirements to comply with HB 1297 and updates the website address for the DSHS Vision and Hearing Screening Program. The proposal specifies screeners for facilities must comply with recordkeeping and reporting requirements. The proposal removes the specific mention of telebinocular screening. The proposal removes the requirement for screeners to submit documentation of certifications and refresher courses for specific vision screening equipment. The proposal updates the program mail code. The proposal changes the deadline by which screeners must submit screening results to a facility from "same day" to "no later than three business days after the day of screening." The proposal adds OAE testing to the reporting and recordkeeping requirements.
The proposed amendment to §37.27 replaces the term "instructor" with "external instructor," replaces additional wording, and edits language for clarity and readability. The proposal specifies screeners in facilities who are not licensed professionals must be certified by DSHS. Further, the definition of licensed professional in §37.22(17) does not include nurses, and therefore nurses must be certified by DSHS. The proposal adds that screeners must follow manufacturer instructions for all instrument-based screening devices. The proposal adds an example of the certificate deadline. The proposal clarifies that screener certification is not intended for medical office staff, nursing students, and individuals who are not screening children in facilities. The proposal adds that DSHS may train a limited number of certified vision or hearing screeners, or both, to become DSHS-certified external instructors who may train and certify screeners, but not other instructors. The proposal adds that DSHS accepts applications to become an external instructor on a limited basis and describes how instructor applications are prioritized. The proposal states external instructors must follow the rules and the external instructors' manual. The proposal changes the external instructor certificate period from five years to two years and makes external instructors subject to audits and observations. The proposal adds that instructors must maintain a copy of all training records for five years. External instructors must conduct each type of screener training at least once a year to maintain their certificate. This includes basic training and recertification training for vision or hearing, or both. External instructors who do not train screeners for over 18 months must reapply for certification.
The proposed amendment to §37.28 removes the requirement for registration of all pure-tone audiometers and the requirement for DSHS to approve all audiometer technicians. The proposal adds American National Standards Institute as the organization to follow for hearing equipment standards. The proposal clarifies all audiometer standards and requirements apply to audiometers used for hearing screening in facilities. The proposal requires screeners or facilities to store proof of calibration with the audiometer. The proposal requires audiometer biological calibrations both monthly and on each screening day, and the calibration records must be kept for three years.
FISCAL NOTE
Christy Havel Burton, Chief Financial Officer, has determined that for each year of the first five years the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments.
GOVERNMENT GROWTH IMPACT STATEMENT
DSHS determined that during the first five years that the rules will be in effect:
(1) The proposed rules will not create or eliminate a government program;
(2) Implementation of the proposed rules will not affect the number of DSHS employee positions;
(3) Implementation of the proposed rules will result in no assumed change in future legislative appropriations;
(4) The proposed rules will not affect fees paid to DSHS;
(5) The proposed rules will not create a new regulation;
(6) The proposed rules will repeal existing regulations;
(7) The proposed rules will not change the number of individuals subject to the rules; and
(8) The proposed rules will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Christy Havel Burton has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because there is no requirement to alter current business practices. No rural communities contract with DSHS in any program or service affected by the proposed rules.
LOCAL EMPLOYMENT IMPACT
The proposed rules will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons and the rules are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.
PUBLIC BENEFIT AND COSTS
Dr. Manda Hall, Deputy Commissioner, Community Health Improvement Division, determined that for each year of the first five years the rules are in effect, the public benefit will be to give vision screeners more flexibility by allowing them to use electronic eye charts for screenings and to make the vision and hearing screening rules easier to understand and therefore follow.
Christy Havel Burton has determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the use of electronic eye charts for visual acuity screenings is optional.
TAKINGS IMPACT ASSESSMENT
DSHS has determined the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rules, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov .
To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register . Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R010" in the subject line.
STATUTORY AUTHORITY
The amendments are authorized by Texas Government Code §524.0151 and Texas Health and Safety Code §1001.075, which authorize the executive commissioner of HHSC to adopt rules for the operation and provision of services by the health and human services system. The amendments are required to comply with Texas Health and Safety Code Chapter 36.
The amendments affect Texas Government Code §524.0151 and Texas Health and Safety Code §§36.002 - 36.006 and §36.011, and Chapter 1001.
§
37.21.
This
[
The purpose of this
] subchapter
implements
[
is to implement
] Texas Health and Safety Code[
,
] Chapter 36, concerning the early identification of individuals from birth through 20 years new
old
[
of age
] who have special senses and communication disorders and [
who
] need remedial vision, hearing, speech, or language services.
§
37.22.
The following words and terms, when used in this subchapter, [
shall
] have the following meanings, unless the context clearly indicates otherwise.
(1)
American Academy of Pediatrics (AAP)--
A
[
The AAP is a nationally recognized
] professional organization
that makes health recommendations for
[
which issues recommended standards pertaining to the health and well-being of
] children.
(2)
American Association for Pediatric Ophthalmology and Strabismus (AAPOS)--
A professional organization that, along
[
AAPOS is a nationally-recognized professional body which, in conjunction
] with the AAP,
sets
[
issues
] recommended vision screening standards. [
The goals of
] AAPOS
works to improve
[
are to advance the quality of
] children's eye care,
supports
[
support
] the training of pediatric
eye doctors, supports pediatric eye
[
ophthalmologists, support
] research [
activities in pediatric ophthalmology
], and
helps
[
advance the care of
] adults with
alignment issues
[
strabismus
].
(3)
American National Standards Institute, Inc. (ANSI)--
A
[
The
] national
organization that provides
[
coordinator of standards development and the United States clearinghouse for
] information
about
[
on national and international
] standards
used in the United States and around the world
.
(4)
Audiometer--
A
[
An electrical
] device
used to test
[
for testing
] hearing[
,
] and
measure how well a person can hear different levels and pitches
[
for measuring bone and air conduction
] of sound.
(5)
Audiometric calibration equipment--
Electronic devices used to adjust
[
Electro-acoustical equipment used to calibrate
] audiometers and audiometric testing devices
, which
[
. The term
] includes frequency counters, voltmeters, and distortion measuring equipment [
used to calibrate audiometers and audiometric testing devices
].
