PROPOSED RULES
(Orthotics and Prosthetics)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-08-098.
Title of Rule: Orthotics and prosthetics continuing competency rules, WAC 246-850-130, 246-850-140, 246-850-150, and 246-850-160.
Purpose: Sets forth a continuing competency program for orthotists and prosthetists consisting of credible categories of continuing competency activities, establishing minimum requirements for each category and a three-year reporting cycle. The purpose of the continuing competency program is to ensure that the practitioner remains competent to provide safe and quality care through continuing education that focus on structured and unstructured activities.
Statutory Authority for Adoption: RCW 18.200.050(13).
Statute Being Implemented: Chapter 18.200 RCW.
Summary: All licensed orthotists and prosthetists must accumulate forty-five continuing competency hours every three years. Those who hold both licenses must accumulate sixty continuing competency hours. Hours may be accumulated in two categories, one category includes structured activities generally offered by recognized associations or institutions, and the second category includes activities that are independent and/or unsupervised. Continuing competency activities are subject to random audit by the department.
Reasons Supporting Proposal: To ensure that practitioners maintain their competency to provide safe and quality care to patients.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Judy Haenke, Program Manager, P.O. Box 47870, Olympia, WA 98504-7870, (360) 236-4947.
Name of Proponent: Washington State Orthotics and Prosthetics Advisory Committee, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: NEW SECTIONS:
• WAC 246-850-130 Continuing competency scope and purpose, describes a successful continuing competency program.
• WAC 246-850-140 Continuing competency requirements for orthotists and prosthetists, sets forth the specific requirements for licensed orthotists and prosthetists and for those who hold dual licensure.
• WAC 246-850-150 Classification of categories of continuing competency, defines the two categories of approved continuing competency activities.
• WAC 246-850-160 Auditing for compliance, advises of audit requirements.
The rules will help maintain and enhance the professional competence and services provided by licensed orthotists and prosthetists.
Proposal does not change existing rules.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
Under the proposed rules, licensed orthotists and prosthetists would be required to accumulate a minimum for forty-five continuing competency hours every three years. Those who hold a license in both disciplines would be required to accumulate sixty continuing competency hours every three years. Continuing competency falls into two categories:
Category 1: Structured activities such as lectures series or education courses sponsored by organizations recognized by the industry as qualified providers. Those organizations include national certifying bodies and associations and accredited schools or colleges.
Category 2: Activities which are generally independent and/or unsupervised such as participation in peer review, mentoring, grand rounds, scientific journal review and reporting and practice management.
Costs passed on to the licensee to implement the continuing competency rules would include costs associated with:
• Processing renewals with continuing competency affidavits;
• Conducting random compliance audits;
• Conducting investigations; and
• Taking legal actions for noncompliance with continuing competency requirements.
Affected Industries: The proposed rules affect practitioners in independent, partnership and clinic settings. It may also affect some who provide medical devices.
| SIC | DESCRIPTION | TOTAL UNITS | TOTAL EMP. | SMALLEST 90% | LARGEST 10% |
| 3842 | Surgical appliances and supplies | 37 | 733 | 4.7 | 70 |
| 8049 | Offices of other health practitioners | 913 | 5,450 | 2.57 | 27.38 |
| 8093 | Specialty outpatient clinic | 245 | 7,530 | 9.28 | 113.54 |
• It is not uncommon for an employee to be licensed in both disciplines, as individuals who hold licenses as both an orthotist and prosthetist can provide a much broader spectrum of care. The hourly requirements increase for individuals who hold both licenses.
O Forty hours every three years is required for individuals licensed in one discipline.
O Sixty hours is required for individuals licensed in both disciplines.
• The rule provides for two categories of continuing competency.
O Category one activities represent more cost because they generally require payment of a registration fee and travel to and from the meeting.
O Category two hours are most often independent and/or unsupervised and often can be accomplished during or after regular work hours at little or no costs to the participant.
• Of the forty-five hours required for individuals licensed in one discipline, eighteen hours can be earned in category two.
• Of the sixty hours required for individuals licensed in two disciplines, twenty-four hours can be earned in category two.
Survey: The following survey was sent to persons on the orthotic and prosthetic mailing list and to individuals who responded to mailings during the rules development process. A total of one hundred eighty-five surveys were mailed.
| Are you affiliated with other organizations that require coursework as a requirement for continued membership? | Yes | No |
| Will the coursework requirements in the proposed rules meet the coursework requirements of other organizations in which you are affiliated? | Yes | No |
| If you are a business owner with employees, do you pay the CC registration fees for your employees? | Yes | No |
| ___ Employee ___ Business owner ___ Number of employees |
| Category | Explanation | Time needed to comply in hours or parts of hours | Expense to comply to nearest whole dollar |
| Record keeping | Time or expense to document and store CC records | ||
| Registration fees | Payment of registration fees for CC events (annual costs including employees) | ||
| Travel costs | Costs for travel and meals to attend CC events (annual costs including employees) | ||
| Supplies and equipment | Additional supplies including files, disks, software, text books, etc. (annual costs) | ||
| Labor | Cost for temporary help while yourself or staff is attending CC events (annual costs) | ||
| Lost sales or revenue | A loss sustained directly attributed to compliance with the CC rules (annual costs) | ||
| Total time/ expense |
1. Record keeping: Records which document completion of continuing competency activities must be retained by practitioners during each three-year reporting period. 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 placed in a single file and stored as a negligible share of the practitioner's other records.
