Original Notice.

     Preproposal statement of inquiry was filed as WSR 02-19-083.

     Title of Rule: WAC 246-815-020 Dental hygiene examination eligibility, 246-815-050 Examination, 246-815-100 Licensure by interstate endorsement of credentials, 246-815-110 Application procedures for approval of dental hygiene expanded functions education programs, and 246-815-115 Exception procedures for approval of dental hygiene expanded functions education programs.

     Purpose: The rules need to be revised to bring them up-to-date to accurately reflect examination standards. The Dental Hygiene Examination Committee recently accepted the central regional dental testing service (CRDTS) examination for endorsement applicants. The proposed rule will assure the state standards reflect CRDTS standards. Removing time restrictions will streamline the application process for examination applicants and expanded function education programs.

     Statutory Authority for Adoption: Chapter 34.05 RCW, RCW 43.70.280, 18.29.120, 13.29.140 [18.29.140], and 18.29.150.

     Statute Being Implemented: Chapter 18.29 RCW.

     Summary: The proposal improves clarity and eliminates redundancy within dental hygienist examination requirements; and updates the existing language to reflect current protocols and requirements.

     Reasons Supporting Proposal: The rules need to be revised to bring them up-to-date to accurately reflect the examination standards, additionally, the proposal will help broaden the applicant pool of dental hygienists in the state.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Vicki L. Brown, Department of Health, 310 Israel Road S.E., Tumwater, 98501, (360) 236-4865.

     Name of Proponent: Department of Health, Dental Hygiene Examination Committee, governmental.

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

     Explanation of Rule, its Purpose, and Anticipated Effects: These rules set the eligibility and exam requirements for Washington state dental hygienists. The proposed rule changes provide clear, concise standards for the examination of dental hygienists in the state of Washington and removes the four-year approval frequency for schools with dental hygiene expanded function educational programs. By improving clarity, and reducing redundancy and updating the examination requirements, the department anticipates a reduction in costs to applicants, and increase in the number of hygienists that may be licensed in Washington and assurance that exam standards reflect current practice and protocol.

     Proposal Changes the Following Existing Rules:

     WAC 246-815-050 Replaces the state-administered Washington written examination with the Washington law examination.

     WAC 246-815-050 Removes the requirement for applicants to take the state-administered Washington restorative examination.

     WAC 246-815-050 Specifies the approved examination for dental hygienists to be administered by the Western Regional Examination Board (WREB) with a passing score determined by national standards. Essentially, the WREB exam will replace parts of the state-administered examination process.

     WAC 246-815-100 Updates existing language and requirements to reflect current protocol and practice, i.e., replacing language and rules detailing the state-administered exam with those for the WREB exam.

     WAC 246-815-100 The use of WREB allows more dental hygienists to become licensed and to practice in a broader area of ten western regional states, rather than being limited to just one specific state. In the end, savings will be afforded by applicants as well as the various licensing state governments including the Department of Health.

     WAC 246-815-020 Reduces the applicant photograph requirement from two to one, resulting in a savings to the applicant and the state.

     WAC 246-815-110 and 246-815-115 Removes the four-year approval frequency for schools with dental hygiene expanded function education programs. Instead, there is a one-time approval with a requirement for schools to contact the Dental Hygiene Examining Committee if there are changes to their educational or administrative curricula.

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

     Under RCW 18.29.110, the Dental Hygiene Examining Committee is authorized to establish qualifications and define education, training, and examination requirements of dental hygienists in the state of Washington. Ultimately, the committee establishes rules that it considers are appropriate for the protection of the consumers of dental hygiene services, the people of the state of Washington.

     Purpose and Objective: The Dental Hygiene Examining Committee is proposing rule changes that will:

•	Add clarity to the examination requirements for dental hygienists.
•	Eliminate redundancy in the examination requirements for dental hygienists.
•	Broaden the applicant pool of dental hygienists practicing in the state.
•	Update existing language to reflect current protocols and requirements.
•	Ensure that all dental hygienists are competent and capable of carrying out their respective professional duties.
•	Improve the overall quality of care provided by dental hygienists.

     Rule-making Requirements of the Regulatory Fairness Act (chapter 19.85 RCW): The Regulatory Fairness Act, RCW 19.85.030 requires the department to conduct a small business economic impact statement (SBEIS) for proposed rules that have more than minor impact on small businesses. As defined in RCW 19.85.020 a small business is "any business 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, and that has fifty or fewer employees."