(6)
Audiometric testing device--
A machine that uses a variety of
[
An electro-acoustical generator that provides acoustic energy of a
] calibrated
sounds to test hearing and help identify the presence, type, and severity of hearing loss
[
output
].
(7)
Biological calibration check--
A method to check an audiometer's accuracy by testing the device on an individual with known hearing levels
[
The process of testing a person having a known, stable audiometric curve that does not exceed 25 decibels (dB) hearing level at any frequency between 250 and 6000 Hertz (Hz), and comparing the test results with the subject's known baseline audiogram
].
(8)
Calibration--The process of comparing an instrument or device
to
[
with
] a standard
and making adjustments
to
an acceptable level of
[
determine its
] accuracy [
and to make the necessary repairs or adjustments to assure that the operating characteristics are within the allowable limits established by a national standard, all in accordance with applicable legal requirements
].
(9) Certificate--A qualification given to individuals who complete vision or hearing screener training provided by either the Department of State Health Services (DSHS) or a DSHS-certified instructor.
[(9) Certification--The process by which the Department of State Health Services (department) trains individuals to conduct vision and/or hearing screening or provides training to instructors. The applicable certification is awarded following the successful completion of any of the course scenarios in this paragraph.]
(10)
dB--The decibel is a unit for
measuring
[
expressing
] the
loudness
[
relative intensity
] of sounds
. Decibels range
[
on a scale
] from zero
, which is the quietest sound an average person can hear, up
[
for the average least perceptible sound
] to
around
[
approximately
] 130
, which is
[
for
] the average [
pain
] level
of sound that causes pain
.
(11) Electronic eye chart--A computerized or other electronic system, device, or method that displays medically accepted and properly sized optotypes (letters, numbers, or symbols) to check an individual's visual acuity. Automated programs that measure visual acuity through interactive activities, like games, are not included.
(12)
[
(11)
] Exhaustive calibration--
An audiometer
[
A
] calibration that tests all settings for both earphones.
(13)
[
(12)
] Extended recheck--A
hearing test
[
screen
] used after
a
[
the
] child has failed two sweep-check screens. [
The screener may perform an extended recheck or initiate a referral for a professional examination, as defined in this section, after the two failed sweep-check screens.
]
(14)
[
(13)
] Facility--Includes public
and
[
or
] private preschools and schools, [
as
] defined as follows:
(A)
schools, as [
the term is
] defined
in
[
at
] Texas Health and Safety Code
§36.003
[
, §36.003(7)
];
(B)
preschools, as [
the term is
] defined
in
[
at
] Texas Health and Safety Code
§36.003
[
, §36.003(3)
];
(C)
child care centers licensed by the
Health and Human Services Commission (HHSC)
[
Department of Family and Protective Services (DFPS)
]; and
(D)
child care homes licensed by
HHSC
[
DFPS
].
(15)
[
(14)
] Hz--Hertz is a unit of frequency equal to one cycle per second.
(16) Instrument-based vision screeners--Automated devices like photoscreeners and autorefractors that estimate refractive errors and other factors that may cause vision problems in children. These devices do not test visual acuity.
(17)
[
(15)
] Licensed professional--An individual
who is legally allowed to conduct
[
whose legally-defined scope of practice under the license includes knowledge and experience in conducting
] professional examinations
, make diagnoses,
and
perform
screenings for vision
or
[
and/or
] hearing abnormalities
, or both,
in children
. This must be done according to
[
, all consistent with
] this subchapter and Texas Health and Safety Code[
,
] Chapter 36.
The term "licensed professional" in this subchapter does not include nurses.
[
The terms "professional examination" and "screening" are as defined in this section.
]
(18) Optotype--A standardized figure or letter used to test visual acuity.
(19) Otoacoustic emissions (OAE) testing--A hearing test that checks vibrations from the inner ear using sounds from a small device placed in the ear. OAE is an alternate screening method for children with intellectual or developmental disabilities.
(20)
[
(16)
] Pass/Fail--Allowable documentation of results
if
[
of vision screening when
] photoscreening is used for vision screening,
as outlined
in [
accordance with
] this subchapter. [
The documentation of the screening results is in lieu of visual acuity results using "20/20" format.
]
[(17) Photoscreening--A form of pediatric vision screening that uses a special-purpose camera to determine how well a child can see. It is an alternative under this subchapter to visual acuity-based screening with an eye chart for certain children, as specified herein. Other related terms are: autorefractor, objective screening and instrument-based screening. Photoscreening cannot determine exactly how well a child's visual acuity is developing. Important factors that affect visual acuity such as accommodative ability (focusing ability), binocular vision development, and other eye health issues are not assessed via photoscreening.]
(21) Photoscreener--A device that uses a special camera to check a child's vision. As described in this subchapter, a photoscreener can be used instead of a visual acuity screening for certain children.
(22)
[
(18)
] Professional examination [
(also referred to as examination)
]--A diagnostic evaluation performed by
a
[
an appropriately
] licensed professional
who has the
[
or by a department-certified individual whose
] expertise
to address
[
addresses
] the diagnostic needs of
an
[
the
] individual
with
[
identified as having a
] possible
vision or hearing issues
[
special senses or communication disorder
].
This
[
A professional
] examination
meets
[
is one that is done according to
] the requirements of this subchapter and [
of the
] Texas Health and Safety Code[
,
] Chapter 36.
(23)
[
(19)
] Program--
DSHS
[
The department's
] Vision and Hearing Screening Program.
(24)
[
(20)
] Pure-tone audiometer--A
device that
[
pure-tone audiometer
] electronically generates
pure tones
[
pure-tones which are
] used as signals to test
an individual's
[
a person's
] hearing.
(25)
[
(21)
] Reporting year--A 12-month period beginning June 1 of each year and ending May 31 of the
next
[
following
] year.
(26) Screener--An individual conducting vision or hearing screenings. A screener is either a licensed professional as defined in this subchapter or is trained and certified by DSHS to conduct vision or hearing screenings, or both.
(27)
[
(22)
] Screening--A
quick
test or
set
[
battery
] of tests
to see if someone might
[
for rapidly determining the
] need [
for
] a professional examination.
(28)
[
(23)
] Screening equipment--An instrument or device used to
measure
[
perform a measurement or measurements for the assessment of
] sensory abilities.
