Original Notice.

Preproposal statement of inquiry was filed as WSR 98-01-159.

Title of Rule: WAC 246-843-090 Preexamination requirements, 246-843-093 Exemption, and 246-843-095 Preceptors for administrator-in-training programs.

Purpose: Rules describe administrator-in-training (AIT) program requirements, who is exempt from AIT program and AIT preceptor qualifications.

Statutory Authority for Adoption: Chapters 18.52, 34.05 RCW.

Statute Being Implemented: Chapter 18.52 RCW.

Summary: Amended and new rules clarify existing language and incorporate board policy.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Barbara Hayes, Department of Health, (360) 236-4921.

Name of Proponent: Board of Nursing Home Administrators, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Rules explain to readers that an AIT program is required for those who are new to the profession and provides exemption from an AIT program for persons who have acquired sufficient and comparable experience. Housekeeping changes to preceptor rule clarifies the board's intent.

Proposal Changes the Following Existing Rules: Exemption is provided for graduates of a long-term care program approved by the National Association of Boards of Examiners for Long-Term Care Administrators.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Cost does not exceed minor cost threshold.

RCW 34.05.328 applies to this rule adoption. This rule is legislatively significant because it amends standards that relate to the qualification of a permit or license.

Hearing Location: Wesley Gardens Board Room, 815 South 216th, Des Moines, WA 98198, on November 19, 1999, at 3:00 p.m.

Assistance for Persons with Disabilities: Contact Erin Obenland, (360) 236-4920, by November 12, 1999, TDD (800) 525-0127, or (800) 833-6388.

Submit Written Comments to: Barbara Hayes, fax (360) 236-4922, by November 12, 1999.

Date of Intended Adoption: November 19, 1999.

September 10, 1999

Barbara A. Hayes

Program Manager

OTS-2348.5

AMENDATORY SECTION(Amending WSR 95-07-128, filed 3/22/95, effective 4/22/95)

WAC 246-843-090
((Preexamination requirements.)) Administrator-in-training.

((No person)) An applicant shall be ((admitted to or permitted)) approved to take an examination for licensure as a nursing home administrator ((without having first submitted)) after submitting evidence satisfactory to the board that the applicant meets the following requirements:

(1) ((All applicants shall)) Be at least twenty-one years ((of age, and in addition, shall otherwise meet the requirements of suitability and character set forth in WAC 246-843-200)) old.

(2) ((All applicants shall)) Complete an application for licensure provided by the division of health professions quality assurance, department of health((, and shall)) that includes all information and fees requested ((in said application)). Refer to chapter 246-12 WAC, Part 2.

(3) ((All applicants shall)) Submit documentation ((demonstrating that they meet the)) of a minimum ((requirements set forth in RCW 18.52.071)) of a baccalaureate degree from a recognized institution of higher learning.

(4) ((Applicants not having)) Completed ((at least a one thousand hour practical experience requirement in a nursing home included in a degree program from a recognized educational institution, shall undertake and complete the following)) an administrator-in-training (AIT) program as described below:

(a) A one thousand five hundred hour ((administrator-in-training)) AIT program in a nursing home ((for individuals who have no experience in health care)); or

(b) A one thousand hour ((administrator-in-training)) AIT program ((in a nursing home)) for individuals with a minimum of two years experience as a department manager in a ((health care facility)) state licensed nursing home or hospital with supervisory and budgetary responsibility; or

(c) A five hundred hour ((administrator-in-training)) AIT program in a nursing home for individuals with a minimum of two years experience in the last five years with supervisory and budgetary responsibility in one of the following positions or their equivalent:

Hospital administrator;

Assistant administrator in a ((hospital or large health care facility)) state licensed nursing home or hospital;

Director of a hospital based skilled nursing facility;

Director of a subacute or transitional care unit;

Director of the department of nursing in a state licensed nursing home;

Health care consultant to the long-term care industry;

Director of community-based long-term care service((; or

(d) No administrator-in-training program is required for individuals with a minimum of five years experience in the last seven years with extensive supervisory and budgetary responsibility in one of the following positions or their equivalent:

Hospital administrator;

Assistant administrator in a hospital or large health care facility or agency;

Director of a hospital based skilled nursing facility;

Director of a subacute or transitional care unit; or

An individual who worked as a licensed nursing home administrator for a minimum of five years, in the past ten years, and whose license did not expire more than three years prior to application date)).

(5) The AIT program((, if required, shall include without limitations, the following)) shall be:

(a) ((The program shall be)) Under the guidance and supervision of a qualified preceptor((, and shall be conducted for a period of one thousand five hundred hours, one thousand hours, or five hundred hours));

(b) ((The program shall be)) Designed to provide for individual learning experiences and instruction based upon the person's academic background((s)), training, and experience;

(c) ((The)) Described in a prospectus ((for the program shall be)) signed by the preceptor((, submitted and approved by the board prior to its commencement.  Any)). The prospectus shall include a description of the rotation through departments and is to be submitted to the board for approval before beginning an AIT program. Changes in the AIT program shall be immediately reported in writing to the board((, and)). The board may withdraw ((the)) approval ((given,)) or alter ((the)) conditions under which approval was given((,)) if the board finds that the approved program ((as originally submitted and approved)) has not been or is not being followed((;)).

