WSR 97-20-162

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed October 1, 1997, 11:51 a.m.]

Original Notice.

Exempt from preproposal statement of inquiry under RCW 34.05.310(4).

Title of Rule: WAC 246-840-990 Fees, this rule describes fees for practical nurses, registered nurses and advanced registered nurses.

Purpose: The proposed amendment of WAC 246-840-990 is to combine the three fee categories into one listing of fees that cover all three professions (RN, LPN and advanced registered nurse practitioners). In addition, some of the fees will be raised and some fees will be lowered according to an updated fee study. The fee study takes into account current workload, an existing $300,000 deficit and anticipated workload and expenses for the upcoming biennium in setting fees.

Statutory Authority for Adoption: Chapter 18.79 RCW.

Statute Being Implemented: Chapter 18.79 RCW.

Summary: This would create only one set of fees that covers all of the nursing professions. This would decrease confusion and allow nurses referencing the law book to only refer to one section instead of three. The new fees would lower and raise fees according to current workload data.

Reasons Supporting Proposal: This would finalize the merging of the two sets of WACs into one set that covers both registered nurses and practical nurses.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Terry J. West, 1300 S.E. Quince Street, Olympia, WA 98504, (360) 664-4207.

Name of Proponent: Washington State Nursing Care Quality Assurance [Commission], governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: When the legislature decided in 1994 that the Registered Nursing Board and the Practical Nursing Board should be combined to create the new Nursing Commission, the commission decided that the WACs should be combined. The combining of WACs will make it easier for staff and the public to understand the rules that apply to all nursing professions. The rules were combined in 1997 except for the fees. This last rule needs to be amended to combine the fee categories and adopt new fees that reflect the current workload, anticipated expenses and existing $300,000 deficit.

A comprehensive fee study has been prepared which reflects the current workload, addresses anticipated expenses for the upcoming biennium and addresses the $300,000 deficit which occurred because the existing fees do not adequately cover the expenses.

Since all health care professions must be self-sufficient in raising adequate revenue to cover the cost of expenses, some of the fees must be raised to cover expenses.

Proposal Changes the Following Existing Rules: Three separate lists of fees will be combined into one listing of fees. Some of the fees will be reduced and some of the fees will be increased according to the current fee study.

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

Introduction: In 1994 the legislature combined the Registered Nursing Board and the Practical Nursing Board and created the Nursing Care Quality Assurance Commission. From 1995 to 1997 the nursing program has worked on combining all of the rules into one set of rules so that it will be easier for the staff, the practitioner and the public to understand the requirements for the nursing professions. The fees rule is the last remaining rule that has not been combined. The fee rule currently has three separate listings to detail fees for registered nurses, practical nurses and advanced registered nurse practitioners. In 1997 the legislature authorized the Nursing Program to exceed I-601 to raise fees sufficiently to cover expenses.

This rule amendment would combine the three separate lists into one set of fees to cover all three categories. In addition, the fees would either be increased or decreased according to an updated fee study of the current workload, the current $345,000 deficit and the anticipated expenses. Fees being charged currently have not been updated for LPNs since 1995 and since 1993 for RNs and no longer cover the increased cost of doing business since all health care professions must be self- sufficient.

Necessity of the Proposed Fee Increases: The proposed fee increases are necessary to meet the increased costs of operating the nursing programs. Fees are based upon the cost of regulatory activity which includes salaries and benefits; goods and services such as rent, telephone and mail, printing, training, attorney general support; travel and equipment; and indirect costs.

Increased costs can also be attributed to increased program activities. Some of these activities include:

An increase in requests for advisory opinions and technical assistance by nurses, employers and others.

An increase in complaints against nurses.

New legislation which requires resources for implementation. This includes the new nurse delegation protocol, participation in the monitoring and study of this protocol, the regulatory reform legislation passed in 1995, whistleblower protection legislation and evaluation of all current rules for simplification.

Establishing standardization of disciplinary and licensing processes within the Department of Health.

Implementing avenues for nurses to access information from the Nursing Commission through programs, interactive television forums and consultation.

3% cost-of-living increase in salaries, effective July 1, 1997.

Magnitude of the Proposed Fee Increase: The fees for some fee categories will be reduced and the fees for other categories will increase. Following is a table indicating the amount proposed to increase or decrease for each fee category.

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Attachment A indicates the current $345,000 deficit, the anticipated expenses for the 1997-1999 biennium, the indirect costs, the current fees and proposed fees, anticipated revenue and cost recovery.

Impact to Licensees: The fees contained in WAC 246-840-990 cover a wide variety of fee categories and cover registered nurses, practical nurses and advanced registered nurse practitioners. Therefore, the rule's economic impact to a given licensee varies depending on the type of license and whether one is a licensee or applicant.

New Reporting Requirements: None.

Imposes New Compliance Requirement: Licensees and applicants must comply with new fees. This rule amendment proposes no other compliance requirements.

