DEPARTMENT OF HEALTH

(Chiropractic Quality Assurance Commission)

[Filed December 5, 2018, 9:37 a.m.]

Preproposal statement of inquiry was filed as WSR 17-02-045.

Title of Rule and Other Identifying Information: WAC 246-808-020 Accreditation and Approval of Colleges—Policy (formerly Colleges—Policies), 246-808-030 Accreditation of colleges—Procedure and 246-808-040 Colleges—Educational standards required for accreditation, the chiropractic quality assurance commission (commission) is proposing amending these sections to update, clarify, and modernize the language. Additionally, the commission is creating WAC 246-808-050 Early remediation program—Purpose, 246-808-060 Early remediation program—Definitions, and 246-808-070 Early remediation program—Criteria. The commission is proposing creating new sections as an alternative to certain disciplinary actions.

Hearing Location(s): On January 10, 2019, at 10:30 a.m., at the DoubleTree by Hilton - Seattle Airport, 18740 International Boulevard, Seattle, WA 98188.

Date of Intended Adoption: January 10, 2019.

Submit Written Comments to: Robert Nicoloff, Exectutive Director, Chiropractic Quality Assurance Commission, P.O. Box 47858, Olympia, WA 98504-7858, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2360, by January 2, 2019.

Assistance for Persons with Disabilities: Contact Robert Nicoloff, phone 360-236-4924, fax 360-236-2360, TTY 360-833-6388 or 711, email cqac@doh.wa.gov, by January 2, 2019.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The commission is proposing to amend WAC 246-808-020, 246-808-030 and 246-808-040, to provide clarity and modernize the commission's accreditation and approval process. These rules were last updated in 1996. Since that time, chiropractic professional best practices have evolved relative to policies, procedures, and educational standards required for accreditation of chiropractic colleges. Under the commission's regulatory jurisdiction and authority, the proposal would maintain the commission's authority to accredit chiropractic schools. It also identifies established national and international chiropractic bodies, such as the Council on Chiropractic Education (CCE) and the Council on Chiropractic Education International (CCEI), citing their expertise in cost-effectively assessing and validating chiropractic schools and colleges that meet Washington's chiropractic educational requirements under chapter 18.25 RCW. New sections are added to establish an early remediation process to better address minor practice deficiencies not resulting in patient harm.

Reasons Supporting Proposal: Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state. The proposal meets the intent of the statute by clarifying, streamlining, and modernizing the rules, and to make the rules consistent with current laws and practice standards for accreditation and approval of college programs while further protecting the public. Implementation of an early remediation process would allow the commission to better address a wider range of disciplinary issues to further patient safety.

Statutory Authority for Adoption: RCW 18.25.0171 and 18.130.050.

Statute Being Implemented: RCW 18.25.0171.

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

Name of Proponent: Chiropractic quality assurance commission, governmental.

Name of Agency Personnel Responsible for Drafting and Implementation: Leann Yount, Program Manager, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2822; and Enforcement: Tammy Kelley, Disciplinary Manager, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-2326.

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 Robert Nicoloff, Executive Director, Chiropractic Commission, P.O. Box 47858, Olympia, WA 98504-7858, phone 360-236-4924, fax 360-236-2360, TTY 360-833-6388 or 711, email cqac@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. Minor cost threshold = one percent of annual payroll of colleges, universities, and professional schools = $64,917. NAICS code 611310 lists annual payroll covering ninety-one establishments at $590,748,000. ($590,748,000/91) * 0.01 = $64,917.

Annualized accreditation cost (see table below for details):

First four years: $5,313 per year ($313 + $625 + $2625 + $1750).

Fifth year and thereafter: $4,438 per year ($313 + $625 + $2625 + 875).

Amount	Description	Requirements	Notes
$2,500	Initial application fee	$2,500 one-time	For initial accreditation only $2,500/8 = $313 per year first eight years
$5,000	Initial self-study report	$5,000 one-time	For initial accreditation only $5,000/8 = $625 per year first eight years
$21,000	Focused comprehensive site visit	Initial and every eight years	$21,000/8 = $2,625 per year
$7,000	Interim site visit	$7,000 once every four years after each comprehensive site visit	$7,000/4 = $1750 per year for the first four years. $7,000/8 = $875 annual cost for year five and after.
Unavailable	College resources to prep CCE application (time x salary, printing, copying, postage…)	One-time	Neither CCE nor the colleges contacted were willing to provide this information. They expressed that it is proprietary/confidential.
Unavailable	College resources to accompany/be available to CCE personnel for site visits	Every four years	Costs may differ based on comprehensive vs. interim site visit (length of time and number of personnel required). Same as above.

