WSR 98-07-085

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed March 17, 1998, 4:34 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-22-023

Title of Rule: WAC 246-834-990 Midwifery fees, this rule describes fees for licensed midwives

Purpose: The purpose of amending this rule is to eliminate the deficit in the midwifery budget by July 1, 2001. A new fee schedule takes into account that the department will be administering a national examination rather than their own licensure examination. Those fees will be adjusted accordingly. In addition, some of the current fees will be raised or lowered according to an updated fee study, which takes into account current workload, the existing deficit and anticipated workload and expenses for the upcoming biennium in setting fees. Language will also be changed to be consistent with other professions in order to implement chapter 191, Laws of 1996

Statutory Authority for Adoption: Chapter 18.50 RCW and RCW 43.70.250

Statute Being Implemented: Chapter 18.50 RCW and RCW 43.70.250

Summary: This fee adjustment allows a reasonable fee for national and state examination administrations. In addition, the new fees will eliminate a budget deficit by the end of the second biennium. Language will be changed to be consistent with other professions

Reasons Supporting Proposal: The midwifery program is required by law to support their programs with revenues obtained through licensure fees. This proposed amendment would allow the midwifery program to eliminate a current deficit and continue to support the program through their fees

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kendra N. Pitzler, 1300 S.E. Quince Street, Olympia, WA 98504, (360) 664-4216

Name of Proponent: Midwifery Advisory Committee, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: This rule determines the fees for midwifery licensure, examination, renewal of licensure and other program related fees. The fees collected are used to pay for salaries of staff, goods and services, investigations, disciplinary actions and other program related expenses. The purpose of this amendment is to raise or lower fees in order to eliminate the current deficit by July 1, 2001, and allow the program to pay for all related costs as required by law. Language changes will also allow uniformity across health care professions

Proposal Changes the Following Existing Rules: Some fees will be changed because the department will be using a national examination rather than their own licensure examination. Other fees will be reduced or increased according to the current fee study

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

Small Business Economic Impact Statement

and

Economic Impact Analysis

Introduction: The midwifery program last amended the fees in 1991. In 1997 the legislature authorized the midwifery program to exceed I-601 to raise fees sufficiently to cover expenses.

This rule amendment would allow the fees to be increased or decreased according to an updated fee study of the current workload, the current deficit and the anticipated expenses. Fees being charged currently have not been updated since 1991 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 midwifery program. 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:

A new computer information system.

A new adjudicative clerk office for handling and tracking adjudicative proceedings.

New legislation which requires resources for implementation. This includes 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.

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.

Attachment A indicates the current $40,000 deficit, the anticipated expenses for the 1997-1999 biennium, the indirect costs, the current fees and proposed fees, anticipated revenue and cost recovery.

Two fee categories, renewal fee and application for midwife in training program, have the highest proposed increase. The proposed fees do not increase the initial application fee. In the past, this initial application fee covered some of the costs of applicants applying through the midwife in training program. These new proposed fees clearly capture the exact costs of the midwife in training program and are not supplemented by fees raised through initial applications. The renewal fee is increasing to cover the increased costs of licensing and disciplinary, the current deficit and anticipated expenses. In the initial fee study analysis the proposed renewal fee was to have been higher because the deficit was to be recovered within the current biennium. A decision was made to spread the increased fees over one and a half bienniums which would result in a lower proposed renewal fee than first anticipated.

There are three new proposed fee categories which did not previously exist. These three categories are proposed because the midwifery program is going towards a national examination. The fees will cover the state's cost to administer the national examination and the state jurisprudence examination.

Impact to Licensees: The fees contained in WAC 246-834-990 cover a wide variety of fee categories for the midwifery program. Therefore, the rule's economic impact to a given licensee varies depending on the type of license and whether one is a licensee or an 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 licensees 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: Of the one hundred fifteen licensed midwives, approximately 3-5% of them work in a birthing center. The remaining licensed midwives work independently. Therefore, the majority of licensed midwives are not disproportionately impacted. Those who work in a birthing center may choose to pay the new renewal fee for each licensed midwife employed. However, the business is not required to pay the renewal fee, the individual licensed midwife is responsible for his or her own renewal fee.

Reduce Costs: A comprehensive fee study analysis was prepared which demonstrates the $40,000 deficit, the anticipated spending for the next biennium and the revenue that would be charged at the proposed fees. Each profession must be self sufficient. A smaller profession such as the midwifery program would have larger fees because they have fewer licensees to spread the fees amongst. 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: A CR-101 was mailed to each and every licensee notifying them of the anticipated change to fees. A copy of the notice was also mailed to the association and other interested persons. The interested persons list includes licensees, schools, attorneys, associations and students. Discussions on proposed fee changes were made at public Midwifery Advisory Committee meetings on July 15, 1996, June 20, 1997, and October 3, 1997.