(29)
[
(24)
] Sweep-check--A quick hearing [
screening
] test using a pure-tone audiometer to
check if an individual
[
determine whether a person
] can hear
tones at
[
the following frequencies:
] 1000 Hz, 2000 Hz, and 4000 Hz at [
less than or equal to
] 25 dB.
(30)
[
(25)
] Telebinocular instrument--A
device used to check
[
stereoscopic instrument
] for [
screening
] various eye defects and
measure
[
measuring
] visual acuity.
(31)
[
(26)
] Testing equipment--An instrument or device used
as described in
[
under
] this subchapter to
check for
[
perform a measurement or measurements to substantiate or verify the presence or absence of
] sensory
problems
[
impairment(s)
].
(32)
[
(27)
] Tests--Procedures
used as described in
[
under
] this subchapter to measure special senses and communication functions.
(33) Vision disorder--An impairment of the sense of vision.
(34)
[
(28)
] Visual acuity--The
ability to distinguish letters or symbols at 20 feet or with a chart that simulates 20 feet. In this subchapter, visual acuity specifically means how clearly an individual can see things far away,
[
relative ability of the visual organ to resolve detail that is
] measured
as a standard ratio like
[
and recorded using an internationally recognized, two-figured indicator, such as
] 20/20.
§
37.23.
(a)
Visual acuity screening
[
Screening
] is required
to find specific vision disorders
[
,
] for individuals
attending
[
who attend
] a facility[
, to detect vision disorders
].
The vision screening rules follow national standards from AAPOS.
Vision screening
as described
[
conducted under this subchapter by a person who is not a licensed professional, as the term is defined
] in this subchapter
must meet the following requirements
[
, must be conducted following the national standards set by AAPOS currently found at http://www.aapos.org/terms/conditions/131, as revised, as they apply to age, verbal ability, ability to cooperate with screening, allowable methods of screening in different situations, and referral criteria, with the following exceptions
].
(1) Perform screenings using traditional wall charts or electronic eye charts that show approved optotypes at the correct distances. See the vision screening manual on the Department of State Health Services (DSHS) website for detailed instructions and a list of approved optotypes.
(2)
[
(1)
]
Refer children aged four years and younger
[
For children less than five years of age, refer
] for a professional examination
if either eye cannot correctly identify the majority of optotypes on the 20/40 acuity line or if
[
when
] there is a difference of two lines between passing acuities in either eye.
For example, if a child has 20/40 vision in one eye and 20/20 in the other, the child must be referred. However, if a child has 20/40 vision in one eye and 20/30 in the other, the child passed the screening.
(3)
[
(2)
]
Refer
[
For
] children
aged
five years [
of age
] and older[
, refer
] for a professional examination
if either eye cannot correctly identify the majority of optotypes on the
[
when screening results indicate visual acuity of less than
] 20/30
line. The DSHS requirement differs from the AAPOS standard of 20/32
[
in either eye (rather than 20/32 as listed in the AAPOS standards)
].
(4) Refer to and comply with additional pass or fail criteria in the vision screening manual on the DSHS website.
(5)
[
(3)
]
Use
[
In addition to AAPOS' recommendation regarding
] photoscreening
, when applicable,
for children
aged
42 months to five years [
of age
],
as recommended by AAPOS, and for individuals
[
photoscreening may be used for any individual (referenced in §37.21 of this title (relating to Purpose)
] with disabilities who
do
[
does
] not respond well to other [
allowable
] screening methods.
Refer a child for
[
A referral to
] a professional examination
if the child fails
[
is recommended if the individual fails
] the photoscreening.
(b)
A
screener
[
person
] who is not a [
"
]licensed professional
and
[
," as that term is defined in this subchapter, who
] conducts vision screening
in facilities
must be trained and certified as described in §37.27 of this
subchapter
[
title
](relating to Standards and Requirements for Screening Certification and Instructor Training).
(c)
Facilities must give the child's parent, other legally responsible adult, or the individual in the scenarios described in Texas Family Code §32.003, a referral form if the child fails a screening. The referral is for further evaluation by an appropriate licensed professional. Facilities must not refer a child
[
When a screener makes a referral based on the screening results under subsection (a) of this section, that referral shall be to a licensed professional for a professional examination, and not
] to a specific
person
[
individual
].
(d)
A individual is exempt from
[
The requirements of
] this section
if the individual gives the facility
[
do not apply when the individual is already actively under medical care by an appropriate licensed professional for one or more of the vision problems for which screening is done under this section. In order to claim this exception, the individual under the scenarios described at Texas Family Code, §32.003 or, if the individual is a minor, the individual's parent, managing conservator or legal guardian, must submit
] documentation from
an appropriate
[
the
] licensed professional
stating
[
to the facility. The documentation must be signed and dated by the licensed professional, and must affirmatively state that
] the individual is under active
or
[
,
] ongoing medical care [
from the licensed professional
] for
a
[
specific
] vision
problem
[
problems as referenced in this subsection
].
(e) Facilities, school districts, and screeners must follow all instructions in the vision screening manual available on the DSHS website.
§
37.24.
(a)
Hearing screening to detect hearing disorders
[
Screening
] is required[
,
] for individuals
attending
[
who attend
] a facility[
, to detect hearing disorders
]. Hearing screening
as described in
[
under
] this subchapter must
meet the following
[
be conducted using screening methods and referral criteria, and in compliance with other
] requirements[
, as follows
].
[(b)]
[
A person who is not a "licensed professional," as that term is defined in this subchapter, who conducts hearing screening must be trained and certified as described in §37.27 of this title (relating to Standards and Requirements for Screening Certification and Instructor Training).
]
(1)
[
(c)
]
Use a
[
A
] pure-tone audiometer [
shall be used
] to
perform
[
conduct
] a sweep-check screen.
(2)
[
(d)
]
Record the screening
[
Screening
] results [
shall be recorded
] for each ear at less than or equal to 25 dB for 1000 Hz, 2000 Hz, and 4000 Hz.
(3)
[
(e)
]
If the results show that the child did not respond to any of the three frequencies in either ear, perform a second sweep-check screen. If the child has a cold, congestion, fluid buildup in the ears, or any other condition impacting hearing, delay the second sweep-check screen. Perform the rescreening no later
[
A rescreen with another sweep-check is recommended if test results indicate failure to respond to any of the three frequencies in either ear, and it should be conducted no sooner than three weeks but not more
] than
28 calendar days
[
four weeks
] after the initial screening.
