WSR 02-11-031

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed May 7, 2002, 4:01 p.m. ]

Supplemental Notice to WSR 01-23-074.

Preproposal statement of inquiry was filed as WSR 00-23-049.

Title of Rule: New WAC 388-112-0200 through 388-112-0410 Residential long-term care services -- Training; and amending WAC 388-78A-050 Boarding homes.

Purpose: Implement SSB 6502 and SHB 2707 on training for adult family homes and boarding homes; combine training requirements for these settings into one WAC. Significant revisions have been made based on public comment to the proposal published in WSR 01-23-074.

This document compares draft WAC 388-112-0200 through 388-112-0410 with the earlier version WAC 388-112-0180 through 388-112-0375, published in WSR 01-23-074.

Changes in WAC numbering, including added and deleted sections:


Earlier version of chapter 388-112 WAC published as WSR 01-23-074 New version of chapter 388-112 WAC
0180 0200
0185 0205
0190 0210
0195 0215
0200 Text only deleted as proposed
0205 0220
0210 0225
0215 0230
-- Added new 0235
0220 0240
0225 0245
0230 0250
0235 0255
0240 0260
0245 0265
0250 0270
0255 0275
-- Added new 0280
0260 0285
0265 0290
0270 0295
0275 Text only deleted as proposed
0280 0300
0285 0305
0290 0310
0295 0315
0300 0320
0305 0325
0310 0330
0315 0335
0320 0340
0335(3) 0345
-- Added new 0350
0325 0355
0330 0360
0335 (1) and (2) 0380
0340 0365
0345(1) 0370
0345 (2)-(6) 0375
0350 Moved to 0400
0355 0385
0360 0390
0365 0395
0350 0400
0370 0405
0375 0410

Statutory Authority for Adoption: RCW 18.20.090 Boarding homes, 70.128.040 Adult family homes, 34.05.020.

Statute Being Implemented: Chapter 121, Laws of 2000, chapter 233, Laws of 2002.

Summary: Implements requirements for licensed boarding home administrators and caregivers to have continuing education; moves all training requirements for these two settings into one training WAC; implements processes for approval of alternative curricula and for instructors.

Reasons Supporting Proposal: Implementing statutes referenced above.

Name of Agency Personnel Responsible for Drafting: Dotti Wilke, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2539; Implementation and Enforcement: Marta Acedo, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2549.

Name of Proponent: Department of Social and Health Services, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: This rule implements RCWs on training for adult family homes and boarding homes, and consolidates the current training rules for those settings into one place. The rule also sets the processes for approval of instructors and alternative curricula for certain trainings. New requirements in the RCW include requirements for licensed boarding homes for administrators or their designees, and caregivers to have continuing education. The rule has been revised based on public comment on the rule proposed in WSR 01-23-074.

Proposal Changes the Following Existing Rules: This proposal moves existing rules for residential care settings from two separate chapters into one new chapter 388-112 WAC.

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

Small Business Economic Impact Statement

SUMMARY OF PROPOSED RULES: The Department of Social and Health Services' Aging and Adult Services Administration (AASA) is proposing to create new chapter 388-112 WAC, Home and community long-term care services -- Training. The new chapter contains the training rules for adult family homes, and boarding homes. The proposed rules have been changed in response to public comments.

New chapter 388-112 WAC consolidates training rules by including rules moved from:

&sqbul; Chapter 388-76 WAC, Adult family homes;
&sqbul; Chapter 388-78A WAC, Boarding homes; and
&sqbul; Chapter 388-110 WAC, Contracted residential services.
The chapter also contains new rules implementing changes mandated by the following RCWs:

&sqbul; Chapter 18.20 RCW, Boarding homes; and
&sqbul; Chapter 70.128 RCW, Adult family homes.
The purpose of this chapter is to: Define minimum training requirements; define the types of training; clarify curriculum requirements and instructor requirements; and establish department procedures for approval of curricula and instructors. The statutory authority for these chapters includes RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.

The major proposed changes are:

&sqbul; Incorporating a new requirement for orientation training for new staff in both settings, as required in chapters 18.20 and 70.128 RCW.
&sqbul; Incorporating new training requirements for licensed boarding homes that do not contract with DSHS, including orientation, basic training, special needs (specialty) training, and continuing education, as required in RCW 18.20.270.
&sqbul; Creating an approval system for alternative curricula for basic and specialty training, as required by RCW 18.20.270 Boarding homes and 70.128.230 Adult family homes.
&sqbul; Creating an approval system for trainers as required by the RCWs.
Background of the proposed rule: In 1995, as part of long-term care reform, the legislature allocated funds for training during the following year. Providers and caregivers who were trained included:

&sqbul; Caregivers in boarding homes that contract with DSHS; and
&sqbul; All licensed adult family home providers and caregivers.
In 1997, two task forces were created under the auspices of the legislature, to review caregiver training:

&sqbul; The Joint Executive-Legislative Long Term Care Task Force's subcommittee on training. This task force reported to the legislature in December 1998 and January 2000.
&sqbul; The training task force, which DSHS, the Department of Health, and the Nursing Care Quality Assurance Commission created, under legislative directives, to review caregiver training. This task force reported to the legislature in December 1998.
Recommendations from both task forces were key in establishing new training requirements created by legislation in the 2000 session. This same legislation created the Community Long Term Care Education and Training Steering Committee to advise the department on the development of rules to implement the new law. (See RCW 74.39A.190.) This steering committee has advised the department for two years on the development of these rules.

Goals for the proposed rules:

&sqbul; Increase the number of caregivers who will be trained;
&sqbul; Ensure that all caregivers have an orientation when they begin to work with residents; and
&sqbul; Allow more boarding homes and adult family homes to teach their own staff and use their own curricula.
Training improves caregiving skills and the quality of care delivered to more than 7,000 adults receiving care through these programs.

SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses. This statute outlines information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a disproportionate economic impact on small businesses.

Aging and Adult Services Administration has analyzed the proposed amendments to their rules and has determined that small businesses will be impacted by these changes, with some costs considered "more than minor."

INDUSTRY ANALYSIS: Aging and Adult Services Administration is responsible for boarding home and adult family home licensing. As part of licensing, this state agency keeps current internal databases that identify all licensed facilities and agencies. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.

INVOLVEMENT OF SMALL BUSINESSES: The data used in this analysis was gathered from several sources:

&sqbul; The statewide organizations that represent the 2,084 adult family homes, and 513 boarding homes affected by these proposed rules.
&sqbul; The residential care services and management services divisions of the Aging and Adult Services Administration.
The organizations that contributed current data on wages, benefits, and cost estimates for the businesses they represent, most of which are small businesses, include: Washington State Residential Care Council (AFH), the Adult Family Home Association (AFH), Washington Health Care Association (BH), Washington Association of Housing and Services for the Aging (BH), and Northwest Assisted Living Facilities Association (BH).

This proposed chapter has been developed with the advice of the Training Steering Committee, which has been meeting monthly for twenty-two months to consider and recommend the rules to implement these laws. Represented in this committee are small business members from the statewide provider organizations mentioned above.

In addition, four public forums were held during the summer in (Bellevue, Lacey, Spokane, and Yakima) to discuss the rule development and take public comment on the proposed rules as recommended by the steering committee. Approximately 2,000 interested parties were invited; seventy-seven people attended and commented. Small businesses were represented at these forums, as well.

AASA staff have also regularly attended meetings with adult family home and boarding home providers for the past year to update them on the rule development and take their comments and suggestions. To reach those who could not attend meetings, the proposed rules as recommended by the steering committee have been posted on the AASA Internet web site, with contact person information for anyone wishing to comment or make suggestions on the rule. All the input from these various groups and meetings has helped shape the development of this rule. Public comment on the earlier proposed chapter 388-112 WAC included comments from small businesses, and was considered and incorporated into the proposed rules.

COST OF COMPLIANCE: Costs related to record keeping: Each business must keep on file copies of certificates showing successful completion of required trainings for each of their employees. The only new record-keeping requirement for boarding homes that contract with DSHS and adult family homes is orientation. The new requirements for boarding homes that do not contract with DSHS include orientation, basic training, specialty training for some, and continuing education. Boarding homes that contract with DSHS already meet these requirements under contracting rules, so they will incur no additional costs. Training costs are included in the DSHS rates paid to both boarding homes and adult family homes. Keeping these certificates on file will result in a minor cost to the business.

Costs related to professional services: In estimating costs, AASA has chosen to assume that staff are trained on-site for orientation, and sent off-site for other trainings, with the intent that these are probably the highest cost scenarios. However, if a boarding home or adult family home chooses to contract with a trainer to come in and provide training in their own facility, this will result in costs for the professional services of a trainer. This training strategy, however, eliminates the costs of paying tuition and paying for travel time to and from training, for each trainee, and should reduce the overall costs of training.

Estimated training costs: Expected costs include:

&sqbul; The trainer's wages and benefits (if an on-staff trainer is used, as for orientation);
&sqbul; The trainee's wages and benefits; and
&sqbul; Costs for training materials (if training is on site) or for tuition, if off-site.
See Tables 1 and 2 below for estimated costs for each type of provider.

To fairly consider costs of compliance, AASA has elected to look at costs per trainee. This is because there is no reliable data on the number of employees that will be required to have this training, or the rate of turnover, both of which affect total training costs.

In each setting, the most costly wage scenarios were generally used for cost estimates. Facilities may well be able to reduce these costs by making different choices. The assumptions include:

&sqbul; For orientation, using a registered nurse as the orientation trainer, and assuming a one-on-one training, rather than in a group;
&sqbul; For basic training, assuming the facility will pay tuition rather than providing training at the facility;
&sqbul; For specialty, which is required only if the boarding home has residents with special needs, assuming the administrator (or designee) will attend the specialty training and then train their own caregivers at the facility;
&sqbul; For continuing education, assuming the facility will pay tuition rather than providing training at the facility.
Circumstances that may be used to mitigate these costs are noted in the section on mitigating expenses, which follows the cost estimates.

Costs of Compliance for Boarding Homes:

&sqbul; Orientation is a new requirement for all boarding homes. It is always provided at the facility, by facility staff.
&sqbul; Basic training is a new requirement for boarding homes that do not contract with DSHS. It may be provided by the facility or staff may be sent to another educator for training.
&sqbul; Specialty training is a new requirement for all boarding homes that serve residents with special needs in dementia, mental health, or developmental disabilities.
&sqbul; Continuing education is a new requirement for boarding homes that do not contract with DSHS. It includes ten hours of training on caregiving issues, per calendar year. The requirement begins the second year after the basic training is completed. It may be provided by the facility, or staff may be sent to another educator for training.
Tables 1 and 2 below show estimated training costs for each type of provider. Based on public comments, a number of assumptions were changed, including:

&sqbul; The number of hours of orientation was increased from two to three hours.
&sqbul; Specialty training costs were added.
&sqbul; One hour of travel time was added to basic and specialty training.
&sqbul; Continuing education tuition was increased from $5 to $8 per hour.