List of Industries Required to Comply: The only known business is birthing centers. Birthing centers employ approximately 3-5% of licensed midwives. There are no other large businesses or industries that are required to comply with these proposed midwifery 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 one hundred fifteen licensed midwives.

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

Reporting, Recordkeeping and Other Compliance Requirements: There are no new reporting, recordkeeping or other compliance requirements necessary as a result of the proposed fee changes. Applicants and licensees have in the past been required to pay fees, the only difference is the dollar amount charged. There are no new professional services necessary for a small business to comply with the proposed new fees.

Analysis of Costs of Compliance: There are no new costs to small businesses to comply with the proposed fee changes. Licensees and businesses will not need any additional supplies or labor. Administrative costs may increase if a business were to hire an applicant who needs to apply by application by the midwifery in training program.

Will Compliance Cause Loss of Sales or Revenue? The proposed fee changes will not affect sales. The new fees may affect revenue for some small businesses.

Disproportionate Impact on Small Businesses: The Department of Health is aware of only one small business, birthing centers which employ licensed midwives. Midwives are generally self employed and only 3-5% of the one hundred fifteen licensed midwives are employed in birthing centers. In the event that a midwife were employed by a business, the degree of impact would vary by how many midwives are employed. If a business were to employ two midwives, the increase in renewal fees would be $340 per year or $170 per licensee. The fees are the same for an individual licensee or a small business. The business is not required to pay the renewal fee, but the licensed individual midwife is.

Steps Taken by Agency to Reduce Costs: The midwifery program currently is operating under a $40,000 deficit. The initial plan in raising the fees was to recapture the deficit in the current biennium. Upon reevaluation it was determined that the deficit could be recovered over one and a half bienniums and not affect business detrimentally. This resulted in a lower than anticipated renewal fee change.

How Will the Agency Involve Small Businesses in the Development of the Rule? All licensed midwives have received a copy of the proposal to change fees. Public comment thus far has not been opposed to raising fees. Rather, the public comment received thus far is questioning the legality of the midwifery program paying for unlicensed practice investigations instead of the Department of Health. These concerns were responded to by letter.

Three public meetings were held to discuss the possibility of changing the fee categories. When the rule notice is developed a copy will be mailed to all licensees for their review and comment. A copy of the rule notice will also be mailed to all interested persons which includes applicants, schools, attorneys and licensees.

Industries Required to Comply with the Rule: All licensed midwives and applicants must comply with the proposed fee changes. Any birthing centers must ensure that the licensed midwives they employ have renewed their annual license.

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

RCW 34.05.328 does not apply to this rule adoption. This rule adjusts fees according to an I-601 exemption.

Hearing Location: Department of Health, First Floor Conference Room, 1101 Eastside Street, Olympia, WA 98504, on April 21, 1998, at 9:00 a.m

Assistance for Persons with Disabilities: Contact Kendra Pitzler by April 7, 1998, TDD (800) 833-6388 or (360) 664-4216

Submit Written Comments to: Kendra Pitzler, Department of Health, P.O. Box 47864, Olympia, WA 98504-7864, FAX (360) 586-2165 by April 16, 1998

Date of Intended Adoption: April 22, 1998

March 17, 1998

Bruce Miyahara

Secretary

OTS-1767.5

AMENDATORY SECTION (Amending Order 173, filed 6/6/91, effective 7/7/91)

WAC 246-834-990  Midwifery fees and renewal cycle. ((The following fees shall be charged by the professional licensing division of the department of health:)) (1) Licenses must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.

(2) The following fees are nonrefundable:

[Statutory Authority: RCW 43.70.250. 91-13-002 (Order 173), § 246-834-990, filed 6/6/91, effective 7/7/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-834-990, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.250. 90-04-094 (Order 029), § 308-115-405, filed 2/7/90, effective 3/10/90. Statutory Authority: RCW 18.50.135. 89-08-008 (Order PM 827), § 308-115-405, filed 3/24/89. Statutory Authority: RCW 43.24.086. 87-18-031 (Order PM 667), § 308-115-405, filed 8/27/87. Statutory Authority: 1983 c 168 § 12. 83-17-031 (Order PL 442), § 308-115-405, filed 8/10/83. Formerly WAC 308-115-400.]

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