PROPOSED RULES
Original Notice.
Preproposal statement of inquiry was filed as WSR 01-07-085.
Title of Rule: WAC 246-928-440, 246-928-441, 246-928-442 and 246-928-443, continuing education requirements for licensed respiratory care practitioners.
Purpose: To implement the provisions of 2000 legislation (chapter 93, Laws of 2000). The proposed rules will mandate and define continuing education requirements for licensed respiratory care practitioners.
Statutory Authority for Adoption: RCW 18.89.050(1) and 18.89.140.
Statute Being Implemented: Chapter 18.89 RCW.
Summary: The statute requires licensed respiratory care practitioners to obtain thirty hours of continuing education.
Reasons Supporting Proposal: The proposed rules are necessary to define the continuing education requirements.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Tracy Hansen, 1300 S.E. Quince Street, Olympia, WA 98504, (360) 236-4940.
Name of Proponent: Department of Health, governmental.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Health professions must be self supportive.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The purpose of the rules is to define the continuing education requirements for licensed respiratory care practitioners. The rules will require and ensure licensed respiratory care practitioners to obtain continuing education to further their knowledge.
Proposal does not change existing rules.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
This rule has been reviewed and does not affect small or large businesses. The companies that hire the licensees affected by the rule do not generally pay for continuing education. Further, the rule has been found not to have a disproportionate impact on the licensees because each licensee must obtain the same continuing education.
WAC 246-928-440 through 246-928-443 results from a new statutory requirement for continuing education as a condition for renewal of a respiratory care license. Thirty hours of continuing education are required. Respiratory care licenses are renewed every two years. This requirement is in the law and cannot be reduced.
Costs Required To Comply: WAC 246-928-440, the new statute requires all licensed respiratory care practitioners to obtain thirty hours of continuing education every two years as approved by the secretary. The cost is associated with obtaining the continuing education through programs approved by the secretary. Ten of the thirty hours must be obtained through continuing education courses endorsed by the American Association for Respiratory Care.
The most substantial cost come from obtaining the ten hours of continuing education. This is $400-$800 or $200–$400 annually. Typically a practitioner will have to attend two courses to obtain ten hours. Each course is approximately $200-$400. The remaining hours can be obtained through low or zero cost training options activities such as self-study modules and formal in-service programs. Two thirds to three fourths of health care practitioners obtain continuing education regardless of any mandates. "Health professionals work in a highly structured, regulated and accountable environment. The vast majority of licensed and certified health care practitioners participate in lifelong learning as a concomitant responsibility of their privileged professional status." (Morrison, R., Resource Briefs, 93-3 1993). Thus for most of the licensees, the lower cost twenty hours of continuing education is probably occurring in any case.
Records, which document completion of continuing education courses, must be retained by practitioners for four years. The documents that demonstrate completion are included in the cost of the course. No cost is attributed to maintaining these records and other notes since they can be put in a single small file and stored as a negligible share of the practitioner's other medical records. If a license is audited a cost of less than $5 will cover copying and mailing in the file.
There are no equipment, supplies, or labor costs to comply with this rule.
Does the proposed rule affect both large and small businesses? The Regulatory Fairness Act defines a business as any "entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit." The act defines a small business as one that employs less than fifty individuals.
These rules do not regulate a business. These rules regulate individuals who are respiratory care practitioners and each respiratory care practitioner must obtain an individual license. Each practitioner must also obtain the continuing education hours individually.
Does the proposed rule impose disproportionate cost on small businesses? This rule is not expected to impose disproportionate costs on the licensees. The costs to comply with the rules are the same for each respiratory care practitioner.
What cost minimizing features have been included in the rule? This rule allows the following:
1. In the case of emergencies a one year extension can be granted.
2. Rather than submitting the records every two years, on a random basis, up to 25% may be audited.
3. Only ten rather than thirty hours of continuing education must be obtained through continuing education courses endorsed by the American Association for Respiratory Care.
After the cost minimizing features were included the costs will be from 1.13% to 2.27% of the average wages in the lowest paid SIC that hires the licensees.
How did the department involve the public in the development of the proposed rule? This program has maintained open contact with stakeholders during the course of the rules development. This open contact has been with a variety of stakeholders, such as, Respiratory Care Society of Washington, educators, other various related associations, the general public, and individuals credentialed under chapter 18.89 RCW.
