Original Notice.

Preproposal statement of inquiry was filed as WSR 98-22-083.

Title of Rule: Renewal and CME cycles.

Purpose: These rules will change the current annual license renewal for physicians and physician assistant to once every two years. In addition, the continuing medical education cycles will also be revised from three to four years for physicians and from one year to two years for physician assistants.

Other Identifying Information: WAC 246-919-421, 246-919-430, 246-919-450, 246-919-460, 246-919-990, 246-918-171, and 246-918-990.

Statutory Authority for Adoption: RCW 18.71.017 and 18.130.050(1).

Statute Being Implemented: RCW 18.130.040(4), 18.130.050(12), and 18.130.340.

Summary: These regulations revise the cycles for license renewal and reporting of continuing medical education, which would allow a more efficient use of staff resources, as well as accommodating the request by numerous practitioners to lengthen the amount of time between renewal due dates to better align with other national intervals of the same type.

Reasons Supporting Proposal: There has been an increase of approximately 5% of all credentials under the jurisdiction of the Medical Quality Assurance Commission over the last four years. While this increase in workload has occurred, licensing program staffing levels have decreased from six individuals in 1994 to four individuals in 1998. Implementing these rules appears to be the most logical and efficient solution to accommodate practitioner requests for increased renewal cycles, as well as staff resource issues.

Name of Agency Personnel Responsible for Drafting: Susan Anthony, Licensing Manager, 1300 S.E. Quince Street, Olympia, (360) 236-4787; Implementation: Beverly Teeter, Administrator, 1300 S.E. Quince Street, Olympia, (360) 236-4788; and Enforcement: Bonnie King, Executive Director, 1300 S.E. Quince Street, Olympia, (360) 236-4789.

Name of Proponent: Medical Quality Assurance Commission and Department of Health, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: These rules have been developed in response to requests from practitioners to revise the license renewal cycle from an annual basis to a two year renewal. In addition, continuing medical education reporting cycles have also been modified to coincide with renewal due dates: A four year reporting cycle for physicians, and a two year reporting cycle for physician assistants. While revisions are being made for physicians and physician assistants, physicians with a retired active license status or a post graduate training license will continue to renew on an annual basis. This will allow those with reduced incomes to maintain current renewal fees.

Proposal Changes the Following Existing Rules: Existing rules pertaining to continuing medical education, renewal cycles, and fees are being changed to accommodate the revision to a two year renewal cycle and continuing medical education reporting cycles of four years for physicians and two years for physician assistants.

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

As a result of these rules, there will be no administration expenses or professional service requirements. Also, there will be no reduced business and no change to, nor the addition of, paperwork for the licensed practitioners.

All licensed practitioners are governed under RCW 18.130.180.

Public involvement has been solicited from interested party lists and from licensees via an article in the Medical Quality Assurance Commission UPDATE! publication. In addition, two public rule writing workshops were held, one on November 4, 1998, in Spokane and one on November 6, 1998, in SeaTac.

Opportunity for written and oral comments will also be provided during the formal public rules hearing to be held October 12, 1999, in Olympia, Washington.

A copy of the statement may be obtained by writing to Susan Anthony, Licensing Program Manager, Department of Health, Medical Quality Assurance Commission, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4787, fax (360) 586-4573.

RCW 34.05.328 does not apply to this rule adoption. This rule does not change requirements for licensure, just the reporting time period.

Hearing Location: Department of Health, 1101 Eastside Street, Olympia, WA 98504, on October 12, 1999, at 1:30 p.m.

Assistance for Persons with Disabilities: Contact Susan Anthony by October 5, 1999, TDD (800) 833-6388, or (360) 236-4787.

Submit Written Comments to: Susan Anthony, fax (360) 586-4573, by October 5, 1999.

Date of Intended Adoption: October 12, 1999.

August 17, 1999

Bonnie King

Executive Director

OTS-2838.4

NEW SECTION
WAC 246-919-421
Renewal and continuing medical education cycle revision.

Beginning January 1, 2000, the one-year renewal cycle for physicians will transition to a two-year cycle and a four-year continuing medical education reporting cycle. The renewal and continuing medical education reporting cycle will be as follows:

(1) Effective January 1, 2000, any physician whose birth year is an even number will renew their credential for twenty-four months and every two years thereafter. Those physicians must obtain two hundred hours of continuing medical education within the next forty-eight months from the date of the initial two-year license and every four years thereafter.

(2) Effective January 1, 2001, any physician whose birth year is an odd number will renew their credential for twenty-four months and every two years thereafter. Those physicians must obtain two hundred hours of continuing medical education within the next forty-eight months from the date of the initial two-year license and every four years thereafter.