Table 1 Boarding Homes

Training Personnel & other costs Wages Benefits & Taxes Total per hour Hours Tuition

(if applies)

Total Cost
Orientation Trainer (RN) $24.24 $6.14 $30.38 3 N/A $91.14
Trainee $9.15 $2.32 $11.48 3 N/A $34.44
Materials $10.00
Total per trainee $135.58
Basic Trainee $9.15 $2.32 $11.47 28 $129.00 $450.16
Travel 1 $11.47
Total $461.63
Specialty

(Administrator)

Trainee $28.13 $7.16 $35.29 20 $200 $905.80
Travel 1 $35.29
Total $941.09
Specialty

(Caregiver)

Trainee $9.15 $2.32 $11.47 20 N/A $229.40
Continuing Education Trainee $9.15 $2.32 $11.47 10 $80.00 $194.70

Costs of Compliance for Adult Family Homes: Orientation is a new requirement for all adult family homes. It is always provided at the facility, by facility staff.


Table 2 Adult Family Homes


Training Personnel, other costs Wages Benefits & Taxes Total per hour Hours Tuition Total Cost
Orientation Trainer (RN) $24.24 $6.14 $30.38 3 $91.14
Trainee $9.15 $2.32 $11.47 3 $0.00 $34.44
Materials $10.00
Total $135.58

Disproportionate Economic Impact Analysis: When there are more than minor costs to small businesses as a result of proposed rule changes, the Regulatory Fairness Act requires an analysis to be done, comparing these costs between small businesses and 10% of the largest businesses.

All for-profit adult family homes are by nature small businesses; an adult family home can serve a maximum of six residents at a time, and so has a small number of employees. No data is available on the actual numbers of employees in boarding homes, but many or most boarding homes are small businesses with fewer than fifty employees. While the per-trainee costs do not differ between small and large businesses, the costs may be a higher proportion of overall costs for a small business. AASA elected to focus on mitigating expenses regardless of results of comparing large and small businesses; therefore AASA considered this type of comparative analysis unnecessary. Therefore, AASA proposes several measures that will mitigate the impact of costs for small businesses.

Mitigating Expenses: Aging and Adult Services Administration has included the following to help mitigate training costs for small businesses:

&sqbul; Orientation training costs can be significantly reduced if the person doing the orientation is not an RN (high wage rate). The organization has a choice of who to use in conducting the orientation training. For instance, if an LPN does the orientation, the median hourly wage is estimated to be $15.72, and a social worker's median hourly wage is $18.74 (compared to an RN at $24.24). For instance, an RN's median hourly wage is estimated to be $24.24. If an LPN does the orientation, the hourly wage drops to $15.72; if a social worker does the orientation, the hourly wage is $18.74. Both are qualified to do this training.
&sqbul; Orientation training costs are further reduced if the facility orients more than one person at a time. This can be done any time the facility hires several new caregivers and has them start working at the same time.
&sqbul; Individuals who have already been oriented at another facility can have a much briefer orientation at a new facility, which is a savings for the second business. The orientation can be shorter because basic information on the required topics will be consistent across facilities. The facility will be able to spend less time on basic information, and focus primarily on information specific to the facility.
&sqbul; Basic training costs may be mitigated if the training is done on-site. The rules allow for facilities to train their own staff if the instructor(s) meet minimum qualifications. The instructor minimum qualifications have been reduced in the proposed rules. This means the facility does not have to pay tuition for each student, nor pay for travel time and expenses to the training.
&sqbul; Individuals who take basic, specialty training, or continuing education will not be required to take it again if hired at another business where training is required, which is a savings for the second business.
&sqbul; The revised rules allow the board home administrator or designee, or the adult family home provider or resident manager, to train their caregivers in specialty areas, resulting in tuition and travel savings for every caregiver.
&sqbul; Specialty instructor qualifications have been lowered based on public comment.
&sqbul; Boarding homes with a new requirement for basic training for caregivers will have up to one hundred twenty days following the effective date of the rule to meet the requirement.
&sqbul; Specialty training may be completed up to ninety days after basic training is completed, spreading the costs over a longer period of time.
&sqbul; Continuing education costs may be mitigated by holding this training at the facility rather than sending staff out to training, saving the costs of each person's tuition and travel. No pre-approval of curriculum or instructor is required.
Additional cost savings:

&sqbul; The orientation reduces the time it takes new employees to begin to provide quality care to residents, which translates into higher satisfaction for the clients, and better word-of-mouth publicity for the agency, which may increase income.
&sqbul; Well-trained employees generally have higher job satisfaction and this leads to a lower turnover rate, significantly reducing overall costs. Turnover rates have been estimated as 50% or higher per year, for caregivers. Village Green, a Washington state boarding home, determined that monthly turnover for caregivers dropped from 21% to under 5% after implementing a thorough orientation program.
CONCLUSION: Aging and Adult Services Administration has given careful consideration to the impact of proposed rules in chapter 388-112 WAC, Home and community long-term care services -- Training, on small businesses. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, Aging and Adult Services Administration has analyzed impacts on small businesses and proposed ways to mitigate those costs associated with implementing the training requirements in these rules. Training staff adequately to care for adult residents is a benefit to both the resident and the provider.

A copy of the statement may be obtained by writing to Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

RCW 34.05.328 applies to this rule adoption. A cost benefit analysis has been prepared concerning these proposed rules, and may be obtained by contacting Tresa Harambasic, Aging and Adult Services Administration, P.O. Box 45600, Olympia, WA 98504-5600, phone (360) 725-2548, fax (360) 725-2646.

Hearing Location: Office Building 2 Auditorium (DSHS Headquarters) (parking at 12th and Washington), 1115 Washington, Olympia, WA 98504, on June 25, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by May 21, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., June 25, 2002.

Date of Intended Adoption: Not earlier than June 26, 2002.

May 2, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3012.7SECTION VII -- CONTINUING EDUCATION
NEW SECTION
WAC 388-112-0200   What is continuing education?   Continuing education is additional caregiving-related training designed to increase and keep current a person's knowledge and skills. DSHS does not pre-approve continuing education programs or instructors.

