WSR 19-03-066
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed January 11, 2019, 11:03 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-24-008.
Title of Rule and Other Identifying Information: Chapter 246-850 WAC, Orthotics and prosthetics rules, the department of health (department) is proposing changes to specific rule sections that will better align the rules with industry standards regarding examinations, educational programs, and licensure.
Hearing Location(s): On February 26, 2019, at 10:00 a.m., at the Department of Health, Town Center 2, Room 145, 111 Israel Road S.E., Tumwater, WA 98501.
Date of Intended Adoption: March 5, 2019.
Submit Written Comments to: Kim-Boi Shadduck, Program Manager, Orthotic and Prosthetic Advisory Committee, 111 Israel Road S.E., Tumwater, WA 98501, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by February 26, 2019.
Assistance for Persons with Disabilities: Contact Kim-Boi Shadduck, phone 360-236-2912, fax 360-236-2901, TTY 360-833-6388 or 711, email kimboi.shadduck@doh.wa.gov, by February 19, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule changes update and modernize existing rule pertaining to orthotist and prosthetist services. The proposed revisions clearly describe licensure and application requirements, update continuing competency requirements, and establish clearer standards for applicants and professionals regulated by the secretary of health.
Reasons Supporting Proposal: The proposed rule revisions are necessary to remain current and in alignment with commonly accepted industry standards. The proposed revisions also clarify examination, education and continuing competency requirements. These outcomes support the overarching department goal of access to safe, quality health care services.
Statutory Authority for Adoption: RCW 18.200.050.
Statute Being Implemented: Chapter 18.200 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Kim-Boi Shadduck, Program Manager, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2912.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kim-Boi Shadduck, Program Manager, Department of Health, P.O. Box 47852, Tumwater, WA 98504, phone 360-236-2912, fax 360-236-2901, TTY 360-833-6388 or 711, email kimboi.shadduck@doh.wa.gov.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rules do not impact businesses.
January 10, 2019
John Wiesman, DrPH, MPH
Secretary
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-010Definitions.
The definitions in RCW 18.200.010 and this section apply throughout this chapter unless the context clearly indicates otherwise.
(1) "Maintenance of an orthosis or prosthesis" includes replacement or repair of component parts that is equivalent to the original component and is required due to wear or failure. Maintenance of an orthosis or prosthesis does not include altering the original components or complete replacement of the orthosis or prosthesis.
(2) "NCOPE" means the National Commission on Orthotic and Prosthetic Education.
(3) "CAAHEP" means the Commission for Accreditation of Allied Health Education Programs.
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-020Requirements for licensure.
To qualify for licensure as either an orthotist or prosthetist ((in this state)), a candidate ((must))shall:
(1) Possess a bachelor degree in orthotics or prosthetics from an approved orthotic or prosthetic educational program ((as provided in))consistent with WAC 246-850-110; alternatively, a candidate may complete a certificate program in orthotics or prosthetics from an approved education program as provided in WAC 246-850-110;
(2) Complete a clinical internship or residency ((of 1900 hours)) as required in WAC 246-850-050; and
(3) Successfully complete ((an)) examinations as required in WAC 246-850-060.
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-030Application requirements.
An applicant for licensure shall submit to the department the following:
(1) A completed application and fee as required in chapter 246-12 WAC, Part 2;
(2)(a) Official transcripts, certificate, or other documentation forwarded directly from the issuing agency where the applicant has earned a bachelor degree or completed a certificate program from ((an NCOPE or CAAHEP accredited program as set forth in WAC 246-850-110))a program accredited by NCOPE or CAAHEP, or any other accrediting body with substantially equivalent requirements;
(b) Documentation of successful completion of the clinical patient management course, if the applicant completes education requirements for licensure on or after January 1, 2020;
(3) Documentation of completion of an approved internship or residency ((of at least 1900 hours as provided))as described in WAC 246-850-050;
(4) Documentation of successful completion of ((a)) licensing examinations as approved by the secretary;
(5) Verification of four clock hours of HIV/AIDS education as required in chapter 246-12 WAC, Part 8((.));
(6) Verification from all states in which the applicant holds or has held a license, whether active or inactive, indicating that the applicant is or has not been subject to charges or disciplinary action for unprofessional conduct or impairment; and
(7) Additional documentation as required by the secretary to determine whether an applicant is eligible for licensure.
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-050Approved internship or residency requirement.