(4)
[
(f)
]
If the child does not respond to any of the frequencies
[
An extended recheck may be conducted or a referral to a professional examination shall be made for all children whose test results indicate failure to respond to any of the three frequencies
] in either ear on the second sweep-check
, either perform an optional extended recheck or refer the child for a professional examination
.
(5)
[
(g)
]
Refer a child for professional examination if the child does not respond
[
If the extended recheck results in a failure to respond
] to any frequency in either ear
above 25 dB during an extended recheck
[
at greater than 25dB, the screener must recommend that a professional examination be immediately conducted
].
(b) Otoacoustic emissions (OAE) testing may replace pure-tone audiometry only if a child has a documented disability preventing audiometer screening. OAE testing is optional and dependent on the screener's access to OAE testing equipment. The screener must use the equipment according to the manufacturer's recommendations.
(c) A screener who is not a licensed professional and performs hearing screenings in facilities must be trained and certified as described in §37.27 of this subchapter (relating to Standards and Requirements for Screening Certification and Instructor Training).
(d) Facilities must give the child's parent, other legally responsible adult, or the individual in the scenarios described in Texas Family Code §32.003, a referral form if the child fails a screening. The referral is for further evaluation by an appropriate licensed professional. Facilities must not refer a child to a specific person.
(e) An individual is exempt from this section if the individual gives the facility documentation from an appropriate licensed professional stating the individual is under active or ongoing medical care for a hearing problem.
(f) Facilities, school districts, and screeners must follow all instructions in the hearing screening manual available on the Department of State Health Services (DSHS) website.
[(h) An extended recheck shall be conducted according to the following procedures.]
[(1) Beginning with the right ear, present the tone at 40 dB hearing level (HL) and at 1000 Hz for two to three seconds. If no response is obtained, record " greater than 40 dB."]
[(2) If the child responds at 40 dB, lower the intensity to 30 dB HL and present the tone again.]
[(3) Lower the HL in 10 dB increments until no response is obtained, or until 20 dB is reached. If a response is obtained at 20 dB, record "20 dB."]
[(4) If no response is obtained, increase the HL dial in 5 dB increments until a response is obtained. Record the dB results obtained at 1000 Hz for the right ear.]
[(5) Repeat steps in paragraphs (1) - (4) of this subsection at 40 dB HL for 2000 Hz and 4000 Hz.]
[(6) Repeat steps in paragraphs (1) - (5) of this subsection for the left ear.]
[(i) When a screener makes a referral based on the screening results under subsection (a) of this section, that referral shall be to a licensed professional for a professional examination, and not to a specific individual.]
[(j) The requirements of this section do not apply when the individual is already actively under medical care by an appropriate licensed professional for one or more of the hearing problems for which screening is done under this section. In order to claim this exception, the individual under the scenarios described at Texas Family Code, §32.003 or, if the individual is a minor, the individual's parent, managing conservator or legal guardian, must submit documentation from the licensed professional to the facility. The documentation must be signed and dated by the licensed professional, and must affirmatively state that the individual is under active, ongoing medical care from the licensed professional for specific hearing problems as referenced in this subsection.]
§
37.25.
(a)
The chief administrator
must
[
of each facility shall
] ensure [
that
] each individual admitted to the facility
follows these
[
complies with the
] screening requirements [
of this subchapter (including ensuring that any screening done is performed by a properly certified screener), according to the following schedule
].
(1)
Children
ages
four
and
[
years of age or
] older
as of September 1 of the school year
[
,
] who are enrolled in any facility for the first time[
,
] must
have
[
be screened for possible
] vision and hearing
tests
[
problems
] within 120 calendar days of
enrolling
[
enrollment
]. If a child
enrolls
[
is enrolled
] within 60
calendar
days of the
end of the school year
[
date a facility closes for the Summer
], the child's vision and hearing must be tested within 120
calendar
days of the
start
[
beginning
] of the
next
[
following
] school year.
(2)
Children [
enrolled
] in pre-kindergarten and kindergarten must be screened each year within 120
calendar
days of enrollment.
(3)
Children [
enrolled
] in the first, third, fifth, and seventh grades must
be screened for
[
receive
] vision and hearing
problems within 120 calendar days of enrolling in each of those grades to allow for early intervention if a problem is found
[
screening in each of those grade years (can be done at any time during each of those years)
].
(4)
Children in third, fifth, and seventh grades are
[
Except for children enrolled in pre-kindergarten, kindergarten or first grade, a facility shall
] exempt [
any child
] from screening as required
in
[
by paragraphs (1) - (3) of
] this subsection if the child's parent, managing conservator, or legal guardian, or the individual
in
[
under
] the scenarios described
in
[
at
] Texas Family Code[
,
] §32.003, submits a record to the facility showing [
that
] a professional examination was [
properly
] conducted during the grade year in question or [
during
] the previous year. The record must be submitted to the facility during the grade year
when
[
in which
] the screening would otherwise be required.
(5)
Children
turning
[
enrolled in a facility who turn
] four years
old
[
of age
] after September 1 of
the school
[
that
] year
do not need to be screened
[
are exempt from screening
] until the
next school year
[
following September
].
(6)
Children may be screened
[
Upon written request pre-approved by the department, the screening of vision and hearing performed at a facility may occur
] on an
alternate
[
even-year
] schedule (i.e., pre-kindergarten, kindergarten, [
and
] first, second, fourth, and sixth grades
) if DSHS approves a written request. DSHS may set
[
instead of pre-kindergarten, kindergarten, and first, third, fifth, and seventh grades). Any department approval will include
] conditions so [
that
] children
receive
[
do not miss
] necessary
screenings
[
screening
] during the transition.
(b)
A child's parent, managing conservator, or legal guardian, or the individual
in
[
under
] the scenarios described
in
[
at
] Texas Family Code[
,
] §32.003, may execute an affidavit stating
either
[
that
] a
screener
[
person,
] other than the
screener selected
[
individual secured
] by the facility
will perform
[
to conduct screenings at the facility, shall conduct
] the screening [
(
] or [
that
] a licensed professional
will perform
[
shall conduct
] an examination[
)
] as soon as
possible
[
is feasible
]. The facility may admit the child
temporarily
[
on a provisional basis
] for up to 60
calendar
days[
,
] or may deny admission until the screening
record is
[
record(s) are
] provided [
to the facility
].