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NEW SECTION
WAC 388-112-0205   How many hours of continuing education are required each year?   (1) Individuals subject to a continuing education requirement must complete at least ten hours of continuing education each calendar year (January 1 through December 31) after the year in which they successfully complete basic or modified basic training.

(2) One hour of completed classroom instruction or other form of training (such as a video or on-line course) equals one hour of continuing education.

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NEW SECTION
WAC 388-112-0210   What kinds of training topics are required for continuing education?   Continuing education must be on a topic relevant to the care setting and care needs of residents, including but not limited to:

(1) Resident rights;

(2) Personal care (such as transfers or skin care);

(3) Mental illness;

(4) Dementia;

(5) Developmental disabilities;

(6) Depression;

(7) Medication assistance;

(8) Communication skills;

(9) Positive resident behavior support;

(10) Developing or improving resident centered activities;

(11) Dealing with wandering or aggressive resident behaviors; and

(12) Medical conditions.

[]


NEW SECTION
WAC 388-112-0215   Is competency testing required for continuing education?   Competency testing is not required for continuing education.

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NEW SECTION
WAC 388-112-0220   May basic or modified basic training be completed a second time and used to meet the continuing education requirement?   Re-taking basic or modified basic training may not be used to meet the continuing education requirement.

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NEW SECTION
WAC 388-112-0225   May specialty training be used to meet continuing education requirements?   Specialty training and caregiver specialty training, except any specialty training completed through a challenge test, may be used to meet continuing education requirements.

(1) If one or more specialty trainings are completed in the same year as basic or modified basic training, the specialty training hours may be applied toward the continuing education requirement for up to two calendar years following the year of completion of the basic and specialty trainings.

(2) If one or more specialty trainings are completed in a different year than the year when basic or modified basic training was taken, the specialty training hours may be applied toward the continuing education requirement for the calendar year in which the specialty training is taken and the following calendar year.

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NEW SECTION
WAC 388-112-0230   May nurse delegation core training be used to meet continuing education requirements?   Nurse delegation training under WAC 388-112-0175 may be applied toward continuing education requirements for the calendar year in which it is completed.

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NEW SECTION
WAC 388-112-0235   May residential care administrator training be used to meet continuing education requirements?   Residential care administrator training under WAC 388-112-0275 may be used to meet ten hours of continuing education requirements.

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NEW SECTION
WAC 388-112-0240   What are the documentation requirements for continuing education?   (1) The adult family home or boarding home must maintain documentation of continuing education including:

(a) The trainee's name;

(b) The title or content of the training;

(c) The instructor's name or the name of the video, on-line class, professional journal, or equivalent instruction materials completed;

(d) The number of hours of training; and

(e) The date(s) of training.

(2) The trainee must be given an original certificate or other documentation of continuing education.

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NEW SECTION
WAC 388-112-0245   Who is required to complete continuing education training, and when?   Adult Family Homes

(1) Adult family home providers (including entity representatives as defined under chapter 388-76 WAC), resident managers, and caregivers must complete ten hours of continuing education each calendar year (January 1 through December 31) after the year in which they successfully complete basic or modified basic training.

(2) Continuing education must be on a topic relevant to the care setting and care needs of residents in adult family homes.

Boarding Homes

(3) Boarding home administrators (or their designees) and caregivers must complete ten hours of continuing education each calendar year (January 1 through December 31) after the year in which they successfully complete basic or modified basic training.

(4) Continuing education must be on a topic relevant to the care setting and care needs of residents in boarding homes.

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SECTION VIII -- CPR AND FIRST AID TRAINING
NEW SECTION
WAC 388-112-0250   What is CPR training?   Cardio-pulmonary resuscitation (CPR) training is training that meets the content requirements in WAC 296-800-15010.

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NEW SECTION
WAC 388-112-0255   What is first aid training?   First aid training is training that meets the content requirements in WAC 296-800-15010.

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NEW SECTION
WAC 388-112-0260   What are the CPR and first aid training requirements?   Adult Family Homes

(1) Adult family home providers and resident managers must possess a valid CPR and first aid card or certificate prior to providing care for residents, and must maintain valid cards or certificates.

(2) Adult family home caregivers must obtain a valid CPR and first aid card or certificate:

(a) Within thirty days of beginning to provide care for residents, if the provision of care for residents is directly supervised by a fully qualified caregiver who has a valid first aid and CPR card or certificate; or

(b) Before providing care for residents, if the provision of care for residents is not directly supervised by a fully qualified caregiver who has a valid first aid and CPR card or certificate.

(3) Adult family home caregivers must maintain valid CPR and first aid cards or certificates.

Boarding Homes

(4) Boarding home administrators, licensed nurses, and caregivers must take CPR and first aid within thirty days of employment, and must maintain valid cards or certificates.

[]

SECTION IX -- RESIDENTIAL CARE ADMINISTRATOR TRAINING
NEW SECTION
WAC 388-112-0265   What is residential care administrator training?   Residential care administrator training is a minimum of forty-eight hours of training on topics related to the management of adult family homes. DSHS must approve residential care administrator training curricula.

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NEW SECTION
WAC 388-112-0270   Who must take residential care administrator training and when?   Before operating more than one adult family home, the provider (including an entity representative as defined under chapter 388-76 WAC) must successfully complete residential care administrator training.

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NEW SECTION
WAC 388-112-0275   What knowledge and skills must residential care administrator training include?   Minimally, residential care administrator training must have at least forty-eight hours of class time, and include all of the following:

(1) Business planning and marketing;

(2) Fiscal planning and management;

(3) Human resource planning;

(4) Resident health services;

(5) Nutrition and food service;

(6) Working with people who are elderly, chronically mentally ill, or developmentally disabled;

(7) The licensing process;

(8) Social and recreational activities;

(9) Resident rights;

(10) Legal issues;

(11) Physical maintenance and fire safety; and

(12) Housekeeping.