Source: The Council on Chiropractic Education (CCE). http://www.cce-usa.org/publications.html and http://www.cce-usa.org/uploads/1/0/6/5/106500339/2018-01_cce_manual_of_policies.pdf.

AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)

WAC 246-808-020Accreditation and approval of chiropractic colleges—Policy.

(1) In determining a chiropractic college's eligibility for accreditation and approval in the state of Washington, the commission may utilize((, at its discretion,)) recognized national or international chiropractic accrediting ((associations, recognized regional accrediting associations, and appropriate professional firms, agencies and individuals))bodies that meet the criteria in WAC 246-808-040 (3)(d), (e), and (f), unless the chiropractic college applies directly to the commission for accreditation and approval under RCW 18.25.025, and meets all criteria of WAC 246-808-040.

(2) ((Accreditation shall be))The commission shall accredit and approve chiropractic colleges primarily contingent upon a course of study ((which))that incorporates educationally sound practices and complies with the chiropractic educational requirements for the state of Washington as defined in WAC 246-808-040.

(((3) A college must have successfully graduated a class prior to making application for accreditation.))

AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)

WAC 246-808-030Accreditation of chiropractic colleges—Procedure.

In determining a chiropractic college's eligibility for accreditation and approval in the state of Washington, the chiropractic college must be accredited by a commission-recognized national or international accrediting body whose standards meet the criteria of WAC 246-808-040 (3)(d), (e), and (f), or receive accreditation and approval from the commission in accordance with RCW 18.25.025 and WAC 246-808-040.

(1) Application and determination. ((A chiropractic college which desires to be accredited by the commission may secure an application form by sending a written request to the commission. The applicant shall complete the application form and submit it to the commission, along with any accompanying documents. Recent photographs of the college or the buildings in which the college is located shall be submitted with the application.))

(a) To apply for accreditation and approval by the commission, a chiropractic college shall send a written request to the commission requesting an application form. The applicant shall complete the application form and submit it to the commission, along with any accompanying documents, and recent photographs of the chiropractic college or the buildings in which the chiropractic college is located.

(b) Within one hundred twenty days after the receipt of the completed application, the commission shall consider the application, determine whether or not the chiropractic college fulfills the requirements ((for accreditation))in WAC 246-808-040, and notify the applicant((, by mail,)) of the commission's determination. If the commission determines that the chiropractic college ((is not))cannot be accredited and approved ((for accreditation)), the notice shall ((set forth))include the reasons for denial. The commission may withhold making a determination for a reasonable period of time for any justifiable cause upon giving notice to the applicant.

(2) ((Interrogatories. If))Additional information. The commission ((desires, it)) may request additional information from the applicant ((to))including answers to specific inquiries. The ((granting or the denial of accreditation may be))commission may grant or deny the accreditation and approval contingent upon the applicants' response to such inquiries.

(3) ((Oath. The answers to the inquiries in the application, and any other inquiries, shall be sworn to before a notary public.

(4))) Inspection. ((If))The commission ((desires, it)), at its discretion, may make ((the))a physical inspection of ((a particular))the applicant's chiropractic college a condition for ((its being accredited. Reasonable costs for necessary on-campus visitation shall be paid by the applicant.

(5)))accreditation and approval.

(4) Duration. ((A college which is once accredited))An accredited and approved chiropractic college shall continue to be accredited and approved for ((so))as long as it fulfills the requirements ((set forth by the commission, or to be set forth by the commission. Upon receiving convincing evidence that a college has ceased to fulfill the requirements, the commission shall withdraw the accreditation of the college and shall inform the college of its reasons for doing so))of this chapter.

(a) A chiropractic college shall ((inform))report to the commission ((of))any changes((, if any, in status which could reasonably jeopardize the))to its accreditation status, financial solvency, ownership status, administration, or curriculum.

(b) A chiropractic college shall also report any changes to its faculty, facilities, or equipment that may affect the chiropractic college's qualifications for ((accreditation. Such changes shall include, but are not limited to, changes in curriculum, administration, faculty, classrooms and equipment.