2. Reporting: If a licensee is audited, a cost of less than $5.00 will cover copying and mailing of the required records on file.
3. Professional services: There is no evidence that professional services would be required. Employers stagger absences to avoid the need to hire additional staff.
4. Equipment: Registration costs cover any equipment required for course attendance.
5. Supplies: Registration costs cover the costs of any supplies required for course attendance.
6. Labor: Employers stagger absences to avoid the need to hire temporary labor.
7. Increased administrative costs: Administrative costs are negligible.
8. Lost sales or revenue: Employees stagger absences to avoid lost sales or revenue due to lack of employee coverage.
9. Compliance costs: Average compliance costs to businesses.
Survey Results: Of the one hundred eighty-five surveys mailed, twenty-five were returned. Of the twenty-five returned, ten were from businesses that claimed a total of forty-nine employees. Fifteen of the surveys returned were from individual employees.
Most significant was the response to affiliation with other organizations. Of twenty-five responses, twenty-four indicated that they were affiliated with other organizations that require coursework as a requirement for continued membership. (One person did not respond to the questions.)
Of those twenty-four who are members of national certifying bodies that require continuing education to maintain certification, twenty-one responded that the coursework requirements in the proposed rules meets the coursework requirements of the organization in which they are affiliated. (Two persons did not respond to the questions, two persons responded "no.")
The two primary national certifying bodies are the Board for Orthotists and Prosthetists Certification (BOC) and American Board for Certification in Orthotics and Prosthetics, Inc. (ABC). Both certifying bodies require completion of professional coursework to maintain certification. The continuing competency requirements proposed by the department and those in place for these organizations are similar.
| ORGANIZATION | CYCLE | HOURS PER
CYCLE 1 Discipline |
HOURS PER CYCLE 2 Disciplines |
ONE DISCIPLINE Hours per year | TWO DISCIPLINES Hours per year |
| DOH Proposed rules | 3 years | 45 | 60 | 15 | 20 |
| ABC | 5 years | 75 | 100 | 15 | 20 |
| BOC | Annual | 12 | 24 | 12 | 24 |
| • | Payment of registration fees to attend to continuing competency events: | $ | 100.00 | to | $ | 2,000.00 |
| • | Costs for travel and meals to attend continuing competency events: | $ | 118.42 | to | $ | 4,000.00 |
| • | Additional supplies including files, disk software, textbooks, etc.: | $ | 0.00 | to | $ | 1,000.00 |
| • | Costs for temporary help while staff is attending continuing competency events: | $ | 0.00 | to | $ | 3,750.00 |
| • | Loss directly attributed to compliance with continuing competency rules: | $ | 0.00 | to | $ | 10,000.00 |
Is the costs disproportionate? No. Costs per employee are the same for large and small businesses.
What cost minimizing features have been included in the rule? Licensees may receive Category 2 hours for some activities that occur during regular business hours such as mentoring at additional cost to the licensee.
Involvement of Small Business in the Rule Making: Development of continuing competency rules has taken place in open public meetings both in eastern and western Washington. Notices of meetings have been sent to all persons who have expressed an interest in participating in the rule-making process. The mailing lists consist of one hundred eighty-five individuals.
A copy of the statement may be obtained by writing to Judy Haenke, Program Manager, P.O. Box 47870, Olympia, WA 98504-7870, phone (360) 236-4947, fax (360) 586-4359.
RCW 34.05.328 applies to this rule adoption. Because continuing competence is a requirement for maintaining licensure.
Hearing Location: Department of Health, 1101 Eastside Street, Room 5, Olympia, WA 98504, on July 25, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Judy Haenke by July 10, 2003, TDD 1-800-525-0127 or 1-800-833-6388.
Submit Written Comments to: Judy Haenke, Program Manager, P.O. Box 47870, Olympia, WA 98504-7870, (360) 236-4947, judy.haenke@doh.wa.gov.
Date of Intended Adoption: July 25, 2003.
June 3, 2003
M. C. Selecky
Secretary
OTS-5009.5
ORTHOTICS AND PROSTHETICS CONTINUING COMPETENCY RULES
NEW SECTION
WAC 246-850-130
Continuing competency scope and purpose.
The purpose of continuing competency requirements is to
maintain and enhance the professional competency of services
provided by licensed orthotists and prosthetists. A
successful continuing competency program focuses on all
aspects of the practice to ensure that the practitioner is
competent to provide safe and quality care to patients.
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(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) All licensed orthotists and prosthetists must accumulate continuing competency hours as follows:
(a) Licensed orthotists must accumulate a minimum of forty-five continuing competency hours every three years in the area of orthotics.
(b) Licensed prosthetists must accumulate 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 a minimum of sixty continuing competency hours every three years.
(4) 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) 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.
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(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 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.
(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 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 subsections (1)(a) through (k) of this section.
(2) Category 2. Category 2 continuing competency activities are primarily independent and/or unsupervised and consistent with the goals specified in the individual licensee's professional enhancement plan. Licensees must 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) 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.
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