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NEW SECTION
WAC 388-112-0280   Is competency testing required for residential care administrator training?   Competency testing is not required for residential care administrator training.

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NEW SECTION
WAC 388-112-0285   What documentation is required for residential care administrator training?   (1) Residential care administrator training must be documented by a certificate of successful completion of training, issued by the instructor or training entity, that includes:

(a) The trainee's name;

(b) The name of the training;

(c) The location of the training;

(d) The instructor's name and signature; and

(e) The date(s) of training.

(2) The trainee must be given an original certificate. A copy of the certificate must be in the adult family home's files.

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SECTION X -- COMPETENCY TESTING
NEW SECTION
WAC 388-112-0290   What is competency testing?   Competency testing, including challenge testing, is evaluating a trainee to determine if they can demonstrate the required level of skill, knowledge, and/or behavior with respect to the identified learning outcomes of a particular course.

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NEW SECTION
WAC 388-112-0295   What components must competency testing include?   Competency testing must include the following components:

(1) Skills demonstration of ability to perform and/or implement specific caregiving approaches, and/or activities as appropriate for the training;

(2) Written evaluation to show level of comprehension and knowledge of the learning outcomes for the training; and

(3) A scoring guide for the tester with clearly stated criteria and minimum proficiency standards.

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NEW SECTION
WAC 388-112-0300   What training must include the DSHS-developed competency test?   Basic, modified basic, specialty, caregiver specialty, and nurse-delegation core training must include the DSHS-developed competency test.

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NEW SECTION
WAC 388-112-0305   How must competency test administration be standardized?   To standardize competency test administration, testing must include the following components:

(1) The person teaching the course must oversee all testing; and

(2) The tester must follow DSHS guidelines for:

(a) The maximum length of time allowed for testing;

(b) The amount and nature of instruction given to students before beginning a test;

(c) The amount of assistance to students allowed during testing;

(d) The accommodation guidelines for students with disabilities; and

(e) Accessibility guidelines for students with limited English proficiency.

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NEW SECTION
WAC 388-112-0310   What form of identification must students provide before taking a competency or challenge test?   Students must provide photo identification before taking a competency test (or challenge test, when applicable) for basic, modified basic, specialty, or nurse delegation training.

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NEW SECTION
WAC 388-112-0315   How many times may a competency test be taken?   (1) A competency test that is part of a course may be taken twice. If the test is failed a second time, the person must re-take the course before any additional tests are administered.

(2) If a challenge test is available for a course, it may be taken only once. If the test is failed, the person must take the classroom course.

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SECTION XI -- CURRICULUM APPROVAL
NEW SECTION
WAC 388-112-0320   What trainings must be taught with a curriculum approved by DSHS?   (1) The following trainings must be taught using the DSHS curriculum or other curriculum approved by DSHS: Basic, modified basic, mental health specialty, dementia specialty, and developmental disabilities specialty training, and any training that integrates basic training with a specialty training or a caregiver specialty training.

(2) The residential care administrator training must use a curriculum approved by DSHS.

(3) The nurse delegation training must use only the DSHS curriculum.

(4) A curriculum other than the DSHS curriculum must be approved, at a minimum by attestation, before it is used.

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NEW SECTION
WAC 388-112-0325   What are the minimum components that an alternative curriculum must include in order to be approved?   In order to be approved, an alternative curriculum must at a minimum include:

(1) All the DSHS-published learning outcomes and competencies for the course;

(2) Printed student materials that support the curriculum, a teacher's guide or manual, and learning resource materials such as learning activities, audio-visual materials, handouts, and books;

(3) The recommended sequence and delivery of the material;

(4) The teaching methods or approaches that will be used for different sections of the course, including for each lesson:

(a) The expected learning outcomes;

(b) Learning activities that incorporate adult learning principles and address the learning readiness of the student population;

(c) Practice of skills to increase competency;

(d) Feedback to the student on knowledge and skills;

(e) An emphasis on facilitation by the teacher; and

(f) An integration of knowledge and skills from previous lessons to build skills.

(5) A list of the sources or references used to develop the curriculum;

(6) Methods of teaching and student evaluation for students with limited English proficiency and/or learning disabilities; and

(7) A plan for updating material. Substantial changes to a previously approved curriculum must be approved before they are used.

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NEW SECTION
WAC 388-112-0330   What is the curriculum approval process?   (1) An alternative curriculum must be submitted to DSHS for approval with:

(a) Identification of where each DSHS-published required learning outcome and competency is located in the alternate curriculum;

(b) All materials identified in WAC 388-112-0325; and

(c) A letter from the boarding home administrator or adult family home provider attesting that the training curriculum addresses all of the training competencies identified by DSHS;

(2) DSHS may approve a curriculum based upon the attestation in (1)(c) above, until it has been reviewed by DSHS;

(3) If, upon review by DSHS, the curriculum is not approved, the alternative curriculum may not be used until all required revisions have been submitted and approved by DSHS.

(4) After review of the alternative curriculum, DSHS will send a written response to the submitter, indicating approval or disapproval of the curriculum and if disapproved, the reasons for denial;

(5) If the alternative curriculum is not approved, a revised curriculum may be re-submitted to DSHS for another review.

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SECTION XII -- HOME-BASED TRAINING
NEW SECTION
WAC 388-112-0335   What are the requirements for a boarding home or adult family home that wishes to conduct basic, modified basic, or specialty staff training?   A boarding home or adult family home wishing to conduct basic, modified basic, specialty, or caregiver specialty training may do so if the home:

(1) Verifies and documents that all instructors meet each of the minimum instructor qualifications for the course they plan to teach;

(2) Teaches using a complete DSHS-developed or approved alternative curriculum.

