WSR 98-23-072

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed November 17, 1998, 8:40 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 98-11-064.

Title of Rule: WAC 246-834-050 Examination requirements for licensure as a midwife, 246-834-060 Application requirements for licensure as a midwife, 246-834-070 Release of examination results, and 246-834-080 Failures.

Purpose: To amend the existing rules to identify the midwifery licensure examination, what is required for the examination, procedures for release of examination results and procedures when an applicant fails the examination.

Statutory Authority for Adoption: RCW 18.50.060.

Statute Being Implemented: RCW 18.50.060.

Summary: The current state midwifery examination is currently in need of revision. This revision would involve a large amount of time and resources. The department has researched the option of adopting a national examination developed by the North American Registry of Midwives. This examination was based upon an intensive job analysis, is substantially equivalent to the current examination, is updated periodically and would have little or no cost to the department.

Reasons Supporting Proposal: This examination is based on an intensive job analysis, is substantially equivalent to the current licensure examination. This examination is updated periodically and would not cost the department.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kendra Pitzler, Program Manager, 1300 Quince Street, Olympia, WA, (360) 236-4723.

Name of Proponent: Midwifery Advisory Committee.

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

Explanation of Rule, its Purpose, and Anticipated Effects: The midwifery licensure examination, as required by RCW 18.50.060, assures that applicants for a license to practice midwifery have the knowledge and skills to practice midwifery with reasonable skill and safety. The midwifery examination currently needs to be updated. There would be a great cost to do so. The department instead has chosen to adopt a national examination developed by the North American Registry of Midwives. This examination is based upon an extensive job analysis of midwifery practice, is accepted by other states and is cost effective. This amendment would assure that the midwifery examination is current, covers the appropriate topic areas and is cost effective. In addition, this could facilitate endorsement of licensure between other states which accept and/or offer this examination.

Proposal Changes the Following Existing Rules: This proposal adopts the national examination offered by the North American Registry of Midwives, specifically describes the requirements for examination and explains the requirements which will be used for applicants that fail the examination.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

and

Economic Impact Analysis

Background: RCW 18.50.060 requires the secretary of the Department of Health (DOH) to offer examinations in midwifery at least twice a year. An examination was developed in the early 1980s and has not been updated since that time. Due to the fact that the examination had not been updated for so long, department staff and the Midwifery Advisory Committee recognized the need to update this examination.

In early 1997, department staff and members of the Midwifery Advisory Committee met with representatives of the North American Registry of Midwives (NARM) and reviewed their examination. It was noted that the examination was based upon a job analysis which was psychometrically valid and that the questions were appropriate for licensure of direct entry midwives. Possible adoption of this examination was discussed at the next advisory committee meeting on March 28, 1997, and it was determined that a comparison study between the current licensure examination and this national examination should be done by an independent party.

When this transportability study was received, it stated that the two examinations have a similar generalized topical focus on the practice of midwifery. Adoption of the NARM examination was again discussed at advisory committee meetings on June 20, 1997, October 3, 1997, and March 27, 1998. In addition to receiving verbal feedback at these meetings, the department has also received written comment from many individuals. These comments have been received from licensees, applicants, midwifery student and the Seattle Midwifery School. The overwhelming majority of the comments endorse adoption of this examination.

On May 19, 1998, a preproposal statement of inquiry was filed with the code reviser's office. A subsequent meeting was held on June 5, 1998, to elicit further input and formulate language. The proposed rules are a result of this input.

Necessity of Amendments to Examination Rules: The midwifery statute regulates licensed midwives in the state of Washington. In order to assure that licensed midwives have the knowledge and skills to practice with reasonable skill and safety, applicants must meet certain qualifications. Without these standards, unqualified practitioners could create a risk of harm to mother and infant. The midwifery licensure examination, as required by RCW 18.50.060, is one avenue to assure that licensed midwives are duly qualified to practice safely. The current examination has not be updated since the early 1980s. Because of this, a new examination must be developed in order that the department may ensure that all new licensees possess the knowledge required to perform midwifery services safely. Please see below the estimated costs to develop and maintain a new examination. The department is choosing instead to adopt a national examination.

Costs to a Business: There are no new additional costs to a business to comply with these proposed amendments. All applicants are already required to submit to an examination and these costs are paid directly by the applicant.

DOH Costs to Administer the Regulation: There are no new additional costs to the Department of Health to regulate these amendments. In fact, this reduces the cost to the Department of Health for developing and maintaining the examination.

Magnitude of Amendments to Midwifery Rules: These proposed amendments would not add any additional requirements. They do, however, clarify the specific documentation that is required. This will make it easier for a person interested in applying for examination to understand what is required.

Impact to Licensees: The impact to licensees is that they will be required to take a national examination rather than one developed and maintained by the Department of Health. This will make it easier to obtain endorsement because if the applicant has taken this examination within the past two years, it will be accepted. It will also make it easier for Washington state licensees to obtain a license in another state which accepts this examination.