((Applicants must complete an internship of at least 1900 hours in each area for which a license is sought. Individual internships must be completed within a minimum period of one year and a maximum period of two years unless extended by the secretary for good cause shown. The internship or residency must be completed under a supervisor qualified by training and experience in an established facility and incorporate patient management and clinical experience in rehabilitation, acute and chronic care in pediatrics and of adults. Applicants who submit evidence of completion of a 1900 hour internship or residency which is approved by the National Commission on Orthotic and Prosthetic Education (NCOPE) or Commission for Accreditation of Allied Health Education Programs (CAAHEP) are considered to have met the requirements of this section. The 1900 hours of internship training must be completed subsequent to graduation from an approved program))(1) An applicant shall submit evidence of successful completion of a clinical internship or residency approved by NCOPE or CAAHEP.
(2) The clinical internship or residency in either orthotics or prosthetics must be at least one year in duration.
(3) The combined clinical internship or residency in both orthotics and prosthetics must be at least eighteen months in duration.
AMENDATORY SECTION(Amending WSR 99-07-122, filed 3/24/99, effective 4/24/99)
WAC 246-850-060Examination requirements.
(1) An applicant for licensure as an orthotist ((must))shall successfully complete the following examinations:
(a) The orthotic written multiple choice examination prepared and administered by the American Board for Certification in Orthotics ((and Prosthetics, Inc., administered after July 1, 1991. The passing score is determined by utilizing a criterion-referenced cut score methodology.)), Prosthetics and Pedorthics;
(b) The orthotic written simulation examination prepared and administered by the American Board for Certification in Orthotics ((and Prosthetics, Inc., administered after July 1, 1991. The passing score is determined by utilizing a criterion-referenced cut score methodology)), Prosthetics and Pedorthics; and
(c) The Washington state jurisprudence examination.
(2) An applicant for licensure as a prosthetist ((must))shall successfully complete the following examinations:
(a) The prosthetic written multiple choice examination prepared and administered by the American Board for Certification in Orthotics ((and)), Prosthetics((, Inc., administered after July 1, 1991. The passing score is determined by utilizing a criterion-referenced cut score methodology.))and Pedorthics;
(b) The prosthetic written simulation examination prepared and administered by the American Board for Certification in Orthotics ((and)), Prosthetics((, Inc., administered after July 1, 1991. The passing score is determined by utilizing a criterion-referenced cut score methodology))and Pedorthics; and
(c) The Washington state jurisprudence examination.
(3) An applicant who has successfully completed examinations administered by the American Board for Certification in Orthotics, Prosthetics and Pedorthics prior to July 1, 1991, may be considered by the secretary in order to determine if the applicant meets alternative standards that are substantially equivalent.
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-110Approval of orthotic and prosthetic educational programs.
(((1) For purposes of WAC 246-850-020,))The secretary recognizes as approved those orthotic and prosthetic programs ((that:
(a) Are)) approved by ((the National Commission on Orthotic and Prosthetic Education (NCOPE) or its successor, or the Commission on Accreditation of Allied Health Programs (CAAHEP) or its successor))NCOPE, CAAHEP or any other accrediting body with substantially equivalent requirements((; and
(b) Meet the requirements of subsections (2) and (3) of this section.
(2) Approved baccalaureate degree programs or certificate programs must have as prerequisites the following college level coursework:
(a) Biology.
(b) Psychology.
(c) Physics.
(d) Chemistry.
(e) Physiology.
(f) Human anatomy.
(g) Algebra/higher math.
(3) Approved baccalaureate degree programs or certificate programs must include the following coursework within a minimum of three quarters or two semesters, or in a substantially equivalent accelerated program, in each practice area for which a license is sought.
(a) Orthotics only:
(i) Lower extremity orthotics.
(ii) Upper extremity orthotics.
(iii) Spinal orthotics.
(iv) Pathophysiology.
(v) Biomechanics and kinesiology.
(vi) Radiographic interpretation.
(vii) Normal and pathological gait.
(viii) Clinical evaluation.
(ix) Clinical affiliation.
(x) Research methods.
(xi) Practice management.
(b) Prosthetics only:
(i) Lower extremity prosthetics.
(ii) Upper extremity prosthetics.
(iii) Pathophysiology.
(iv) Biomechanics and kinesiology.
(v) Radiographic interpretation.
(vi) Normal and pathological gait.
(vii) Clinical evaluation.
(viii) Clinical affiliation.
(ix) Research methods.
(x) Practice management)).
AMENDATORY SECTION(Amending WSR 98-21-086, filed 10/21/98, effective 11/21/98)
WAC 246-850-120Withdrawal of program approval.
Approval of an educational program((s)) may be withdrawn by the secretary, as provided in chapter 34.05 RCW and chapter 246-10 WAC, if the program:
(1) ((A program))Ceases to be approved by NCOPE or CAAHEP; or
(2) Fails to maintain the accreditation standards of NCOPE or CAAHEP((; or
(3) Does not meet the minimum curriculum requirements as provided in WAC 246-850-110)).
AMENDATORY SECTION(Amending WSR 03-17-093, filed 8/20/03, effective 12/1/03)
WAC 246-850-140Continuing competency requirements for orthotists and prosthetists.