(3) Notifies DSHS in writing of the home's intent to conduct staff training prior to providing training, including:

(a) Home name;

(b) Name of training(s) the home will conduct;

(c) Name of curriculum(s) the home will use; and

(d) Whether the home will train only the home's staff, or will also train staff from other homes;

(4) Ensures that DSHS competency tests are administered as required under this chapter;

(5) Provides a certificate of completion of training to all staff that successfully complete the entire course, including:

(a) The trainee's name;

(b) The name of the training;

(c) The location of the training;

(d) The instructor's name and signature; and

(e) The date(s) of training;

(6) Keeps a copy of student certificates on file for six years, and gives the original certificate to the trainee;

(7) Keeps attendance records and testing records of students trained and tested on file for six years; and

(8) Reports training data to DSHS in DSHS-identified time frames.

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NEW SECTION
WAC 388-112-0340   Do homes need department approval to provide continuing education for their staff?   Homes may provide continuing education for their staff without prior approval of curricula or instructors by the department.

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NEW SECTION
WAC 388-112-0345   When can DSHS prohibit a home from conducting its own training?   DSHS may prohibit a home from providing its own basic, modified basic, specialty, or caregiver specialty training when:

(1) DSHS determines that the training fails to meet the standards under this chapter;

(2) The home's instructor does not meet the applicable qualifications under WAC 388-112-0375 through 388-112-0395; or

(3) The home's instructor has been a licensee, boarding home administrator, or adult family home resident manager, as applicable, of any home while it was under temporary management or subject to a revocation or summary suspension of the home's license, a stop placement of admissions order, a condition on the license related to resident care, or a civil fine of five thousand dollars or more; or

(4) The home has been operated under temporary management or has been subject to a revocation or suspension of the home license, a stop placement of admissions order, a condition on the license related to resident care, or a civil fine of five thousand dollars or more.

(5) Nothing in this section shall be construed to limit DSHS' authority under chapters 388-76 or 388-78A WAC to require the immediate enforcement, pending any appeal, of a condition on the home license prohibiting the home from conducting its own training programs.

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XIII -- INSTRUCTOR APPROVAL
NEW SECTION
WAC 388-112-0350   What trainings must be taught by an instructor who meets the applicable minimum qualifications under this chapter?   (1) The following trainings must be taught by an instructor who meets the applicable minimum qualifications for that training: Basic training; modified basic training; mental health, dementia, and developmental disability specialty training; and caregiver specialty training that is not taught by the boarding home administrator (or designee) or adult family home provider or resident manager.

(2) Nurse delegation training and residential care administrator training must be taught by an instructor who is approved by DSHS.

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NEW SECTION
WAC 388-112-0355   What are an instructor's or training entity's responsibilities?   The instructor or training entity is responsible for:

(1) Coordinating and teaching classes,

(2) Assuring that the curriculum used is taught as designed,

(3) Selecting qualified guest speakers where applicable,

(4) Administering or overseeing the administration of DSHS competency and challenge tests,

(5) Maintaining training records including student tests and attendance records for a minimum of six years,

(6) Reporting training data to DSHS in DSHS-identified time frames, and

(7) Issuing or re-issuing training certificates to students.

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NEW SECTION
WAC 388-112-0360   Must instructors be approved by DSHS?   (1) DSHS-contracted instructors

(a) DSHS must approve any instructor under contract with DSHS to conduct basic, modified basic, specialty, or nurse delegation core training classes using the training curricula developed by DSHS.

(b) DSHS may select contracted instructors through a purchased services contract procurement pursuant to chapter 236-48 WAC or through other applicable contracting procedures. Contractors must meet the minimum qualifications for instructors under this chapter and any additional qualifications established through a request for qualifications and quotations (RFQQ) or other applicable contracting procedure.

(2) Homes conducting their own training

Homes conducting their own training programs using the training curricula developed by DSHS or alternative curricula approved by DSHS must ensure that their instructors meet the minimum qualifications for instructors under this chapter, except for boarding home administrators (or designees), and adult family home providers or resident managers who are teaching their own caregiver staff as permitted under this chapter.

(3) Other instructors

DSHS must approve all other instructors not described in subsection (1) and (2) of this section.

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NEW SECTION
WAC 388-112-0365   Can DSHS deny or terminate a contract with an instructor or training entity?   (1) DSHS may determine not to accept a bid or other offer by a person or organization seeking a contract with DSHS to conduct basic, modified basic, specialty, or nurse delegation core training classes using the training curricula developed by DSHS. The protest procedures under chapter 236-48 WAC, as applicable, are a bidder's exclusive administrative remedy. No administrative remedies are available to dispute DSHS' decision not to accept an offer that is not governed by chapter 236-48 WAC, except as may be provided through the contracting process.

(2) DSHS may terminate any training contract in accordance with the terms of the contract. The contractor's administrative remedies shall be limited to those specified in the contract.

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NEW SECTION
WAC 388-112-0370   What is a guest speaker, and what are the minimum qualifications to be a guest speaker for basic and developmental disabilities specialty training?   Guest speakers for basic and developmental disabilities specialty training teach a specific subject in which they have expertise, under the supervision of the instructor. A guest speaker must have as minimum qualifications, an appropriate background and experience that demonstrates that the guest speaker has expertise on the topic he or she will teach. The instructor must select guest speakers that meet the minimum qualifications, and maintain documentation of this background. DSHS does not approve guest speakers.