Public involvement was solicited through one open public meeting in May 2000. The new legislative mandate that may require a new section to current rules was discussed. Two notices were also sent to stakeholders, one in January in 2001 to eighty stakeholders and one in February 2001 to six hundred five stakeholders to solicit comment regarding the drafting of the rule to implement HB 2452 continuing education for licensed respiratory care practitioners.
Some stakeholders objected to a preliminary draft, which stated that twenty of the thirty hours must be obtained from the American Association of Respiratory Care. The department responded by changing the requirement to ten of the thirty hours.
How will the department notify the licensees of the change in the rule? The department will send a mailing to all licensees.
| Table 1: 1999 Data for SIC Codes That Hire Licensed Respiratory Care Personnel | |||||
| Employer Units | Average Employment | Wages Paid | Average Number of Employees by Type of Employer Unit | Average Wages per Employee | |
| 80 HEALTH SERVICES | |||||
| 8011 Offices & clinics of medical doctors | 2,778 | 42,121 | $1,621,092,405 | 15.2 | $38,487 |
| 8049 Offices of health practitioners, nec | 887 | 5,445 | $148,566,715 | 6.1 | $27,285 |
| 8051 Skilled nursing care facilities | 277 | 27,043 | $564,319,574 | 97.6 | $20,867 |
| 8052 Intermediate care facilities | 33 | 2,010 | $44,486,009 | 60.9 | $22,132 |
| 8059 Nursing and personal care, nec | 94 | 3,506 | $61,791,932 | 37.3 | $17,625 |
| 8062 General medical & surgical hospitals | 63 | 55,384 | $2,092,126,288 | 879.1 | $37,775 |
| 8082 Home health care services | 151 | 7,706 | $147,132,546 | 51.0 | $19,093 |
| 8093 Specialty outpatient clinics, nec | 237 | 7,010 | $196,604,721 | 29.6 | $28,046 |
| 8099 Health and allied services, nec | 87 | 1,535 | $53,291,542 | 17.6 | $34,718 |
| Other industries | 140 | 671 | $15,494,778 | 4.8 | $23,092 |
| Total | 4,747 | 152,431 | $4,944,906,510 | 32.1 | $32,440 |
| 10% of Units | 474.7 | ||||
| Large Businesses Averaging more than 50 employees | |||||
| 8051 Skilled nursing care facilities | 277 | 27,043 | $564,319,574 | 97.6 | $20,867 |
| 8052 Intermediate care facilities | 33 | 2,010 | $44,486,009 | 60.9 | $22,132 |
| 8062 General medical & surgical hospitals | 63 | 55,384 | $2,092,126,288 | 879.1 | $37,775 |
| 8082 Home health care services | 151 | 7,706 | $147,132,546 | 51.0 | $19,093 |
| Large Businesses Total | 524 | 92,143 | $2,848,064,417 | 175.8 | $30,909 |
| Small Businesses Averaging fewer than 50 employees | |||||
| 8011 Offices & clinics of medical doctors | 2,778 | 42,121 | $1,621,092,405 | 15.2 | $38,487 |
| 8049 Offices of health practitioners, nec | 887 | 5,445 | $148,566,715 | 6.1 | $27,285 |
| 8059 Nursing and personal care, nec | 94 | 3,506 | $61,791,932 | 37.3 | $17,625 |
| 8093 Specialty outpatient clinics, nec | 237 | 7,010 | $196,604,721 | 29.6 | $28,046 |
| 8099 Health and allied services, nec | 87 | 1,535 | $53,291,542 | 17.6 | $34,718 |
| Other industries | 140 | 671 | $15,494,778 | 4.8 | $23,092 |
| Total^ | 4,223 | 60,288 | $2,096,842,093 | 14.3 | $34,780 |
| Number of Licensed Practitioners | 3020 | ||||
| Percent of total employees | 1.98% | ||||
| Cost Minimizing Features of the Rule | $ per license per 2 year period | ||||
| Low Cost | High Cost | ||||
| Cost of training per person in AARC Classes | $1,200 | $2,400 | |||
| Minimum potential cost of alternate continuing education* | $0 | $0 | |||
| Savings from reducing the number of AARC hours of training from 30 to 10 hours | $800 | $1,600 | |||
| Final costs | $400 | $800 | |||
| Costs as a percentage of the lowest wage bill | 1.13% | 2.27% | |||
| ^ Total for businesses, but particularly small businesses, does on [not] include sole proprietorships with no employees. | |||||
| *The lowest cost alternative is self study by reading of the literature and writing up results, which has no charge. | |||||
A copy of the statement may be obtained by writing to Tracy Hansen, Program Manager, Respiratory Care Practitioners Program, P.O. Box 47870, Olympia, WA 98504-7870, phone (360) 236-4940, fax (360) 586-0745.