(1) ((Beginning on January 1, 2004,))The continuing competency reporting cycle begins with the first full three-year period after initial licensure. All orthotists and prosthetists shall ((report))attest to completion of continuing competency activities every ((three years. The reporting cycle begins at the first license renewal following initial licensing.
(2) Each licensed orthotist and prosthetist shall complete a professional enhancement plan describing the goals the licensee will develop to maintain proficiency in their practice. A professional enhancement plan must be completed in the first year of each three-year reporting period on forms provided by the secretary. The plan may focus on one specific area of practice or broader areas as determined by the individual's goals.
(3)))year at renewal and shall comply with chapter 246-12 WAC, Part 7.
(2) All licensed orthotists and prosthetists ((must accumulate))shall complete continuing competency hours as follows:
(a) Licensed orthotists ((must accumulate))shall complete a minimum of forty-five continuing competency hours every three years in the area of orthotics.
(b) Licensed prosthetists ((must accumulate))shall complete a minimum of forty-five continuing competency hours every three years in the area of prosthetics.
(c) Individuals who are licensed as both an orthotist and as a prosthetist ((must accumulate))shall complete a minimum of sixty continuing competency hours every three years.
(((4)))(3) For individuals licensed in one discipline, a maximum of eighteen Category 2 continuing competency hours may be earned in any three-year reporting period.
(((5)))(4) For individuals licensed in both disciplines, a maximum of twenty-four Category 2 continuing competency hours may be earned in any three-year reporting period.
(((6) Refer to chapter 246-12 WAC, Part 7 for additional requirements.))(5) Licensees may alternatively meet the continuing competency requirement if they hold a current certification from the American Board for Certification in Orthotics, Prosthetics and Pedorthics. The required documentation is proof of certification during the three-year cycle.
AMENDATORY SECTION(Amending WSR 03-17-093, filed 8/20/03, effective 12/1/03)
WAC 246-850-150Classification of categories of continuing competency.
Continuing competency activities are distinguished between activities which are sponsored by those organizations listed in subsection (1) of this section and those which are generally either independent ((and/or))or unsupervised, or both and are listed in subsection (2) of this section.
(1) Category 1. Courses offered or approved by the following organizations ((are presumed to)) qualify as Category 1 continuing competency activities. Category 1 activities receive one continuing competency credit hour for every fifty minutes spent in a course or other activity. Licensees ((must))shall maintain documentation of attendance at courses. Acceptable documentation includes certificates or receipts with an authorized signature, stamp or seal.
(a) American Board for Certification in Orthotics ((and)), Prosthetics((, Inc))and Pedorthics.
(b) Board for Orthotist/Prosthetist Certification.
(c) American Academy of Orthotists and Prosthetists.
(d) American Orthotic and Prosthetic Association.
(e) International Association of Orthotics and Prosthetics.
(f) International Society of Prosthetics and Orthotics.
(g) Association of American Children's Orthotics and Prosthetics Clinics.
(h) Canadian Orthotic and Prosthetic Association.
(i) Any school or college of orthotics or prosthetics ((whose standards are deemed sufficient))approved by the secretary under RCW 18.200.050(5).
(j) Relevant school or college courses from an institution accredited by a recognized regional accrediting body.
(k) Relevant courses or seminars offered by organizations or associations such as the American Society of Orthopedic Surgeons, the American Academy of Physical Medicine and Rehabilitation, the American College of Sports Medicine, the American Medical Association, the American Occupational Therapy Association, the American Physical Therapy Association, the American Osteopathic Association, and the American Podiatric Medical Association.
(l) Manufacturer courses approved/sponsored by organizations listed in subsection((s)) (1)(a) through (k) of this section.
(2) Category 2. Category 2 continuing competency activities are primarily either independent ((and/or))or unsupervised ((and consistent with the goals specified in the individual licensee's professional enhancement plan)), or both. Licensees ((must))shall maintain documentation of completion of Category 2 activities. The following activities, and designated continuing competency credit hours, are considered Category 2 continuing competency:
(a) Relevant allied health seminars not identified as Category 1 activities. A credit hour is fifty minutes spent in a course or other activity. A maximum of five continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation includes certificates or receipts with an authorized signature, stamp or seal.
(b) Practice management. For the purpose of this section, practice management includes only those activities which are directly related to patient care. A credit hour is fifty minutes spent in this activity. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation includes verification of completion of a course or seminar, or a written certification by the licensee describing the activity, the total time required to complete the activity and the date completed.
(c) Journal reading, including electronic publications that are consistent with the goals specified in the individual licensee's professional enhancement plan.