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NEW SECTION
WAC 388-112-0375   What are the minimum general qualifications for an instructor teaching a DSHS curriculum or DSHS-approved alternate curriculum as defined under chapter 388-112 WAC?   An instructor teaching a DSHS curriculum or DSHS-approved alternate curriculum must meet the following minimum general qualifications:

(1) Twenty-one years of age; and

(2) Has not had a professional health care or social services license or certification revoked in Washington state (however, no license or certification is required).

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NEW SECTION
WAC 388-112-0380   What are the minimum qualifications for an instructor for basic or modified basic training?   An instructor for basic or modified basic training must meet the following minimum qualifications in addition to the general instructor qualifications in WAC 388-112-0375:

(1) Education and work experience:

(a) Upon initial approval or hire, must have:

(i) A high school diploma and one year of caregiving experience within the last five years in an adult family home, boarding home, supported living through DDD per chapter 388-820 WAC, or home care setting; or

(ii) An associate degree in a health field and six months caregiving experience within the last five years in an adult family home, boarding home, supported living through DDD per chapter 388-820 WAC, or home care setting.

(2) Teaching experience:

(a) Must have one hundred hours of experience teaching adults on topics directly related to the basic training; or

(b) Meet up to forty hours of the one hundred hours of teaching experience, hour for hour, by teaching while being mentored by an instructor who meets these qualifications, and attend a class in adult education that meets the requirements of WAC 388-112-0400.

(3) The instructor must be experienced in caregiving practices and capable of demonstrating competency with respect to the course content or units being taught;

(4) Instructors who will administer tests must have experience or training in assessment and competency testing; and

(5) If required under WAC 388-112-0075 or 388-112-0105, instructors must successfully complete basic or modified basic training prior to beginning to train others.

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NEW SECTION
WAC 388-112-0385   What are the minimum qualifications for mental health specialty instructors?   The minimum qualifications for mental health specialty instructors, in addition to the general qualifications in WAC 388-112-0375 include:

(1) The instructor must be experienced in mental health caregiving practices and capable of demonstrating competency in the entire course content;

(2) Education

(a) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education, or in college classes, in subjects directly related to mental health, such as, but not limited to, psychology. (One year of education equals twenty-four semester hours, forty-five quarter hours, or one hundred ninety-two hours of seminars, conferences, and continuing education.)

(b) If required under WAC 388-112-0160, successful completion of the mental health specialty training, prior to beginning to train others.

(3) Work experience - Two years full-time equivalent direct work experience with people who have a mental illness; and

(4) Teaching experience

(a) Two hundred hours experience teaching mental health or closely related subjects; and

(b) Successful completion of an adult education class or train the trainer as follows:

(i) For instructors teaching alternate curricula, a class in adult education that meets the requirements of WAC 388-112-0400, or a train the trainer class for the curriculum they are teaching;

(ii) For instructors teaching DSHS-developed mental health specialty training, successful completion of the DSHS-developed train the trainer.

(5) Instructors who will administer tests must have experience in assessment and competency testing.

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NEW SECTION
WAC 388-112-0390   What are the minimum qualifications for dementia specialty instructors?   The minimum qualifications for dementia specialty instructors, in addition to the general qualifications under WAC 388-112-0375, include:

(1) The instructor must be experienced in dementia caregiving practices and capable of demonstrating competency in the entire course content;

(2) Education

(a) Bachelor's degree, registered nurse, or mental health specialist, with at least one year of education in seminars, conferences, continuing education or college classes, in dementia or subjects directly related to dementia, such as, but not limited to, psychology. (One year of education equals twenty-four semester hours, forty-five quarter hours, or at least one hundred ninety-two hours of seminars, conferences, or continuing education.)

(b) If required under WAC 388-112-0160, successful completion of the dementia specialty training, prior to beginning to train others.

(3) Work experience - Two years full-time equivalent direct work experience with people who have dementia; and

(4) Teaching experience

(a) Two hundred hours experience teaching dementia or closely related subjects; and

(b) Successful completion of an adult education class or train the trainer as follows:

(i) For instructors teaching alternate curricula, a class in adult education that meets the requirements of WAC 388-112-0400, or a train the trainer class for the curriculum they are teaching;

(ii) For instructors teaching DSHS-developed dementia specialty training, successful completion of the DSHS-developed train the trainer.

(5) Instructors who will administer tests must have experience in assessment and competency testing.

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NEW SECTION
WAC 388-112-0395   What are the minimum qualifications for developmental disabilities specialty instructors?   The minimum qualifications for developmental disabilities specialty instructors, in addition to the general qualifications under WAC 388-112-0375, include:

(1) Education and work experience:

(a) Bachelor's degree with at least two years of full-time work experience in the field of disabilities; or

(b) High school diploma or equivalent, with four years full time work experience in the field of developmental disabilities, including two years full time direct work experience with people who have a developmental disability; and

(2) Successful completion of developmental disabilities specialty training under WAC 388-112-0120; and

(3) Teaching experience:

(a) Two hundred hours of teaching experience; and

(b) Successful completion of adult education or train the trainer as follows:

(i) For instructors teaching alternative curricula, a class in adult education that meets the requirements of WAC 388-112-0400, or a train the trainer class for the curriculum they are teaching;

(ii) For instructors teaching DSHS-developed developmental disabilities specialty training, successful completion of the DSHS-developed train the trainer.

(4) Instructors who will administer tests must have experience in assessment and competency testing.

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NEW SECTION
WAC 388-112-0400   What must be included in a class on adult education?   A class on adult education must include content, student practice, and evaluation of student skills by the instructor in:

(1) Adult education theory and practice principles;

(2) Instructor facilitation techniques;

(3) Facilitating learning activities for adults;

(4) Administering competency testing; and

(5) Working with adults with special training needs (for example, English as a second language or learning and literacy issues).