(6) Revocation of accreditation. When the commission receives evidence that an accredited institution is not complying with commission criteria, it may, after meeting with institutional representatives, place the institution on probation. The institution shall be supplied))commission accreditation and approval.

(5) Enforcement. The commission may place an accredited and approved chiropractic college on probation when the commission receives evidence that the chiropractic college is not meeting criteria for continued commission accreditation and approval. The commission will provide the chiropractic college with a written statement of ((charges setting forth))deficiencies describing the specific((s))areas of ((the)) noncompliance. The commission and ((chief administrative officer of the institution))the chiropractic college may agree on a mutually acceptable timetable and procedures for correction of the deficiencies or the commission may set the timetable. Should the ((institution))chiropractic college not make the required corrections ((recommended)), or should further deficiencies develop during the probation, the commission may((, after meeting with institutional representatives,)) revoke the ((accreditation))approval of the chiropractic college. The commission need not place a chiropractic college on probation before pursuing suspension or revocation of the approval.

(((7) Reinstatement of accredited status. Once the commission has revoked the accredited status of an institution, it must reapply by submitting either a new self-study or an updated self-study as may be required by the commission. The commission's usual procedure for applicants for initial accreditation and petitions for renewal is applied to petitioners for reinstatement. The visitation team report, hearing evidence and supporting data must show not only correction of the deficiencies which led to the disaccreditation but, in addition, compliance with the commission's criteria.

(8) Appeal. An appeal of a decision adverse to the college))(6) Appeal. A chiropractic college whose approval is suspended or revoked may request an adjudicative proceeding under chapter 246-11 WAC to contest the decision. A request for an adjudicative proceeding must be filed with the commission within thirty calendar days of ((receipt))service of the commission's ((written))notice of decision. ((To be valid the appeal must contain a certified copy of a formal action authorizing the appeal, taken by a lawfully constituted meeting of the governing body of the institution. The appeal is based on a review of self-evaluation documents, catalog, visitor's report, institution's response to visitor's report, predecision hearing of the commission and commission decision. Alleged improvements effective subsequent to the evaluation which can be verified only through another on-site visit provide the basis for another evaluation, not for an appeal. An appeal does not include a dispute on a finding of fact unless appellant presents a valid reason showing the finding is clearly erroneous in view of the reliable, probative and substantial evidence on the whole record before the commission. The commission shall meet to consider the appeal at its earliest opportunity, and send a formal reply to the appealing college within thirty days of such meeting, unless it extends the time for good cause shown.))

AMENDATORY SECTION(Amending WSR 96-16-074, filed 8/6/96, effective 9/6/96)

WAC 246-808-040Chiropractic colleges—Educational standards required for accreditation and approval.

(1) ((Objectives - The college))A chiropractic college seeking to obtain or maintain commission accreditation and approval shall have clearly defined education objectives.

(2) Administration and organization(( - )). The chiropractic college shall:

(a) Be incorporated as a nonprofit institution and recognized as such by its state of domicile((.));

(b) Have a full-time administrator((.));

(d) Adopt ((policy of))policies on nondiscrimination as to national origin, race, religion, or ((sex))sexual orientation.

(3) The chiropractic college shall provide educational offerings ((- The college shall))that:

(a) ((Provide educational offerings which prepare))Prepare the student for successfully completing the licensing examination and engaging in practice((.));

(b) ((Offer))Have an educational program with a minimum of four thousand ((in-class))classroom hours provided over a four year academic term((.));

(d) Offer a chiropractic curriculum as follows:

(i) Principles of chiropractic - Two hundred ((in-class))classroom hours;

(ii) Adjustive technique - Four hundred ((in-class))classroom hours;

(iii) Spinal roentgenology - One hundred seventy-five ((in-class))classroom hours;

(iv) Symptomatology and diagnosis - Four hundred twenty-five ((in-class))classroom hours; and

(v) Clinic - Six hundred twenty-five ((in-class))classroom hours.

(e) ((Offer at least one hundred twenty hours for the study of "principles of chiropractic" as the study of chiropractic philosophy, which shall be defined as the commonly held tenets which provide the basis for chiropractic as a separate and distinct form of practice.

The required one hundred twenty hours of philosophy instruction shall be clearly identified in the application and subsequent college catalogue as philosophy of chiropractic by course title and description. The remaining eighty required hours may include history of chiropractic, ethics, interprofessional relationships and other subjects specifically relating to the principles and practice of chiropractic.