The applicants will also be required to pay a fee of $400 directly to the North American Registry of Midwives, as well as pay the department an examination fee of $50 and a state add-on examination of $50, a total of $500. While this is a higher cost than the past fee of $375, it is probable that the examination fee would increase to an amount higher than $500 if the department were to develop and maintain a new examination.

Summary: These proposed amendments will allow the department to adopt the national examination developed by the North American Registry of Midwives. This examination will save the department the costs of developing and maintaining a new examination. In addition, this will benefit applicants coming from or moving to another state since many other states already accept this examination. Most importantly, this will assure that the department will always have an examination which is current and pertinent to the practice of midwifery. This will assure that midwifery applicants have the knowledge to practice safe midwifery which will act to protect the public safety.

Small Business Economic Impact Statement: In preparing this small business economic impact statement (SBEIS), the department used SIC code 809 Miscellaneous Health & Allied Services, Not Elsewhere Classified which has a minor impact threshold of $53.00. The cost paid to the department by applicants under the old rules was $375 for the examination. The costs paid under the amended rules to the department for the examination will be $100. The cost paid to NARM will be $400. The total amount is $500. Since most providers qualify as small businesses, there is no disproportionate impact to small businesses. When there is no disproportionate impact, mitigation is not necessary.

Estimated Cost to Develop New Midwifery Examination

1. Task Analysis will require three to five practitioners for three to five days. The department may not be able to get volunteers for this task and would have to pay experts. The department currently pays midwifery experts $75/hour. The calculations below are for four experts at four days.

8 hour day x $75.00 .= $600.00 per expert per day

$600/day x 4 days .= $2,400 per expert

$2,400 x 4 experts .= $9,600

Total: $9,600 for the task analysis

2. Mail sample to licensed midwives for comment. Envelopes will contain approximately six pages.

110 licensees x .55 .= $60.50

Business Reply Envelopes and Postage: 110 licensees x .70 .= $77.00

Total: $137.00

3. Analysis done by program staff. Time approximately three days. Program Manager I level.

24 hours x $16.19 per hour .= $388.56

Total: $388.56

4. Developing a blueprint will again require that the three to five practitioners meet and identify the exam question areas, how many questions should be devoted to each area, the weight of such questions and the number of total questions. This takes approximately two days. This estimate will again be based on four practitioners.

$600 per expert per day

$600/day x 2 days .= $1,200 per expert

$1,200 x 4 experts .= $4,800

5. Developing a blueprint would require one hour per question to write. The current examination is 200 questions. It would be imperative to have at least double the questions so that if an exam were compromised in any way, the department would be able to give another examination immediately. This estimate assumes that only one expert would be developing each question.

400 hours x $75.00 .= $30,000

Total: $30,000

6. Pretesting: Giving the examination to volunteers. If done one time, it would include staff time and possible room rental. We assume that we could get volunteers and would, therefore, not incur any costs from the persons taking the examination.

Staff time: $16.19 per hour x 8 hours .= $129.52

Rental Room: $200.00

Total: $329.52

7. Establish cut-score. This would encompass one day per fifty questions. For 200 questions, a total of four days. This again will be estimated on the basis of four experts.

$600 per expert per day

$600 per day x 4 days .= $2,400

$2,400 per expert x 4 experts .= $9,600

Total: $9,600

8. An analysis would need to be done. This would take four hours per fifty questions. Therefore, a total number of sixteen hours. This would need to be done by an examination or educational expert. The department has paid such experts $416 per day. Sixteen hours would encompass two days.

$416 x 2 .= $832

Grand Total to Develop Examination: $55,687.08

Maintenance of Midwifery Examination: In addition, these same procedures would need to be used every two to four years to maintain the examination. This would not cost as much, but even if it were to cost only 1/4 of the original cost, it would still take $13,921.77. If it were to be done every three years, this breaks down to $4,640.59 per year.

Note: If the Department of Health elects to create a new examination rather than to adopt the NARM examination, the above costs would need to be reviewed in a new fee study, which could raise midwifery fees considerably.

A copy of the statement may be obtained by writing to Department of Health, Midwifery Program, P.O. Box 47864, Olympia, WA 98504-7864, phone (360) 236-4723, fax (360) 236-4738.

RCW 34.05.328 applies to this rule adoption. These rules are significant under section 201, chapter 403, Laws of 1995, because they adopt substantive provisions which subject the violator to penalty or sanction and establish, alter or revoke qualification or standard for the issuance, suspension or revocation of a license or permit.

Hearing Location: Department of Health, 1101 Eastside Street, Olympia, WA 98504, on December 22, 1998, at 1:00 p.m.

Assistance for Persons with Disabilities: Contact Kendra Pitzler by December 8, 1998, TDD (800) 833-6388, or (360) 236-4738.

Submit Written Comments to: Kendra Pitzler, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, fax (360) 236-4738, by December 15, 1998.

Date of Intended Adoption: December 23, 1998.