     What Does the Proposed Rule Amendment Do? The proposed rule changes provide clear, concise standards for the examination of dental hygienists in the state of Washington. The proposed amendment directly affects dental hygienists in the following ways:

•	Replaces the state-administered Washington written examination with the Washington law examination.
•	Removes the requirement for applicants to take the state-administered Washington restorative examination.
•	Specifies the approved examination for dental hygienists to be administered by the Western Region Examination Board (WREB) with a passing score determined by national standards. Essentially, the WREB exam will replace parts of the state-administered examination process.
•	Updates existing language and requirements to reflect current protocol and practice, i.e., replacing language and rules detailing the state-administered exam with those for the WREB exam.
•	The use of WREB allows more dental hygienists to become licensed and to practice in a broader area of ten western region states, rather than being limited to just one specific state. In the end, savings will be afforded by applicants as well as the various licensing state governments including the Department of Health.
•	Reduces the applicant photograph requirement from two to one, resulting in a savings to the applicant and the state.
•	Removes the four-year approval frequency for schools with dental hygiene expanded function education programs. Instead, there is a one-time approval with a requirement for schools to contact the Dental Hygiene Examining Committee if there are any changes to their educational or administrative curricula.

     Affected Industries/Disproportionate Impact: In preparing this SBEIS, the Department of Health used the following SIC codes:

SIC	Description	Minor Impact Thresh
8021	Offices and clinics of dentists	$ 66.10
8099	Health and allied services, nec	$ 66.10
8093	Specialty outpatient clinics, nec	$ 116.33

     These three SIC codes indicate a minor impact threshold of $66.10 - $116.33. The estimated cost to all health care practitioners, including dentists and dental hygienists, for amending these rules is zero. Therefore, there is no disproportionate cost to small business.

     Immediate and direct savings are expected for dental hygienists, as they are now required to take a regional exam that encompasses a ten-state region of the United States. This alleviates a burden on dental hygienists, and results in a reduction in lost wages and alternative time costs spent on registration, preparation, fees, and successfully passing multiple exams in order to obtain multiple state licensure. With the WREB exam, dental hygienists from outside the state can become more easily and quickly licensed in Washington state. In addition, dental clinics and facilities can hire dental hygienists more expeditiously, reducing costs spent on recruiting and hiring from outside the state, within the ten-state, Western United States region. Furthermore, the reduction in the photograph requirement - from two to one - results in quantifiable savings directly to the applicant. Furthermore, by eliminating the requirement for a four-year frequency for approving schools with expanded function education programs, savings are afforded to schools, the state and the public, resulting in improved education outcomes. In the end, savings is expected on all sides by all parties involved: Dental hygienists, dental offices and clinics, the department, and most importantly the consumers of dental hygiene services, the people of the state of Washington.

     How the Department of Health Will Notify Businesses: Upon adoption, these rules will be made available to businesses that involve dental hygienists, dental professionals, employers and facilities in a number of ways.

•	Available on the internet.
•	Copy sent electronically to all businesses that have asked to be placed on the interested persons e-mail list.
•	Included in the next updated law book which is sent upon request to businesses and licensees.
•	Available at the front counter for businesses and licensees.
•	Copy of rule is available through the Code Reviser's Office, which is available to all businesses and licensees.

     How the Department of Health Has Involved Businesses in the Rules-Making Process: At the very beginning of the rules writing process, notices were sent to all persons on the interested parties mailing list. Additionally, several rules writing meetings were scheduled in which the public - including small businesses - were invited.

     Costs to the Department of Health to Administer the Regulation: There are no new additional costs to the Department of Health to amend or repeal these rules. No additional review time and no additional analyses are required as a result of the amendments.

     A copy of the statement may be obtained by writing to Vicki Brown, Program Manager, Department of Health, P.O. Box 47868, Olympia, WA 98504-7868, phone (360) 236-4865, fax (360) 664-9077.

     RCW 34.05.328 applies to this rule adoption. These rules are legislatively significant because they amend a qualification for the issuance of a license.

     Hearing Location: Department of Health, Point Plaza East, 310 Israel Road S.E., Room 139, Tumwater, WA 98501, on July 6, 2004, at 10:30 a.m. to 11:00 a.m.

     Assistance for Persons with Disabilities: Contact Vicki Brown by June 29, 2004, TDD (800) 833-6388.

     Submit Written Comments to: Department of Health, Vicki Brown, P.O. Box 47868, Olympia, WA 98504-7868, fax (360) 664-9077, by June 29, 2004.

     Date of Intended Adoption: July 12, 2004.

May 27, 2004

M. C. Selecky

Secretary

OTS-6154.4

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

WAC 246-815-020   Dental hygiene examination eligibility.   (1) To be eligible to take the ((Washington)) approved dental hygiene examination, the applicant must meet the following requirements:

     (a) The applicant must have successfully completed a dental hygiene education program approved by the secretary of the department of health pursuant to WAC 246-815-030.