(i) Scientific journals with required examination((:)). Each examination qualifies for two continuing competency credit hours. A maximum of six continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a certificate issued by the sponsoring organization or author showing successful completion of the examination.
(ii) Scientific journals not requiring an examination((:)). Each report qualifies for one continuing competency credit hour. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation for each article is a written report identifying the publication source, author, publication date, and a summary of at least five points from the article.
(iii) Business journals((:)). Each report qualifies for one continuing competency credit hour. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation for each article, is a written report identifying the publication source, author, publication date, and a summary of at least five points from the article.
(d) Instruction video, videodisc or internet courses((:)). A credit hour is fifty minutes spent in this activity. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a written report identifying the source of the instruction, the release date, and summarizing at least five points presented in the instruction.
(e) Manufacturer courses sponsored by organizations not identified as Category 1 activities((:)). A credit hour is fifty minutes spent in this activity. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation includes certificates or receipts with an authorized signature, stamp or seal.
(f) Participating in peer review((:)). For the purpose of this section, peer review means either serving on a formal peer review panel, committee or individual review of a sole provider, where the purpose of the review is to determine whether appropriate treatment was rendered, or whether the services rendered were within accepted standards. Each occurrence qualifies for three credit hours. A maximum of nine continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a certification signed by the facilitator of the peer review providing the date and the total time spent in the peer review process.
(g) Student or peer mentoring((:)).
(i) Student mentoring. Each four-hour period spent in this activity qualifies for one credit hour. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a copy of the mentoring contract or agreement and a certification from the student substantiating the date(s) engaged in mentoring and the total mentoring time.
(ii) Peer mentoring. Each four-hour period spent in this activity qualifies for one credit hour. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a certification summarizing the subject of the mentoring, the date, and total mentoring time and signed by the licensee and at least one other practitioner participating in the mentoring activity.
(h) Documented group study((:)). A credit hour is fifty minutes spent in this activity. A maximum of six continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a summary of the group study topics, the date, and total group study time, signed by the facilitator or other authorized personnel.
(i) Grand rounds((:)). Each report qualifies for one credit hour. A maximum of three continuing competency credit hours may be earned in this activity in any three-year reporting period. Acceptable documentation is a report summarizing the cases presented, the location, date, and total time spent in the grand rounds activity and signed by the facilitator or other authorized personnel.
(j) Presentation or lecture to professional group((:)). Each presentation or lecture qualifies for two credit hours. A maximum of six continuing competency credit hours may be earned in this activity in any three-year reporting period. Credit for subsequent presentations will only be considered if the licensee can demonstrate that substantial additional preparation was required. Acceptable documentation is a course outline and a certification from the licensee providing the location, date and total presentation time.
(k) Other activities that enhance or expand the practice may be submitted to the secretary for consideration.
AMENDATORY SECTION(Amending WSR 03-17-093, filed 8/20/03, effective 12/1/03)
WAC 246-850-160Auditing for compliance.
Licensed orthotists and prosthetists ((must))shall comply with continuing competency auditing and documentation requirements as required in chapter 246-12 WAC, Part 7((. If audited, the licensee will be required to submit the professional enhancement plan and documentation of completion of the activities projected in the plan))and WAC 246-850-150. The secretary may require additional information as needed to ((assess the compliance))complete the audit.
AMENDATORY SECTION(Amending WSR 15-19-149, filed 9/22/15, effective 1/1/16)
WAC 246-850-990Orthotic and prosthetic fees.
(1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.
(2) The following nonrefundable fees will be charged:
Title of Fee
Fee
Original application
 
 
Orthotist application
$265.00
 
Prosthetist application
265.00
Active renewal
 
 
Orthotist renewal
125.00
 
Prosthetist renewal
125.00
 
Late renewal penalty fee
65.00
 
Expired credential reissuance fee
190.00
Inactive renewal for orthotist or prosthetist
 
 
Renewal fee
((135.00))
70.00
 
Late renewal fee
((70.00))
50.00
Retired active renewal for orthotist or prosthetist
 
 
Renewal fee
((135.00))
70.00
 
Late renewal fee
((70.00))
50.00
Duplicate credential
30.00
Verification of credential
30.00
REPEALER
The following sections of the Washington Administrative Code are repealed:
WAC 246-850-040
Licensure without examination.
WAC 246-850-130
Continuing competency scope and purpose.