(c)
A [
facility shall not require a
] child
is exempt from screening
[
to be screened
] if the child's parent, managing conservator, or legal guardian, or the individual
in
[
under
] the scenarios described
in
[
at
] Texas Family Code[
,
] §32.003, submits
an affidavit
to the facility[
, on or before the date vision or hearing screening is scheduled, an affidavit in lieu of the screening record(s)
] stating [
that
] the vision or hearing screening
, or both screenings, conflict
[
conflicts
] with the tenets and practices of a church or religious denomination of which the
child or individual is a
[
affiant is an adherent or
] member.
The affidavit must be submitted on or before the day the screening is scheduled.
(d) The facility must verify the screener has a valid DSHS screening certificate before screening begins.
(e)
[
(d)
]
Volunteers must have a
[
Only individuals who have completed
] high school
diploma or equivalent to help with
[
may serve as volunteer assistants during
] vision
and
[
and/or
] hearing screenings.
The screener is responsible for deciding
[
It is the responsibility of the certified screener to determine
] how
a
[
any
] volunteer [
assistant(s)
] will
assist with
[
be used during
] the screening process, consistent with all state and federal confidentiality requirements.
(f) Facilities must follow DSHS rules, instructions, policies, and the vision and hearing screening manuals available on the DSHS website.
(g) DSHS will inform facilities when an external instructor, as described in §37.27 of this subchapter (relating to Standards and Requirements for Screening Certification and Instructor Training), fails to follow all the rules, instructions, policies, and manuals in this subchapter. If the instructor continues to not follow the rules, the instructor's certificate may be canceled.
§
37.26.
(a)
Screeners at facilities
[
Individuals conducting screenings under this subchapter
] must
follow the rules for keeping records
[
comply with the following recordkeeping
] and reporting
information
[
requirements
].
(1)
A screener must
[
Individuals conducting screenings at the facility (and those other than licensed professionals conducting screenings outside of the facility) shall
] document in each child's screening record the specific screening
performed
[
conducted
], the date the screening was
performed
[
conducted
], observations made during the screening, and the final results [
of the screening
]. The
screener must document
[
individual shall also ensure that the following are included in the documentation:
] the
child's
name [
of the child
], age or birthdate [
of the child
], and
if
[
whether
] the child is wearing corrective lenses during the vision screening. The
screener
[
documentation required under this subsection
] must
sign
[
also be signed
] and
date this information
[
dated by the person who conducted the screening
].
(2) A screener must provide facilities a copy of the screener's Department of State Health Services (DSHS) screener certificate.
[(2) Individuals using photoscreening for vision screening must comply with the recordkeeping and reporting requirements detailed at §37.27(b)(2) of this title (relating to Standards and Requirements for Screening Certification and Instructor Training). Additionally, prior to conducting photoscreening at a facility, the individual must submit copies of these same documents to that facility in addition to the documents which must be submitted under subsection (b)(3) of this section.]
[(3) Individuals using a telebinocular instrument for vision screening must comply with the recordkeeping and reporting requirements detailed at §37.27(b)(3) of this title. Additionally, prior to conducting telebinocular screening at a facility, the individual must submit copies of these same documents to that facility.]
(3)
[
(4)
]
Screeners
[
Individuals conducting screenings
] at a facility
must
[
(and those other than licensed professionals conducting screening outside of the facility) shall
] submit the
required
documentation referenced in paragraph (1) of this subsection to the facility
by the specified deadline or no later than three business days after
[
at
] the [
time of that
] screening.
[(5) Individuals must submit documentation to the department related to certifications and refresher courses, as specified in §37.27 of this title.]
(b)
Facilities must
follow the rules for keeping records
[
comply with the following recordkeeping
] and reporting
information
[
requirements
].
(1)
A
[
Each
] facility
must
[
shall
] maintain vision and hearing screening records [
under this section
] onsite for at least two years.
(2)
A facility must maintain [
screening
] records
of screening
[
regarding any individual claiming the
] exemptions found in [
§37.23(d) of
] this
subchapter
[
title (relating to Vision Screening) and/or §37.24(j) of this title (relating to Hearing Screening)
] for at least two years.
(3)
A facility
must
[
shall
] maintain the records
received
[
it receives
] from screeners [
under subsection (a)(2) of this section, related to the use of photoscreening for vision screening at the facility
] for at least two years.
(4)
A child's
[
An individual's
] screening records may be transferred
between
[
among
] facilities without [
the
] consent of
the child's parent, managing conservator, or legal guardian, or
the individual
in
[
under
] the scenarios described
in
[
at
] Texas Family Code[
,
] §32.003
, according
[
or, if the individual is a minor, the minor's parent, managing conservator, or legal guardian, pursuant
] to Texas Health and Safety Code[
,
] §36.006(c).
(5)
Facilities
[
The recordkeeping required in this section
] must
provide the required records
[
be made available
] to
DSHS
[
the department
] in a timely manner
if requested
[
upon request
].
DSHS or its representatives
[
The department
] may[
, directly or through its authorized representative,
] enter a facility and inspect
vision and hearing screening
records [
maintained relating to vision and hearing screening
].
(6)
Each
[
On or before June 30 of each year, each
] facility
must
[
shall
] submit
a yearly
[
to the department a complete and accurate annual
] report on the vision and hearing screening status of
the
[
its
] aggregate population screened during the reporting year.
The report must be submitted on or before June 30 of each year
[
Facilities shall report
] in the manner specified by
DSHS at https://www.dshs.texas.gov/vision-hearing-screening
[
the department (currently found at http://chrstx.dshs.state.tx.us). Facilities are required to report on the following categories
].