(3) Effective January 1, 2000, in order to attain full license status, individuals with a post-graduate limited license will pay the fee difference between the limited license application and the full license application. This license will expire on their second birthdate after issuance and every two years thereafter.

(4) Effective January 1, 2000, those physicians on a retired active status will remain on the annual renewal cycle and a four-year continuing medical education reporting cycle. Those retired active physicians must report two hundred hours of continuing medical education within the next forty-eight months and every four years thereafter.

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(1) Licensed physicians must complete ((one)) two hundred ((fifty)) hours of continuing education every ((three)) four years as required in chapter 246-12 WAC, Part 7.

(2) In lieu of the ((one)) two hundred ((fifty)) hours of continuing medical education, the commission will accept a current Physician's Recognition Award from the American Medical Association or a current certificate from any specialty board approved by the American Board of Medical Specialties (ABMS) which is considered by the specialty board as equivalent to the ((one)) two hundred ((fifty)) hours of continuing medical education required under WAC 246-919-430(1).  The commission will also accept certification or recertification by a specialty board as the equivalent of ((one)) two hundred ((fifty)) hours of continuing medical education.  A list of the approved specialty boards are designated in the 1995 Official American Boards of Medical Specialty Director of Board Certified Medical Specialist and will be maintained by the commission.  The list shall be made available upon request.  The certification or recertification must be obtained in the ((three)) four years preceding application for renewal.

[Statutory Authority: RCW 43.70.280.  98-05-060, § 246-919-430, filed 2/13/98, effective 3/16/98.  Statutory Authority: RCW 18.71.017 and 18.71A.020.  96-03-073, § 246-919-430, filed 1/17/96, effective 2/17/96.]

((The licensee may earn all one hundred fifty credit hours in Category I.  If the licensee does not earn the one hundred fifty credit hours in Category I, the licensee must earn the total of one hundred fifty credit hours in at least three of the five categories.))  The following are categories of creditable continuing medical education activities approved by the commission:

Category I	Continuing medical education activities with accredited sponsorship
Category II	Continuing medical education activities with nonaccredited sponsorship (maximum of ((sixty)) eighty hours)
Category III	Teaching ((medical)) of physicians or ((the)) other allied health ((services)) professionals (maximum of ((sixty)) eighty hours)
Category IV	Books, papers, publications, exhibits (maximum of ((sixty)) eighty hours)
Category V	((Nonsupervised)) Self-directed activities: Self-assessment, self-instruction, specialty board examination preparation, quality of care and/or utilization review (maximum of ((sixty)) eighty hours).

[Statutory Authority: RCW 18.71.017 and 18.71A.020.  96-03-073, § 246-919-450, filed 1/17/96, effective 2/17/96.]

(1) The credits must be earned in the ((thirty-six)) forty-eight-month period preceding application for renewal of licensure.

(2) Category I: Continuing medical education activities with accredited sponsorship. ((A maximum of one hundred fifty credit hours may be earned in Category I.))  The commission has approved the standards adopted by the Accreditation Council for Continuing Medical Education or its designated interstate accrediting agency, the Washington State Medical Association, in accrediting organizations and institutions offering continuing medical education programs, and will accept attendance at such programs offered by organizations and institutions offering continuing medical education programs, and will accept attendance at such programs offered by organizations and institutions so recognized as Category I credit towards the licensee's continuing medical education requirement for annual renewal of licensure. The licensee may earn all two hundred credit hours in Category I.

(3) Category II: Continuing medical education activities with nonaccredited sponsorship. A maximum of ((sixty)) eighty credit hours may be earned by attendance at continuing medical education programs that are not approved in accordance with the provisions of Category I.

(4) Category III: Teaching ((medical)) of physicians or ((the)) other allied health ((services)) professionals. A maximum of ((sixty)) eighty credit hours may be earned for serving as an instructor of medical students, house staff, other physicians or allied health professionals from a hospital or institution with a formal training program if the hospital or institution has approved the instruction.

(5) Category IV: Books, papers, publications, exhibits.

(a) A maximum of ((sixty)) eighty credit hours may be earned under Category IV, with specific subcategories listed below.  Credit may be earned only during the ((thirty-six)) forty-eight-month period following presentations or publications.

(b) Ten credit hours may be claimed for a paper, exhibit, publication, or for each chapter of a book that is authored and published.  A paper must be published in a recognized medical journal.  A paper that is presented at a meeting or an exhibit that is shown must be to physicians or allied health professionals.  Credit may be claimed only once for the scientific materials presented.  Credit should be claimed as of the date materials were presented or published.