(((d))) (6) The AIT program prospectus shall include the following components:

(((i))) (a) A minimum of ninety percent of the required ((administrator-in-training)) AIT program hours are spent in a ((planned systematic)) rotation through each department of a resident occupied nursing home licensed under chapter 18.51 RCW;

(((ii) Planned reading and writing assignments;

(iii))) (b) Project assignment including at least one problem-solving assignment to improve the nursing home or nursing home procedures. A description of the project is to be submitted in writing to the board ((or a designated board member.  Problem-solving)) for approval before beginning the AIT program. The description of the project should indicate the definition of ((an acknowledged problem,)) the project and method of approach ((to the problem)) such as data gathering((, the listing of)). A project report that includes possible alternatives, ((the)) conclusions, and final recommendations to improve the facility or procedure is to be submitted to the board for approval at least ten days before the scheduled end date of the AIT program;

(((iv))) (c) Planned reading and writing assignments as designated by the preceptor; and

(d) Other planned learning experiences including ((acquisition of knowledge)) learning about other health and ((welfare)) social services agencies in the community((; and)).

(((v) A)) (7) Quarterly written reports to the board ((by the applicant including)) shall include a detailed outline of AIT activities ((and learning experiences of)) during the reporting period. Reports shall be submitted by both the AIT and preceptor.

(((e))) (8) The program shall provide for a broad range of experience with a close working relationship between preceptor and trainee.  Toward that end, ((as a general rule,)) no program shall be approved ((which would result in an individual preceptor supervising more than two trainees, or)) if the facility ((in which the program is to be implemented)) has a capacity of fewer than 50 beds.  Exceptions to this general rule may be granted by the board in unusual circumstances.

[Statutory Authority: RCW 18.52.061.  95-07-128, § 246-843-090, filed 3/22/95, effective 4/22/95; 93-23-034, § 246-843-090, filed 11/10/93, effective 12/11/93; 93-13-004 (Order 371B), § 246-843-090, filed 6/3/93, effective 7/4/93.  Statutory Authority: RCW 18.52.100.  91-24-050 (Order 217B), § 246-843-090, filed 11/27/91, effective 12/28/91; 91-06-060 (Order 141B), recodified as § 246-843-090, filed 3/1/91, effective 4/1/91.  Statutory Authority: RCW 18.52.100(14).  87-02-008 (Order PM 633), § 308-54-090, filed 12/29/86; Order PL 260, § 308-54-090, filed 12/10/76; Order PL 164, § 308-54-090, filed 3/27/74, effective 1/1/75; Order PL 107, § 308-54-090, filed 3/3/71.]

No AIT program is required for:

(1) An individual with a minimum of five years experience in the last seven years with extensive supervisory and budgetary responsibility in one of the following positions or their equivalent:

Hospital administrator;

Assistant administrator in a hospital or state licensed nursing home;

Director of a hospital based skilled nursing facility; or

Director of a subacute or transitional care unit.

(2) An individual who worked as a licensed nursing home administrator for a minimum of five years, in the past ten years, and whose license did not expire more than three years prior to application date.

(3) An individual who graduated from a long-term care program in a college approved by the National Association of Boards of Examiners for Long-Term Care Administrators.

(4) An individual who graduated from a degree program in a recognized educational institution that included a one thousand hour practical experience (practicum) in a nursing home. This practical experience shall be structured to allow a student a majority of time in a systematic rotation through each department of a resident-occupied nursing home. The practical experience shall include planned readings, writing, and project assignments. The practical experience shall include regular contact with the administrator of the facility in which the practical experience was completed.

[]

((In reviewing proposed administrator-in-training programs, the board shall utilize the following criteria in determining the qualifications and duties of)) The preceptor ((for such program:)) shall submit a statement describing his or her qualifications and an agreement to perform the duties of a preceptor.

(1) Qualifications of preceptor:

(a) The preceptor shall be employed as a licensed nursing home administrator for an accumulation of at least three years.

(b) The preceptor shall be employed full time as the nursing home administrator in the facility where the administrator-in-training is trained.

(c) The preceptor shall have ((demonstrated the ability and skills to provide quality care.

(d) The preceptor shall have demonstrated his or her continued interest in the broadening of his or her professional horizons beyond the requirements of licensure.

(e) The preceptor shall submit, in writing, the preceptor's qualifications as described in subsection (1)(a) through (d) of this section and an agreement to perform the duties in subsection (2)(a) and (b) of this section with the administrator-in-training's application.

(f))) an unrestricted license.

(d) The preceptor shall participate in and successfully complete any preceptor workshop or other training deemed necessary by the board.

(2) Duties of the preceptor:

(a) The preceptor shall take the time necessary and have at least a weekly ((supervisory)) face-to-face conference ((between himself or herself and the trainee in the facility to adequately monitor the education and)) with the AIT about the activities of the ((administrator-in-training)) AIT relative to the training program and the ((facility)) nursing home.

(b) The preceptor shall evaluate the AIT and submit quarterly reports to the board on ((a quarterly basis as to)) the progress of the ((administrator-in-training)) AIT program.

(3) A preceptor shall supervise no more than two AITs at the same time.

[Statutory Authority: RCW 18.52.100.  91-24-050 (Order 217B), § 246-843-095, filed 11/27/91, effective 12/28/91; 91-06-060 (Order 141B), recodified as § 246-843-095, filed 3/1/91, effective 4/1/91.  Statutory Authority: RCW 18.52.100(14).  87-02-008 (Order PM 633), § 308-54-095, filed 12/29/86.  Statutory Authority: RCW 18.52.100 (2) and (14).  78-02-009 (Order PL 282), § 308-54-095, filed 1/6/78.]

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