(A)
Hearing
[
For hearing
] screening--The total number
of children
screened
, including
[
:
] the number who failed;
the number screened by OAE testing;
the number referred for professional examination; the number
who left
[
transferred out of
] the facility
before
[
prior to
] the facility
received
[
receiving
] the professional examination results; professional examination results
showing
[
indicating
] none of the
screened
disorders
were
present [
which are screened for under this section
]; professional examination results
showing a disorder was
[
indicating a disorder(s) which is
] screened for [
under this section
]; and
referrals
[
referral
] for a professional examination
where
[
with
] no [
indication that a
] professional examination was [
ever
] done.
(B)
Vision
[
For vision
] screening--The total number
of children
screened
, including
[
;
] the [
total
] number screened with
glasses or contact lenses
[
correction (e.g. glasses or contacts)
]; the [
total
] number screened with photoscreening;
the number screened with an electronic eye chart;
the number who failed; the number referred for professional examination; the number
who left
[
transferred out of
] the facility
before
[
prior to
] the facility
received
[
receiving
] the professional examination results;
the number whose
professional examination results
indicated no issues
[
indicating none of the disorders present which are screened for under this section
];
the number whose
professional examination results
indicated an issue
[
indicating a disorder(s) which is screened for under this section
]; and
the number referred
[
referral
] for a professional examination
where
[
with
] no [
indication that a professional
] examination was [
ever
] done. The [
"
]total number screened[
"
] includes the number screened with telebinocular screening.
(c)
Additional
[
There are additional
] recordkeeping requirements [
in §37.28(f) and (g) of this title (relating to Hearing Screening Equipment Standards and Requirements)
] for
screeners
[
individuals or entities
] who own
or
[
and/or
] use audiometers and audiometric screening equipment
are in §37.28(f) of this subchapter (relating to Hearing Screening Equipment Standards and Requirements)
.
(d)
Unless otherwise specified on the DSHS website, send documents described in
[
For all submissions to the department under
] this subchapter
to
[
, use the following contact information (unless otherwise specified):
] Vision, Hearing
,
and Spinal Screening Program, Department of State Health Services, Mail Code
1818
[
1978
], P.O. Box 149347, Austin, Texas 78714-9347.
(e) Facilities, school districts, and screeners must follow all recordkeeping instructions in the vision and hearing screening manuals.
§
37.27.
(a)
A screener working in a facility
[
Individuals who conduct vision and/or hearing screening
] must be certified
by the Department of State Health Services (DSHS)
[
under this section
] unless the
screener
[
screening
] is [
conducted by
] a licensed professional.
Training for screeners is provided either
[
There are two options for obtaining this certification: a certificate issued
] directly by
DSHS or by instructors
[
the department; or a certificate issued by an instructor who has been trained and
] authorized by
DSHS
[
the department
] to issue certificates. There is no
fee for
[
cost to
] taking the course in either
case
[
scenario
].
(1)
DSHS provides training
[
The department offers certification courses,
] and issues certificates
when the course is completed. To join, participants
[
to those who successfully complete them. To be eligible to take the department's certification course, an individual
] must
have
[
be
] a high school
diploma or equivalent
[
graduate
] and sign a
form
[
written statement to that effect
] at the
start
[
beginning
] of the course. Individuals who
finish the training and pass
[
successfully complete the course, including passing
] the [
associated
] tests[
,
] will
receive
[
be issued
] a certificate
from DSHS to conduct screenings
[
by the department
].
(2) The training and certification described in this subchapter are not intended for staff in medical offices or students in medical, nursing, or other training programs. Individuals who do not screen children in facilities as defined in this subchapter are neither eligible nor required to be trained and certified by DSHS.
(3)
[
(2)
]
DSHS may train certain people outside the screening program, called external instructors, to conduct
[
The department trains instructors who themselves give
] certification courses
. Screeners who finish the course and pass the tests
[
, as described in this section. The eligibility requirement to attend such a course is the same as is described at paragraph (1) of this subsection. Individuals who successfully complete the course, including passing the associated tests,
] will
receive
[
be issued
] a certificate
from DSHS
[
signed by the authorized instructor. It will have the same validity, and is subject to the same restrictions, as a certificate issued under paragraph (1) of this subsection
].
(b)
Holders of
[
Screening
] certificates issued
as described in
[
under
] this section
must follow these
[
are subject to the following
] requirements.
(1)
Certificate holders may
[
Individuals who receive a certificate are authorized to
] conduct
the type of
[
vision and/or hearing
] screening [
(as applicable to the course taken, and as
] listed on the certificate[
)
,
[
in accordance with this subchapter
].
Certificate holders must follow all the rules in
[
Certified screeners are required to comply with
] this subchapter, and failure to do so
may lead to modifications,
[
is grounds for the modification,
] suspension
, or cancellation
[
and/or revocation
] of the
certificate
[
certification as provided in this section
].
(2)
If a screener uses
[
Individuals using
] a photoscreener
or other instrument-based device
for vision screening
, the screener
must
follow the manufacturer's instructions. The screener
[
have successfully completed instrument-specific training (including passing all associated tests) in accordance with manufacturer guidelines and must have a full understanding of the pass/fail referral criteria in accordance with AAPOS standards. Individuals conducting photoscreening must
] also
needs
[
have
] a current
DSHS
screening certificate
as described in
[
under
] subsection (a)[
(1) or (2)
] of this section. [
Documentation of the photoscreening training must be submitted to the instructor upon attendance at a certification class and include the date and location the training was taken, and the name, affiliation and contact information of the instructor. The individual must successfully complete instrument-specific refresher training (including passing any associated tests) every five years. Such refresher training must be completed during the fifth year of certification from the date the preceding certificate was issued.
]
(3)
If a screener uses
[
Individuals using
] a telebinocular instrument for vision screening
, the screener
must
follow the manufacturer's instructions. The screener
[
be familiar with the instrument in accordance with manufacturer guidelines and must have a full understanding of the pass/fail referral criteria. Individuals conducting telebinocular screening must
] also
needs to
have a current
DSHS
screening certificate
as described in
[
under
] subsection (a)[
(1) or (2)
] of this section.
(4)
A DSHS screening certificate described in
[
Screening certification under
] this section
is valid
[
allows the individual to screen children for vision and/or hearing problems (as applicable to the course taken, and as listed on the certificate) under this subchapter
] for [
a period of
] five years
. Renewing a certificate is explained
[
, with renewals processed as described
] in paragraph (5) of this subsection.
