WSR 99-03-083

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed January 20, 1999, 9:11 a.m.]



Original Notice.

Preproposal statement of inquiry was filed as WSR 98-15-087.

Title of Rule: Examination requirements.

Purpose: Designation of a licensing examination for orthotists and prosthetists.

Statutory Authority for Adoption: RCW 18.200.050 (8)(15).

Statute Being Implemented: RCW 18.200.050.

Summary: Designates a licensing examination for orthotists and prosthetists.

Reasons Supporting Proposal: Implements statutory requirement.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Judy Haenke, 1300 S.E. Quince Street, Olympia, WA 98504, (360) 236-4947.

Name of Proponent: Department of Health, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: Designates a licensing examination for applicants seeking licensure as orthotists or prothetists. The purpose of the rule is to implement statutory requirements by designating an examination that will assess whether candidates for licensure possess adequate knowledge of orthotics and prosthetics as defined in chapter 18.200 RCW.

Proposal does not change existing rules.

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



Small Business Economic Impact Statement

ORTHOTISTS AND PROSTHETISTS

SIGNIFICANT RULES ANALYSIS

ECONOMIC IMPACT ANALYSIS

AND

SMALL BUSINESS ECONOMIC IMPACT STATEMENT

December 7, 1998



objective: To adopt a rule which designates a licensing examination(s) for candidates for licensure as orthotists or prosthetists in Washington state. The single new rule being proposed designates such an examination. The authority for this designation is found in RCW 18.200.070(2) and 18.200.050(8) which provide authority to the secretary of the Department of Health to prepare and administer, or approve the preparation and administration of, examinations for applicants for licensure.

note: The term "O&P provider," "O&P practitioner," or "O&P's" will be used to substitute for "orthotists and prosthetists" throughout this document.

The content outline for the proposed rule is as follows:

WAC 246-850-060 Examination requirements. Candidates for licensure must successfully complete the following examinations in each discipline for which the license is sought:

(1) The 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.

(2) The written simulation examination prepared and administered by the American Board for Certification in Orthotics and Prosthetics, Inc., administered after January 1, 1991. The passing score is determined by utilizing a criterion-referenced cut score methodology.

background: Chapter 18.200 RCW provides for the licensure of orthotists and prosthetists. An orthotist design, fabricates, assembles and fits custom braces or supports for patients who have a disease, injury or deformity that interferes with normal body functions. A prosthetist designs, fabricates and fits prostheses to replace limbs lost due to amputation, deformity or absences.

The secretary has adopted rules relating to licensure and application requirements. Of these rules, WAC 246-850-020(3) requires that a candidate for licensure as an "O or P" complete an examination.

goals and specific objectives of the statute: To protect the consumers of O&P services in Washington from physical, psychological and financial harm by assuring that practitioners are qualified.

is the rule necessary to achieve these goals and objectives? This rule is necessary because it establishes a qualification for the issuance of licenses.

the process used to develop this rule: There are two primary choices when considering a licensing examination. These choices are development of a unique individual Washington state prepared and administered examination, or designation of an existing examination.

Because of the costs and time commitment involved in developing an original examination, the American Board for Certification in Orthotics and Prosthetics, Inc. (ABC) examination was reviewed to determine whether the examination was appropriate to determine minimal competency for Washington candidates.

To assist in the review of the actual examination department staff prepared a comprehensive list of examination content standards for both O&P. When reviewing the actual examination, the Orthotics and Prosthetics Advisory Committee and department staff utilized the comprehensive list to determine whether the content standards for Washington candidates were assessed in the examination. The review also identified whether the examination assessed content areas other than those listed as content areas for Washington candidates. Each question reviewed was scrutinized against the content standards. After the initial review, comparative statistics were developed.

Psychometric standards for both examinations including job/task analysis, construction, administration, analysis, scoring and candidate support were considered.

The two examinations considered are both certifying examination for separate and distinct national certifying associations.

In the final analysis, it was determined that the most appropriate testing mechanism to examine whether candidates are competent in the scope of practice content areas for Washington licensees is the successful completion of the multiple choice and written simulation examinations prepared by ABC and administered after July 1, 1991.

As a matter of clarification, the first administration of the written simulation took place after July 1, 1991. Multiple choice examinations administered after July 1, 1991, incorporated the findings of the first role delineation study conducted by ABC.

It should also be noted that ABC also requires a practical portion for individuals who are seeking national certification with ABC. The practical portion was not included as a requirement for licensure in Washington for a number of reasons.

.*All applicants must complete an internship of at least 1900 hours. These residencies will provide hands on experience to enrollees. Certain standards are required in order to complete the internship programs. It is anticipated that practical skills are assessed during the residency programs.

.*Much of the material covered during the practical component is addressed in the written simulation examination.

.*Because the practical examination is not given at the same time as the multiple choice and written simulation examination, it is a hardship on the candidate.