Medical editing can not be accepted in this or any other category for credit.

(6) Category V: ((Nonsupervised.)) Self-directed activities.

(a) A maximum of ((sixty)) eighty credit hours may be earned under Category V.  ((Credit may be earned only for the thirty-six-month period following the year in which the study, preparation, care and/or review occurred.))

(b) Self-assessment: Credit hours may be earned for completion of a multimedia medical education program.

(c) Self-instruction: Credit hours may be earned for the independent reading of scientific journals and books.

(d) Specialty board examination preparation: Credit hours may be earned for preparation for specialty board certification or recertification examinations.

(e) Quality care and/or utilization review: Credit hours may be earned for participation on a staff committee for quality of care and/or utilization review in a hospital or institution or government agency.

[Statutory Authority: RCW 43.70.280.  98-05-060, § 246-919-460, filed 2/13/98, effective 3/16/98.  Statutory Authority: RCW 18.71.017 and 18.71A.020.  96-03-073, § 246-919-460, filed 1/17/96, effective 2/17/96.]

(1) Licenses must be renewed every two years on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2, except postgraduate training limited licenses and retired active physician licenses.

(2) Postgraduate training limited licenses must be renewed every year to correspond to program date.

(3) Retired active physician licenses shall be renewed every year.

(4) The following nonrefundable fees will be charged:

Title of Fee	Fee
Physicians and surgeons: Chapter 18.71 RCW
Application	$300.00
Retired active physician license renewal	125.00
One-year renewal	200.00
Two-year renewal	400.00
Late renewal penalty	((50.00)) 100.00
Expired license reissuance	((100.00)) 200.00
Substance abuse monitoring surcharge (assessed at $25.00 each year as stipulated in RCW 18.71.310(2))	((25.00)) 50.00
Certification of license	50.00
Duplicate license	15.00
Temporary permit	50.00
Postgraduate limited license fees: RCW 18.71.095
Limited license application	200.00
Limited license renewal	200.00
Substance abuse monitoring surcharge	25.00
Limited duplicate license	15.00

[Statutory Authority: RCW 43.70.280.  98-05-060, § 246-919-990, filed 2/13/98, effective 3/16/98.  Statutory Authority: RCW 18.71.017 and 43.70.250.  97-15-100, § 246-919-990, filed 7/21/97, effective 8/21/97.  Statutory Authority: RCW 18.71.017 and 18.71A.020.  96-03-073, § 246-919-990, filed 1/17/96, effective 2/17/96.]

OTS-2837.3

NEW SECTION
WAC 246-918-171
Renewal and continuing medical education cycle revision.

Beginning January 1, 2000, the one-year renewal cycle for physician assistants will transition to a two-year cycle and two-year continuing medical education cycle. The renewal and continuing medical education will be as follows:

(1) Effective January 1, 2000, any physician assistant whose birth year is an even number will renew their credential for twenty-four months and every two years thereafter. Those physician assistants must obtain one hundred hours of continuing medical education within the twenty-four months following the date their first two-year license is issued and every two years thereafter.

(2) Effective January 1, 2001, any physician assistant whose birth year is an odd number will renew their credential for twenty-four months and every two years thereafter. Those physician assistants must obtain one hundred hours of continuing medical education within the twenty-four months following the date their first two-year license is issued and every two years thereafter.

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OTS-3333.2

AMENDATORY SECTION(Amending WSR 99-13-087, filed 6/14/99, effective 7/15/99)

WAC 246-918-990
Fees and renewal cycle.

(1) Licenses must be renewed every two years 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
Physician(('s)) assistants, certified physician assistants, physician assistant-surgical assistants, acupuncture physician assistants:
Application	$50.00
One-year renewal	((35.00)) 70.00
Two-year renewal	70.00
Substance abuse monitoring surcharge (assessed at $25.00 each year as stipulated in RCW 18.71A.020(3))	((25.00)) 50.00
Expired license reissuance	35.00
Duplicate license	15.00

[Statutory Authority: RCW 18.71.017 and 18.71A.020(3).  99-13-087, § 246-918-990, filed 6/14/99, effective 7/15/99.  Statutory Authority: RCW 43.70.280.  98-05-060, § 246-918-990, filed 2/13/98, effective 3/16/98.  Statutory Authority: RCW 18.71.017 and 18.71A.020.  96-03-073, § 246-918-990, filed 1/17/96, effective 2/17/96.  Statutory Authority: RCW 43.70.040.  91-06-027 (Order 131), § 246-918-990, filed 2/26/91, effective 3/29/91.]

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