(5)
To renew a screening certificate, an individual must attend a recertification course either offered directly by DSHS, or approved by DSHS and provided by an external instructor.
[
Screening certification may be renewed by attending a department-approved refresher training course (either offered directly by the department or by an instructor authorized under this section).
] The
individual must finish this course by December 31 of the fifth year after the certificate was issued. For example, if the certificate is dated March 15, 2026, an individual has until December 31, 2031, to finish the recertification course, which then extends the certificate for another five years. If an individual does not complete the recertification within five years,
[
refresher training course must be completed during the fifth year of certification from the date the preceding certificate was issued. Once a refresher training course is successfully completed, the five-year cycle begins again. If certification is not renewed within the required time period,
] the individual must
take the complete
[
attend the basic
] certification training course
again
[
(i.e., a refresher course will not be sufficient)
].
(6)
DSHS may change, suspend, or cancel a certificate. DSHS will provide notice to the affected screener of any action being taken if DSHS receives
[
When the department receives
] information
that the
[
from any source that indicates a
] screener has not
followed
[
been following
] the
rules in
[
requirements of
] this subchapter[
, the department may modify, suspend, or revoke the certification. The department will send a notice to the affected individual as part of any such action being taken
].
(7)
If a screener receives a notice of action, the screener
[
The affected individual
] has 20
business
days [
after receiving the notice, referenced in this paragraph,
] to request a hearing
. DSHS assumes the notice is received five days after being postmarked.
[
on the proposed action. It is a rebuttable presumption that a notice is received five days after the date of the notice.
] Unless the notice [
letter
] specifies
another
[
an alternative
] method,
the hearing
[
a
] request
must
[
for a hearing shall
] be [
made
] in writing[
,
] and mailed or hand-delivered to the program at the address
described
[
specified
] in §37.26(d) of this
subchapter
[
title
](relating to Recordkeeping and Reporting). If [
an individual who is offered
] the [
opportunity for a hearing does not
] request
is not received or postmarked within 25 business days from the notice date
[
a hearing within the prescribed time for making such a request
], the
screener waives
[
individual is deemed to have waived
] the
right to a
hearing and
DSHS
[
the action
] may
proceed with the action
[
be taken
].
(8)
Appeals and administrative hearings
follow DSHS
[
will be conducted in accordance with the department's
] fair hearing rules
in
[
, at
] §§1.51 - 1.55 of this title (relating to Fair Hearing Procedures).
(c)
DSHS may train a limited number of certified vision or hearing screeners, or both, to become DSHS-authorized external instructors. These external instructors may train and certify individuals who screen children in facilities.
[
Individuals who successfully complete a department instructor training course, including all associated testing, are authorized to conduct screening trainings and issue screening certificates to individuals who successfully complete the screening training (including all associated testing), subject to the requirements of this section.
] Instructors may not charge [
any kind of
] fees for
these
[
their
] activities [
under this section
].
(1)
A screener who wants to become an external
[
Individuals wishing to take the
] instructor [
course
] must
apply and
[
first
] meet the following
requirements
[
qualifications
]:
(A)
the applicant has
[
have
] a [
current,
] valid
DSHS
[
department
] screening
certificate
[
certification,
] and
has
[
have
] experience performing screenings [
under that certificate
];
(B)
the applicant has
[
have
] experience
training
[
conducting trainings to
] groups of adults; and
(C)
the applicant is
[
be
] an audiologist, speech pathologist, optometrist, ophthalmologist
,
or a registered nurse
with a valid
[
and must have the applicable
] Texas license[
, current and
] in good standing [
under Texas law
].
(D) An individual who meets the qualifications in subsection (c)(1)(A) - (C) of this section may request external instructor training by contacting DSHS. DSHS will grant or deny the request based on the qualifications described in subsection (c)(1)(A) - (C) of this section and the external instructor manual located on the DSHS website.
(2) DSHS accepts applications on a limited basis, prioritizing the largest school districts and areas where there is a high need for training.
(A) External instructor certifications depend on the size of the facility or school district.
(B) External instructors must hold at least one training session for each type of screener training every year to stay certified. This includes both basic training and recertification training for vision or hearing, or both. If an external instructor does not train screeners for more than 18 months, the instructor must reapply for certification.
[(2) Department authorization for instructors to conduct trainings is valid for five years from the date certification was issued. The individual must successfully complete a department-approved instructor training refresher course (including passing any associated tests) and submit documentation of successful completion to the department within 30 days of completion of the course. Such refresher training must be completed during the fifth year of certification from the date the preceding certificate was issued. Failure to comply with these requirements, by the deadline given, means that the individual must then attend the basic instructor training course (i.e., a refresher course will not be sufficient).]
(3) The DSHS external instructor certificate lasts for two years. To renew an external instructor certificate, an individual must complete an instructor recertification course by December 31 of the second year after the certificate was issued. For example, if the certificate is dated March 15, 2026, an individual has until December 31, 2028, to finish an instructor recertification course, which extends the certificate for another two years. If an individual does not recertify within the required time period, the individual must take the complete training course again. DSHS may not renew an external instructor's certificate if DSHS confirms the training needs of the school district can be met without an external instructor.
(4)
[
(3)
]
DSHS-authorized external
[
Once authorized by the department to conduct trainings,
] instructors must
use the approved
[
do so using
] training materials [
obtained
] from
DSHS and follow all requirements and expectations listed in the instructor training manual
[
the department
].
(5)
[
(4)
]
DSHS must approve all
[
All proposed screening
] training sessions [
must be approved by the department
] at least 15
business
[
working
] days
before the sessions take place
[
prior to the training session
]. The instructor must provide
the necessary details to DSHS
[
all information sought by the department,
] by the
specified due date
[
deadlines given
].
(6)
[
(5)
] Instructors
who have a valid certification
[
in good standing under this section
] may
also
teach
courses for screener recertification. Instructors must make sure the people signing up for these recertification courses are eligible. Instructors must follow all the rules for these recertification
[
screening refresher courses as described in subsection (b)(5) of this section. Such refresher courses are subject to the same requirements under this section as those pertaining to initial screening
] courses.