(f)))The computation of hours required in subsection (3)(d) of this section do not include mechanotherapy, physiotherapy, acupuncture, acupressure, ((or dietary therapy)) or any other therapy ((in computation of the qualifying four thousand classroom hours.

(g))); and

(f) Maintain a clinical program sufficient to fulfill the objectives of the chiropractic college.

(4) Faculty - The chiropractic college shall provide sufficient faculty to support the educational program of the chiropractic college.

(5) Students - The chiropractic college shall:

(a) Select students on a nondiscriminatory basis((.));

(b) Require that students maintain a 2.00 grade point average and have no chiropractic subject grade less than ((2.0.))2.00; and

(c) Require the student to complete a four-year academic program ((which))that meets all requirements of ((statute and rule))chapter 18.25 RCW and this chapter for licensing to practice chiropractic in Washington state.

(6) Physical facilities and equipment - The chiropractic college shall:

(a) Maintain a library of size and quality sufficient to serve the educational program((.));

(b) Maintain a ((basic))physical plant that facilitates the educational program((.)); and

(c) Maintain clinic facilities that are of sufficient size and equipped appropriately to serve the number of students enrolled.

(7) Financial - The chiropractic college shall:

(a) Have adequate present and anticipated income to sustain a sound educational program((.));

(b) Have well formulated plans for financing existing and projected education programs((.));

(d) Make records available for review by the commission upon request.

(8) Self-evaluation - The chiropractic college shall have a program of continuing self-evaluation and such evaluation must be made available upon request by the commission.

(9) A chiropractic college must have successfully graduated a class prior to making application for commission accreditation and approval.

WAC 246-808-050Early remediation program—Purpose.

The purpose of the early remediation program is to address minor practice deficiencies that have not resulted in patient harm. The early remediation program may include education, training, and monitoring to improve the quality of care and reduce the risk of patient harm.

WAC 246-808-060 and 246-808-070 establish the early remediation program and its eligibility criteria and procedures.

The commission intends to use the early remediation program only in cases in which there is no evidence of patient harm as a direct result of the licensee's practice-related deficiencies. The commission may resolve allegations of practice deficiencies through early remediation during an investigation.

WAC 246-808-060Early remediation program—Definitions.

The definitions in this section apply to WAC 246-808-050 through 246-808-070, unless the context clearly requires otherwise.

(1) "Complaint" means a documented report of a possible violation of the Uniform Disciplinary Act, for which the commission shall assess and may subsequently authorize an investigation.

(2) "Licensee" means a chiropractor or chiropractic X-ray technician who holds an active license under chapter 18.25 RCW.

(3) "Remediation plan" means a documented agreement between the licensee named in the complaint(s) and the commission listing remedial steps to be taken by the licensee to resolve the identified practice deficiencies. Remediation plans may include education, training, and monitoring of the licensee.

WAC 246-808-070Early remediation program—Criteria.

(1) The commission shall use the following criteria to determine eligibility for early remediation:

(a) Practice limitations are not needed to ensure patient protection;

(b) The identified practice deficiencies may be corrected by education, training, monitoring, or any combination of these;

(d) The practice deficiency did not result in patient harm.

(2) The commission may offer a remediation plan to resolve a complaint in cases of the following practice deficiencies:

(a) Documentation of care;

(b) Radiographic standards;

(d) Advertising or marketing;

(e) Continuing education; or

(f) Other minor practice concerns as determined by the commission.

(3) The commission may offer a remediation plan to resolve eligible complaints. Nothing in this section requires the commission to offer a remediation plan. A licensee who accepts a remediation plan waives any right to a hearing to modify a remediation plan or challenge the commission's decision regarding successful completion of a remediation plan.

(4) The commission shall use the following process to implement the early remediation program:

(a) After a preliminary investigation identifies the practice deficiencies, the commission shall apply criteria in subsections (1) and (2) of this section to determine eligibility for the early remediation program;

(b) If all of the criteria are met, and if the commission determines the licensee is eligible for participation in the early remediation program, the commission shall propose a remediation plan to the licensee;

(d) The commission may decide to conduct a full investigation and consider disciplinary action if additional facts become known or circumstances change such that the licensee is no longer eligible based on the criteria in subsections (1) and (2) of this section; and

(e) If the licensee complies with the agreed remediation plan, the commission may consider the licensee's completion of the remediation plan as grounds to close the matter without further action.