November 17, 1998

Patty Hayes

for Kristine Van Gorkom

Deputy Secretary

OTS-2512.3

NEW SECTION

WAC 246-834-050 Examination requirements for licensure as a midwife. This rule provides the minimum examination requirements for licensure as a midwife.

(1) The midwifery examination offered by the North American Registry of Midwives (NARM) is the official examination for midwifery licensure. All applicants must complete this examination with a passing score. This examination shall be offered by the department of health midwifery program twice a year. If the applicant passes the examination within two years prior to applying for a Washington license, the department will accept the results.

(2) In addition to the NARM examination, all applicants must pass the Washington state specific component examination.

[]

AMENDATORY SECTION (Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)

WAC 246-834-060 Application ((~~for licensing examination~~)) requirements for licensure as a midwife. ((~~(1) All applicants shall file a completed, notarized application, with the application fee specified in WAC 246-834-990, at least 45 days prior to the examination.~~

~~(2) Applicants shall request that the school of midwifery send an official transcript directly to the department of health.~~

(3) Those who have properly applied to take the midwifery licensing examination and have met all qualifications will be notified of their eligibility to be examined. Upon notification of eligibility, the examination fee specified in WAC 246-834-990 must be submitted. Only applicants so notified will be admitted to the examination.

~~(4) All applicants shall take the current state licensing examination for midwives.~~

~~(5) The minimum passing score on the licensing examination is 75 percent.~~

~~(6) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.~~)) This rule provides the requirements for application for a midwife license.

(1) All applicants must submit a Washington state application for licensure, along with the applicable fees specified in WAC 246-830-990 and additional documentation as specified below. Applications must be received fifty-six days prior to the examination.

(2) Applicants must submit the following documentation:

(a) Transcripts sent directly from an approved school which indicate the applicant has received a certificate or diploma in midwifery. Those applicants applying under WAC 246-834-220 will be exempted from this requirement.

(b) One current passport type photograph, signed and dated across the bottom of the photo or on the back.

(d) A current plan for consultation, emergency transfer and transport.

(e) Verification of seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.

(f) Applicants with disabilities who wish to request special accommodations must do so when submitting their application.

(g) Applicants who have passed the NARM examination within the past two years must have verification of the examination results sent directly from NARM to the department.

(3) It is the applicant's responsibility to complete an application for the NARM examination and submit the application along with the NARM examination fee directly to NARM. A NARM application and instructions will be provided in the state application packet sent to the applicant.

[Statutory Authority: RCW 43.70.280. 98-05-060, � 246-834-060, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.50.135 and 18.50.045. 92-02-018 (Order 224), � 246-834-060, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as � 246-834-060, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. 82-19-079 (Order PL 406), � 308-115-060, filed 9/21/82.]

AMENDATORY SECTION (Amending Order 121, filed 12/27/90, effective 1/31/91)

WAC 246-834-070 Release of examination results. (1) Applicants shall be notified of examination results. All notices shall be by mail.

(2) Applicants who pass both the NARM examination and the Washington state specific component examination and meet all eligibility requirements shall receive ((~~the results of the examination and instructions for obtaining~~)) a license to practice as a midwife, unless there are grounds for disciplinary action under chapter 18.130 RCW.

(3) Applicants who fail shall receive notice of their eligibility to be reexamined, and of the procedure for applying for reexamination.

(4) ((~~Each accredited school of midwifery shall receive a statistical report of the test results of applicants who graduated from that school.~~

~~(5)~~)) Results of the examination will not be released to anyone except as provided above unless release is authorized by the applicant in writing.

((~~(6) The applicant's examination results will be maintained by the department.~~))

[Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as � 246-834-070, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. 82-19-079 (Order PL 406), � 308-115-070, filed 9/21/82.]

AMENDATORY SECTION (Amending Order 224, filed 12/23/91, effective 1/23/92)

WAC 246-834-080 Failures. (1) An applicant who has failed either the NARM examination or the Washington state specific component examination or both must retake and pass the examination(s) which he or she failed. The applicant may ((~~be reexamined~~)) sit for the examination if he((/)) or she:

(a) Applies to the department at least ((30)) fifty-six days prior to the next scheduled examination((,)); and

(b) Pays any required fee as specified in WAC 246-834-990.

(2) ((If an applicant fails his/her first examination, no additional fee will be required if the candidate is reexamined within one year. Applicants shall pay an examination fee determined by the secretary for examinations taken after the first reexamination.

~~(3)~~)) Applicants who fail the second retest shall be required to submit evidence to the secretary of completion of an individualized program of study approved in advance by the department prior to ((~~being permitted to be reexamined~~)) retaking the examination.

(3) Applicants may have their examination hand-scored by submitting a request and appropriate fee directly to NARM within ninety days of the examination administration. A copy of their request must be sent to the department. The department will inform the applicant of the results of the hand-scored examination.

[Statutory Authority: RCW 18.50.135 and 18.50.045. 92-02-018 (Order 224), � 246-834-080, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as � 246-834-080, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.135. 82-19-079 (Order PL 406), � 308-115-080, filed 9/21/82.]