(7)
[
(6)
]
External instructors must turn in all documentation listed in the external instructor training manual to DSHS within 10 business days after training screeners. The external instructor must send the
[
When a department-authorized instructor issues a certificate of vision and/or hearing screening, the instructor has 14 days to submit the attendance sheets, evaluations and the tear-off portion of the department's certification, and the photoscreening certificate, if applicable, to the department. These
] original documents [
should be submitted
] to the [
program at the
] address
listed in
[
found at
] §37.26(d) of this
subchapter unless instructed otherwise in the training manual or on the DSHS website. Instructors must keep
[
title. The instructor should maintain
] a copy
of all records for five years
.
[(7) When the department receives information from any source that indicates a screening instructor has not been following the requirements of this subchapter, the department may modify, suspend, or revoke the certification. The department will send a notice to the affected individual as part of any such action being taken.]
(8) External instructors may certify or recertify screeners but cannot certify instructors.
(9) External instructors must follow all DSHS guidelines in the external instructor training manual, including rules about class size and duration, course and instructor evaluations, and testing. The manual also explains what happens if external instructors do not follow these rules.
(10) External instructors must follow all instructions given in the vision or hearing screening manuals, or both, which can be found on the DSHS website.
(11) External instructors may be audited or observed by DSHS at any time for quality checks without notice or permission.
(12) If DSHS gets any information that an external instructor has not followed the rules described in this subchapter, DSHS may modify, suspend, or cancel the certification. DSHS will notify the instructor about any proposed actions.
(13)
[
(8)
] The
instructor
[
affected individual
] has 20
business
days after receiving the notice[
, referenced in paragraph (7) of this subsection,
] to request a hearing
about
[
on
] the proposed action.
The notice is considered received five business days after being postmarked.
[
It is a rebuttable presumption that a notice is received five days after the date of the notice.
] Unless the notice
states otherwise, the
[
letter specifies an alternative method, a
] request for a hearing
must be written
[
shall be made in writing,
] and mailed or hand-delivered to the [
program at the
] address
described
[
specified
] in §37.26(d) of this
subchapter
[
title
]. If
the
[
an individual who is offered the opportunity for a hearing does not
] request
for
a hearing
is not received or postmarked within 25 business day from the date the notice was sent, the instructor waives the right to a
[
within the prescribed time for making such a request, the individual is deemed to have waived the
] hearing and
DSHS may take
[
the
] action [
may be taken
].
(14)
[
(9)
] Appeals and administrative hearings
follow DSHS
[
will be conducted in accordance with the department's
] fair hearing rules
described in
[
at
] §§1.51 - 1.55 of this title
(relating to Fair Hearing Procedures)
.
§
37.28.
(a)
Unless specified
[
Except as
] otherwise
,
[
specifically provided, the sections in this subchapter apply to all persons and entities (e.g., calibration companies, facilities) who receive, possess, acquire, transfer, own, or use audiometers, audiometric testing devices, and audiometric calibration equipment, and to
] all audiometers
and other hearing equipment
used for
hearing tests
[
audiometric screening and hearing threshold tests, all audiometric testing devices, and all audiometric calibration equipment used
] in
facilities must follow the rules described in this subchapter. The facility and the screener must make sure these requirements are met
[
the State of Texas
].
[(b) Each individual and entity using any of the equipment referenced in subsection (a) of this section must be registered with the department, in the manner prescribed by the department (see information at http://www.dshs.state.tx.us/vhs/audio.shtm). Registration information must be updated in a timely manner to keep it current.]
(b)
[
(c)
]
The equipment mentioned
[
Equipment referenced
] in subsection (a) of this section
must
[
shall
] meet the
relevant
[
appropriate
] current ANSI standards, or the manufacturer's specifications if
there are
no ANSI standards [
apply
], and
must follow
all other applicable federal and state
standards and regulations
[
standard(s) and/or regulation(s)
] for such equipment.
(c)
[
(d)
]
Screeners in facilities
[
Individuals
] must be
certified
[
trained
] by [
or undergo training approved by
] the
Department of State Health Services (DSHS)
[
department
] in
how to properly
[
the proper
] use
the
[
of this
] equipment, as
explained
[
detailed
] in §37.27 of this
subchapter
[
title
] (relating to Standards and Requirements for Screening Certification and Instructor Training).
[(e) Individuals and entities who perform calibration services on the equipment referenced in subsection (a) of this section shall register with the department, and must update that registration in a timely manner to keep it current, in a manner prescribed by the department (see information at http://www.dshs.state.tx.us/vhs/audio.shtm).]
(d)
[
(f)
]
Qualified technicians must
[
Only calibration firms shall
] perform
regular
[
periodic
] electronic calibrations and
complete
exhaustive electronic calibrations
on audiometers used for screenings in facilities
.
The technician must
[
Calibration firms shall
] provide
proof of calibration
[
notification
] to the
audiometer's
owner
. Proof of calibration
[
of the audiometer being calibrated that the audiometer has been calibrated. The notification
] may be
shown with
[
in the form of
] a decal or sticker
attached
[
affixed
] to the audiometer
or the screener may keep a paper
[
, or in hard
] copy
of the latest calibration
documentation
with the audiometer
[
that must be maintained by the owner and be made readily available to the department or its representative upon request
].
(e) The owner of the audiometer or the person in charge at the facility must complete biological calibration checks before a screening to confirm the equipment works properly, and also once a month on all audiometers used in facilities for screenings.
(f)
[
(g)
]
Every facility or screener for a facility that uses
[
Upon reasonable notice, each individual or entity using
] audiometric screening equipment
must keep
[
shall make available to the department, in a timely manner,
] records
of the equipment's calibration and
[
maintained pursuant to this subchapter. Calibration forms and records for all equipment referenced in subsection (a) of this section, including
] monthly biological calibration
checks. These records must be kept for three years and made available to DSHS if requested
[
data, shall be maintained
] for inspection [
by the department for three years
].
[(h) Registration is not required for:]
[(1) equipment in storage, being shipped, or being offered for sale, if the audiometer, audiometric testing devices, and audiometric calibration equipment is not being used; and]
[(2) equipment limited to nonhuman use.]
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on September 26, 2025.
TRD-202503435
Cynthia Hernandez
General Counsel
Department of State Health Services
Earliest possible date of adoption: November 9, 2025
For further information, please call: (512) 776-7420