RCW 34.05.328 applies to this rule adoption. The rule is significant under RCW 34.05.238 [34.05.328] because it requires licensed respiratory care practitioners to obtain additional education. The agency has conducted the additional analysis required by RCW 34.05.328.
Hearing Location: Department of Health Conference Center, 1101 South Eastside Street, Olympia, WA 98504, on August 21, 2001, at 3:00 p.m.
Assistance for Persons with Disabilities: Contact Tracy Hansen by August 11, 2001, TDD (800) 833-6388, or (360) 236-4940.
Submit Written Comments to: Tracy Hansen, fax (360) 586-0745, by August 17, 2001.
Date of Intended Adoption: August 21, 2001.
June 17, 2001
M. C. Selecky
Secretary
OTS-4845.3
NEW SECTION
WAC 246-928-440
Continuing education requirements.
Purposes. The ultimate aim of continuing education is to ensure
the highest quality of professional work. Continuing education
consists of educational activities designed to review existing
concepts and techniques and to convey information and knowledge
about advances in respiratory care as applied to the work
settings. The objectives are to improve and increase the ability
of the respiratory care practitioner to deliver the highest
possible quality of respiratory care work and to keep the
professional respiratory care practitioner abreast of current
developments in a rapidly changing field. All respiratory care
practitioners licensed under chapter 18.89 RCW will be required
to meet the continuing education requirements set forth in these
rules as a prerequisite to license renewal.
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(2) Effective July 2003, renewal of any current license or reinstatement of any license lapsed or on disciplinary status shall require evidence of completion of continuing education which meets the requirements of subsection (3) of this section.
(3) Requirements. RCW 18.89.140 requires that all licensed respiratory care practitioners seeking to renew their license shall acquire thirty credit hours of continuing respiratory care education every two years as required in chapter 246-12 WAC, Part 7.
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(a) Additional courses approved by the American Association for Respiratory Care.
(b) Category I level formal in-service approved by the American Association for Respiratory Care.
(c) Courses in respiratory care approved by the American Medical Association, the American Osteopathic Association and the American Nurses Association.
(d) Courses in Advanced Cardiac Life Support, Pediatric Advanced Life Support and Neonatal Resuscitation Program.
(e) Courses in respiratory care at any college.
(f) Self-study courses in respiratory care.
(g) The National Board for Respiratory Care's self-assessment competency examination.
(h) Educational offerings in respiratory care which include learning objectives provided by hospitals or health organizations.
(i) Educational offerings in respiratory care which include learning objectives, where the licensee serves as the instructor subject to the limitation described in subsection (3) of this section.
(2) Documentation. Licensees are responsible for acquiring and maintaining all acceptable documentation of their continuing education activities. Acceptable documentation shall include transcripts, letters from course instructors, or certificates of completion or other formal certifications provided by hospitals, course instructors, and health organizations, as required in chapter 246-12 WAC, Part 7. In all cases other than transcripts, the documentation must show the participant's name, activity title, number of continuing education credit hours, date(s) of activity, instructor's name(s) and degree and the signature of the verifying individual program sponsor.
(3) The licensee who prepares and presents lectures or education courses that contributes to the professional competence of a licensed respiratory care practitioner may accumulate the same number of hours obtained for continuing education purposes by attendees as determined in WAC 246-12-220. The hours for presenting a specific topic lecture or education may only be used for continuing education credit once during each renewal period.
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(a) Verify on renewal forms provided by the department, that the minimum continuing education has been completed within the two-year renewal cycle prior to the licensee's renewal date; and
(b) Keep records for four years as required in chapter 246-12 WAC, Part 7.
(2) Audits. The department may conduct random compliance audits of continuing education records, as described in chapter 246-12 WAC, Part 7.
(3) Exemptions. In certain emergency situations, the department may excuse all or part of the continuing education requirement as described in chapter 246-12 WAC, Part 7. The department may require verification of the emergency.
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