Loss of Sales or Revenue to Business: There is no loss of sales to licensees because of the proposed rule amendments. There is loss or gain of revenue to licensee due to the increase or decrease of fees and whether or not one is a licensee or applicant. However, licensees will not be losing any business and this will not affect sales.

Disproportionate Impact: There is no disproportionate impact to small businesses since all licensees are small businesses.

Reduce Costs: A comprehensive fee study analysis was prepared which demonstrates the amount of deficit, the anticipated spending for the next biennium and the revenue that would be charged at the proposed fees. Previously, three separate lists of fees were published. Each profession must be self-sufficient. A smaller profession would have larger fees because they have fewer licensees to spread the fees between. This proposal would combine the three different fee lists into one list. Therefore, some nurses will experience an increase and some a decrease. Instead of three professions (registered nurse, licensed practical nurse and advanced registered nurse practitioners) there will be only one fee listing to cover all three since these professions were combined by the legislature in 1994. The fees which are being proposed to be raised, are being raised only to the degree necessary to cover the deficit and anticipated expenses.

Notices to the Public: An article in the nursing newsletter will be distributed to all licensees, applicants and schools. This article will include all of the proposed fees and a description of where a person can send comments or attend the public hearing. A notice is being filed with the Code Reviser's Office to publish the text, date and location of the public hearing. A notice will be sent to all 700 people on the interested persons list for nursing. This interested persons list includes licensees, schools, attorneys, associations, and students.

List of Industries Required to Comply: There are no large businesses or industries that are required to comply with these proposed nursing fees. However, individual licensees or applicants are required to comply with these fees if they wish to become licensed or maintain their license. There are 128,000 licensed nurses.

Summary: All health care professions must be self-sufficient, no general fund money is available to operate the program. The fees charged for services are designed to create sufficient revenue to cover anticipated expenses. These proposed fees will eliminate the deficit and provide sufficient funds to cover the anticipated expenses.

Small Business Economic Impact Statement: In preparing this small business economic impact statement (SBEIS), the department used SIC code 809 Miscellaneous Health & Allied Services, Not Elsewhere Classified which has a minor impact threshold of $53.00. The estimated cost to health care practitioners for each fee category does not exceed a $53 increase for any individual fee category.

Therefore, there is no disproportionate cost for small businesses and a small business economic impact statement is not required.

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A copy of the statement may be obtained by writing to Kris McLaughlin, Department of Health, P.O. Box 47864, Olympia, WA 95804-7864 [98504-7864], phone (360) 664-1355, or FAX (360) 586-5935.

Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This rule does not subject a person to a penalty or sanction; does not establish, alter or revoke a qualification or standard for nursing licensure; and does not make an amendment to a policy or regulatory program. This rule will combine the three existing fee category lists into one fee category list and raise and lower fees according to the new fee study based on current data.

Hearing Location: Department of Health, 1102 S.E. Quince Street, on November 6, 1997, at 9:00 a.m.

Assistance for Persons with Disabilities: Contact Nursing Commission by October 30, 1997, TDD 1-800-833-6388, or FAX (360) 586-2165.

Submit Written Comments to: Kris McLaughlin, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, FAX (360) 586-5935, by October 30, 1997.

Date of Intended Adoption: November 6, 1997.

September 29, 1997

Bruce Miyahara

Secretary

AMENDATORY SECTION (Amending WSR 95-12-021, filed 5/31/95, effective 7/1/95)

WAC 246-840-990 Fees. The following fees shall be charged by the health professions quality assurance ((commission)) division of the department of health. Persons who hold an RN and an LPN license shall be charged separate fees for each license. Persons who are licensed as an advanced registered nurse practitioner in more than one specialty shall be charged a fee for each specialty:

(((1) Practical nurse)) RN/LPN fees:

Title of Fee Fee

Application (((examination and reexamination))

initial or endorsement) (($69.00))

$65.00

License renewal ((37.00))

50.00

((Impaired practical nurse assessment 4.00))

Late renewal penalty ((37.00))

50.00

Inactive renewal ((21.00))

20.00

Inactive late renewal penalty ((21.00))

10.00

((Endorsement - reciprocity 69.00))

Duplicate license ((21.00))

20.00

Verification of licensure/education (written) ((42.00))

25.00

(((2) Registered nurse fees:

Title of Fee Fee

Application (examination) $40.00

License renewal 35.00

Late renewal penalty 100.00

Inactive renewal 10.00

Inactive late renewal penalty 5.00

Endorsement - reciprocity 40.00

Duplicate license 20.00

Examination retake 40.00

Verification of licensure/education (written) 25.00

(3))) Advanced registered nurse fees:

Title of Fee Fee

ARNP application with or without prescriptive

authority (per specialty) (($25.00))

$65.00

ARNP renewal with or without prescriptive

authority (per specialty) ((30.00))

50.00

ARNP late renewal penalty (per specialty) ((100.00))

50.00

ARNP ((with prescriptive authorization application))

duplicate license (per specialty) ((45.00))

20.00

ARNP ((with prescriptive authorization renewal))

written verification of license (per specialty) ((50.00))

25.00

((ARNP with prescriptive late renewal penalty 100.00))