     (b) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.

     (c) The applicant must demonstrate knowledge of Washington law pertaining to the practice of dental hygiene.

     (d) The applicant must complete the required application materials and pay the required fee.

     (2) ((Applications for the dental hygiene examination are available from the department of health dental hygiene program. The completed application must be received by the department of health sixty days prior to the examination.)) The application must include:

     (a) The required examination fee.

     (b) Either the national board IBM card reflecting a passing score or a notarized copy of the national board certificate.

     (c) ((Two)) One photograph((s)) of the applicant taken within one year preceding the application.

     (3) An official transcript or certificate of completion constitutes proof of successful completion from an approved dental hygiene education program. ((Applicants who will successfully complete the dental hygiene education program within forty-five days preceding the examination for which they are applying may provide documentation of successful completion by inclusion of their names on a verified list of students successfully completing the program from the dean or director of the education program.)) No other proof of successful completion is acceptable. ((An applicant may complete the application and be scheduled for the examination, but will not be admitted to the examination if the department of health has not received the required proof of successful completion.))

[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-815-020, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.29 RCW and RCW 18.20.150(4). 95-16-102, § 246-815-020, filed 8/1/95, effective 9/1/95. Statutory Authority: RCW 18.29.130. 92-02-018 (Order 224), § 246-815-020, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-815-020, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 18.29 RCW, RCW 18.29.021, [18.29.]045 and [18.29.]130. 90-23-011 (Order 098), § 308-25-011, filed 11/13/90, effective 12/14/90.]

     (a) The dental hygiene national board examination.

     (b) The Washington ((written)) law examination.

     (c) ((The Washington restorative examination.

     (d) The Western Regional Examining Board (WREB) dental hygiene patient evaluation/prophylaxis and local anesthetic examinations.

     (2))) The ((successful completion of the)) Western Regional Examining Board (WREB) dental hygiene examinations from May 8, 1992((, and thereafter will be accepted)). In lieu of the WREB examination (or any of its subparts), the secretary may accept a substantially equivalent examination (or substantially equivalent subparts).

     (((3))) (2) The committee may, at its discretion, give a test in any other phase of dental hygiene. Candidates will receive information concerning each examination.

     (((4))) (3) The applicant will comply with all written instructions provided by the department of health.

[Statutory Authority: Chapter 18.29 RCW and RCW 18.20.150(4). 95-16-102, § 246-815-050, filed 8/1/95, effective 9/1/95. Statutory Authority: RCW 18.29.120(2). 95-07-003, § 246-815-050, filed 3/2/95, effective 4/2/95. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-815-050, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 18.29 RCW, RCW 18.29.021, [18.29.]045 and [18.29.]130. 90-23-011 (Order 098), § 308-25-015, filed 11/13/90, effective 12/14/90. Statutory Authority: RCW 18.29.031. 86-09-014 (Order PL 585), § 308-25-015, filed 4/7/86.]

     (1) The applicant has successfully completed a dental hygiene education program which is approved by the secretary of the department of health pursuant to WAC 246-815-030.

     (2) The applicant has been issued a valid, current, nonlimited license by successful completion of a dental hygiene examination in another state. The other state's current licensing standards must be substantively equivalent to the licensing standards in the state of Washington. The other state's examination must have included the following portions and minimum level of competency standards.

     (a) Written tests - the written tests include:

     (i) The National Board of Dental Hygiene examination.

     (ii) A state written test covering the current dental hygiene subjects that are tested for Washington state.

     (b) ((Practical tests - all portions shall be graded anonymously by calibrated practicing dental hygienists or dental hygienists and dentists. The calibration process shall consist of training sessions which include components to evaluate and confirm each examiners ability to uniformly detect known errors on pregraded patients and/or dentoforms. Examiners will be calibrated to the established standard of minimum level of competency. The examination must have equivalent patient selection criteria for the patient evaluation, prophylaxis and anesthesia portions. The current Washington state patient selection criteria for examination will be used as the basis of comparison at the time of application for licensure by interstate endorsement of credentials.)) The Western Regional Examining Board (WREB) practical tests. In lieu of the WREB practical tests, the secretary may accept substantially equivalent tests. The practical tests include:

     (i) Patient evaluation clinical competency ((test which includes what is currently tested for the Washington state dental hygiene examination.));

     (ii) Prophylaxis clinical competency ((test which includes what is currently tested for the Washington state dental hygiene examination.));

     (iii) Anesthesia clinical competency ((test which includes what is currently tested for the Washington state dental hygiene examination.)); and

     (iv) Restorative ((test which includes what is currently tested for the Washington state dental hygiene examination)).