.*The fee for the three day practical examination is $550.00. This does not include travel and lodging expenses.

Currently, ABC administers the examination twice each year at twenty locations, the closest being Portland, Oregon. The examinations are administered on the same day. Applicants who sit for the examination in Portland, Oregon would probably require an average of twelve hours to travel to Portland, sit for the two examinations, and return.

are the probable benefits of the rule greater than the probable cost? Probable benefits: Improved quality of care - the examination designated by the rule is appropriate for assessing competency of candidates for licensure in Washington. A decrease in the risk for consumers is a direct benefit of receiving care by competent practitioners.

Improved consumer safety - failure of an orthosis or prosthesis can result in injury or permanent damage to the limb on which the device is worn.

Public sense of well being - confidence that the practitioner has met standards for licensure and is competent to practice. Competent O&P care is a key to rehabilitation and helps to mitigate the effects of injury and chronic disease and helps the patients cope.

Financial gain - the patient, his or her family and society in general sustain a financial cost when a member of society, who could otherwise be productive, is unemployable due to inadequate O&P care. Significant financial cost is incurred if O&P care fails to restore function.

Probable costs to regulated parties: Recordkeeping and reporting: The proposed rule would not represent additional recordkeeping or reporting costs to licensees.

Training and education: It is anticipated that candidates will acquire the knowledge necessary to successfully complete the examination in conjunction with completion of the statutorily mandated educational requirements.

New equipment requirements: The proposed rule would not require the purchase or procurement of equipment.

Inspections - audits: There is no requirement for an inspection or audit.

New licenses/fees: There would not be additional fees assessed by the department.

Examination fees: Candidates who sit for the ABC multiple choice or written simulation examination would be assessed by ABC:

$250.00 for the Multiple Choice Examination

$250.00 for the Written Simulation Examination

$75.00 handling/processing fee (includes reporting of scores)

$180.00 free-time to take the examination



The fee for the examinations are the same fees charged by ABC to sit for the certification examination.

The costs to candidates to sit for the ABC examination are likely less than the cost to candidates for a department prepared examination.

Applicants who were ABC certified after July 1, 1991, would already have taken the required examination. There would be no additional examination requirement or fee. There may be a fee assessed for reporting of scores by ABC to Washington for those persons who have already taken the examination.

Licensure and certification: Although national certification is not required for licensure, it is preferred by some employers and institutions. This preference is more prevalent in the western United States than in the south. Many O&P practitioners complete these examinations to obtain ABC certification regardless of the Washington licensure requirement.

Of the 106 recorded certified prosthetists and orthotists in Washington, 87 are certified by ABC.

Probable costs to DOH: There are not significant additional costs to DOH as a result of this rule.

cost/benefit summary: Given the intangible nature of the benefits of the proposed rules, i.e., improved quality of care, improved consumer safety, public sense of well being, and financial gain, it is difficult to compute an actual monetary value. However, when viewed against the costs to the regulated parties, the department concludes that the benefits exceed the costs.

alternatives to rule making: Because the proposed rule establishes a qualification for the issuance of a license, there is no alternative to rule making for the purpose of designating a licensing examination.

violation of another federal or state law? The proposed rule is not in violation of another federal or state law.

impose stricter performance requirements on private entities than public entities: Any proposed performance requirements would apply equally to both private or public entities.

rules differ from federal regulation or statute: There are no known federal regulations or statutes that differ from the proposed rules.

coordinate rule with other federal, state and local laws on same activity: The program has maintained open contact with stakeholders during the course of the rules development.

small business economic impact statement: Nearly all providers pay the fees for their own credentials. Individual providers qualify as small businesses since less than fifty people are employed. 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.

An estimated thirty orthotists and thirty prosthetists per year will have to comply with the requirements of these rules after the initial grandfathering period has passed. There is no examination requirement for grandfathering purposes. Public involvement was solicited through mail to all persons on the interested persons mailing list. In addition, a public meeting was held in the Seattle area.



A copy of the statement may be obtained by writing to Judy Haenke, P.O. Box 47870, Olympia, WA 98504-7870.

RCW 34.05.328 applies to this rule adoption. It establishes qualifications for the issuance of licenses.

Hearing Location: 1102 S.E. Quince Street, Olympia, WA, on February 24, 1999, at 1:00 p.m.

Assistance for Persons with Disabilities: Contact Judy Haenke by February 12, 1999, TDD (800) 525-0127, or (360) 236-4982.

Submit Written Comments to: Judy Haenke, P.O. Box 47870, Olympia, WA 98504-7870, fax (360) 586-0745, by February 19, 1999.

Date of Intended Adoption: February 25, 1999.

January 20, 1999

Kristine Van Gorkom

Deputy Secretary

OTS-2660.3

NEW SECTION



WAC 246-850-060  Examination requirements. (1) An applicant for licensure as an orthotist must 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.

(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.

(2) An applicant for licensure as a prosthetist must 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.

(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.



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