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SECTION XIV -- PHYSICAL RESOURCES AND STANDARD PRACTICES FOR TRAINING
NEW SECTION
WAC 388-112-0405   What physical resources are required for basic, modified basic, specialty, or nurse delegation core classroom training and testing?   (1) Classroom space used for basic, modified basic, specialty, or nurse delegation core classroom training must be accessible to trainees and provide adequate space for learning activities, comfort, lighting, lack of disturbance, and tools for effective teaching and leaning such as white boards and flip charts. Appropriate supplies and equipment must be provided for teaching and practice of caregiving skills in the class being taught.

(2) Testing sites must provide adequate space for testing, comfort, lighting, and lack of disturbance appropriate for the written or skills test being conducted. Appropriate supplies and equipment necessary for the particular test must be provided.

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NEW SECTION
WAC 388-112-0410   What standard training practices must be maintained for basic, modified basic, specialty, or nurse delegation core classroom training and testing?   The following training standards must be maintained for basic, modified basic, specialty or nurse delegation core classroom training and testing:

(1) Training, including all breaks, must not exceed eight hours within one day;

(2) Training provided in short time segments must include an entire unit, skill or concept;

(3) Training must include regular breaks; and

(4) Students attending a classroom training must not be expected to leave the class to attend to job duties, except in an emergency.

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3008.4
AMENDATORY SECTION(Amending WSR 99-15-067, filed 7/19/99, effective 8/19/99)

WAC 388-78A-050   Staff.   (1) The licensee shall:

(a) Develop and maintain written job descriptions for the administrator and each staff position;

(b) Verify work references;

(c) Verify required credentialling is current and in good standing for licensed and certified staff;

(d) Document and retain weekly staffing schedules, as planned and worked, for the last twelve months;

(e) Provide sufficient, trained staff in each boarding home to:

(i) Furnish the services and care needed by residents;

(ii) Maintain the boarding home free of safety hazards; and

(iii) Implement fire and disaster plans;

(f) Assure one or more resident-care staff eighteen years of age or older, with current cardiopulmonary resuscitation and first-aid cards, is present to assist residents at all times:

(i) On the boarding home premises when one or more residents are present;

(ii) Off the boarding home premises during boarding home activities; and

(iii) When staff transport a resident;

(g) Assure staff provide "on-premises" supervision when any resident is working for, or employed by, the boarding home; and

(h) Provide staff orientation and appropriate training for expected duties, including:

(i) Organization of boarding home;

(ii) Physical boarding home layout;

(iii) Specific duties and responsibilities; and

(iv) Policies, procedures, and equipment necessary to perform duties.

(2) The licensee shall ensure that the administrator and staff complete any training required under chapter 388-112 WAC.

(3) The licensee shall, in addition to following WISHA requirements, protect residents from tuberculosis by requiring each staff person to have, upon employment:

(a) A tuberculin skin test by the Mantoux method, unless the staff person:

(i) Documents a previous positive Mantoux skin test, which is ten or more millimeters of induration read at forty-eight to seventy-two hours;

(ii) Documents meeting the requirements of this subsection within the six months preceding the date of employment; or

(iii) Provides a written waiver from the department or authorized local health department stating the Mantoux skin test presents a hazard to the staff person's health;

(b) A second test one to three weeks after a negative Mantoux skin test for staff thirty-five years of age or older;

(c) A chest x-ray within seven days of any positive Mantoux skin test.

(((3))) (4) The licensee shall report positive chest x-rays to the appropriate public health authority, and follow precautions ordered by a physician or public health authority.

(((4))) (5) The licensee shall retain records of tuberculin test results, reports of x-ray findings, exceptions, physician or public health official orders, and waivers in the boarding home.

(((5) The licensee shall assure that all resident-care staff including those transporting residents and supervising resident activities, except licensed staff whose professional training exceeds first-responder training, have within thirty days of employment:

(a) Current cardiopulmonary resuscitation cards from instructors certified by:

(i) American Red Cross;

(ii) American Heart Association;

(iii) United States Bureau of Mines; or

(iv) Washington state department of labor and industries; and

(b) Current first-aid cards from instructors certified as in (a) of this subsection, except nurses do not need first-aid cards.))

(6) The licensee shall restrict a staff person's contact with residents when the staff person has a known communicable disease in the infectious stage which is likely to be spread in the boarding home setting or by casual contact.

(7) The licensee shall assure any staff person suspected or accused of abuse does not have access to any resident until the licensee investigates and takes action to assure resident safety to the satisfaction of the department.

(8) The licensee shall not interfere with the investigation of a complaint, coerce a resident, or conceal evidence of alleged improprieties occurring within the boarding home.

(9) The licensee shall prohibit an employee from being directly employed by a resident or a resident's family during the hours the employee is working for the boarding home.

(10) The licensee shall maintain the following documentation on the boarding home premises, during employment, and at least two years following termination of employment:

(a) Staff orientation and training pertinent to duties, including but not limited to cardiopulmonary resuscitation, first-aid, tuberculin skin testing and HIV/AIDS training;

(b) Criminal history disclosure and background checks as required in WAC 388-78A-045; and

(c) Verification of contacting work references and professional licensing and certification boards as required by subsection (1) of this section.

[Statutory Authority: RCW 18.20.240. 99-15-067, 388-78A-050, filed 7/19/99, effective 8/19/99; 98-20-021, recodified as 388-78A-050, filed 9/25/98, effective 9/25/98. Statutory Authority: RCW 18.20.090. 94-13-180, 246-316-050, filed 6/21/94, effective 7/22/94. Statutory Authority: RCW 43.43.830 through 43.43.842. 93-16-030 (Order 381), 246-316-050, filed 7/26/93, effective 8/26/93. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-316-050, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.20.090. 89-09-034 (Order 2786), 248-16-046, filed 4/14/89.]

Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

Washington State Code Reviser's Office