     (3) The applicant holds a valid current license, and has been currently engaged in clinical practice at any time within the previous year as a dental hygienist in another state or in the discharge of official duties in the United States Armed Services, Coast Guard, Public Health Services, Veterans' Bureau, or Bureau of Indian Affairs. Verification of licensure must be obtained from the state of licensure, and any fees for verification required by the state of licensure must be paid by the applicant.

     (4) The applicant has not engaged in unprofessional conduct as defined in the Uniform Disciplinary Act in RCW 18.130.180 or is not an impaired practitioner under RCW 18.130.170 in the Uniform Disciplinary Act.

     (5) Applicants must complete seven clock hours of AIDS education as required in chapter 246-12 WAC, Part 8.

     (6) The applicant demonstrates to the secretary knowledge of Washington law pertaining to the practice of dental hygiene.

     (7) The applicant completes the required application materials and pays the required application fee. Applications for licensure by interstate endorsement are available from the department of health dental hygiene program.

     (8) If the secretary of the department of health finds that the other state's licensing standards are substantively equivalent except for a portion(s) of the examination, the applicant may take that portion(s) to qualify for interstate endorsement. That portion(s) of the exam must be successfully completed to qualify for interstate endorsement and an additional examination fee as well as the licensure by interstate endorsement fee shall be required.

[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-815-100, filed 2/13/98, effective 3/16/98. Statutory Authority: Chapter 18.29 RCW and RCW 18.20.150(4). 95-16-102, § 246-815-100, filed 8/1/95, effective 9/1/95. Statutory Authority: RCW 18.29.045. 93-06-042A (Order 332), § 246-815-100, filed 2/24/93, effective 3/27/93. Statutory Authority: RCW 18.29.130. 92-02-018 (Order 224), § 246-815-100, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-815-100, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 18.29 RCW, RCW 18.29.021, [18.29.]045 and [18.29.]130. 90-23-011 (Order 098), § 308-25-041, filed 11/13/90, effective 12/14/90.]

     (2) Applications for approval of dental hygiene expanded functions education programs are available from the department of health, ((professional licensing services,)) dental hygiene program.

     (3) The application shall include but is not limited to a self study guide which reflects WAC 246-815-120 and 246-815-130.

     (4) The application may include a site visit and evaluation at the discretion of the secretary of the department of health.

     (5) An approved dental hygiene expanded function education program shall report in writing all modifications of the approved program to the department of health and shall be required to pay the nonrefundable evaluation fee if the secretary of the department determines that the modification(s) substantially affects an area included in WAC 246-815-120.

     (((6) An approved dental hygiene expanded function education program shall apply for evaluation sixty days prior to the month and day of the initial approval date every four years and shall pay the required nonrefundable evaluation fee. Provided, That the approved dental hygiene expanded function education program has not been required to be evaluated due to modifications within one year prior to the required four year evaluation date.))

[Statutory Authority: RCW 18.29.130. 92-02-018 (Order 224), § 246-815-110, filed 12/23/91, effective 1/23/92. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-815-110, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 18.29 RCW, RCW 18.29.021, [18.29.]045 and [18.29.]130. 90-23-011 (Order 098), § 308-25-072, filed 11/13/90, effective 12/14/90.]

     (a) Currently accredited by the American Dental Association Commission on Dental Accreditation; and

     (b) With accredited program curriculum that includes the administration of local anesthetic, administration of nitrous oxide analgesia and restorative dentistry.

     (2) A program representative may apply for approval of a dental hygiene expanded function(s) education program by submitting to the department:

     (a) An application on forms available from the department of health, ((professional licensing services,)) dental hygiene program((, Olympia, Washington)).

     (b) The current and the proposed expanded function course outlines and syllabuses, and:

     (i) An identification of the differences between the current and proposed courses;

     (ii) Documentation of the differences between the current and proposed courses.

     (3) The program representative shall not submit a self study guide or an application fee.

     (4) The department may, at the secretary's discretion, conduct a site visit and evaluation.

     (5) The representative of an approved expanded function education program shall((: (a))) report all modifications of the approved program to the department in writing((; and

     (b) Apply for evaluation every four years, sixty days prior to the month and day of the initial approval date. Provided, that the program has not been evaluated due to modifications within the year previous to the required evaluation date)).

[Statutory Authority: RCW 18.29.130(6) and 18.29.021 (1)(a). 92-03-126 (Order 236), § 246-815-115, filed 1/21/92, effective 2/21/92.]

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