PROPOSED RULES
(Board of Nursing Home Administrators)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-13-093.
Title of Rule: WAC 246-843-150 Continuing education requirements for renewal of license, 246-843-180 Expired licenses, and 246-843-330 Inactive credential.
Purpose: Reporting continuing education (CE) on a periodic basis ensures that NHAs are gaining current knowledge related to administering a licensed nursing home. For individuals who have had a five-year or more absence from practice, taking the national exam again will ensure that the NHA is knowledgeable of current national practice standards for the profession.
Other Identifying Information: Clarify existing language.
Statutory Authority for Adoption: RCW 18.52.061 and 18.52.110.
Statute Being Implemented: Chapter 18.52 RCW.
Summary: Rule amendment will change the reporting cycle for continuing education to a two-year cycle but the ratio of hours accumulated to number of years remains the same. Rule amendments will create a requirement for nursing home administrators with an expired license or an inactive license to take the current examination if the NHA is out of practice for five years and wants active license.
Reasons Supporting Proposal: Changing the reporting cycle will require NHA to keep CE documentation for a shorter time. Requiring national examination will assure that NHAs who are out of practice are competent to be in administrative charge of a licensed nursing home for the safety, health and welfare of residents.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Barbara A. Hayes, Department of Health, (360) 236-4921.
Name of Proponent: Boarding of Nursing Home Administrators, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The rule requires reporting continuing education to ensure current knowledge of profession and requires certain NHAs to retake the national exam.
The purpose of the changes is to assure that the NHA is knowledgeable regarding current national practice standards for the profession. Federal and state regulations change frequently and people who are out of practice for five years will have to retake the national examination.
The board anticipates this rule will improve safety, health and welfare of residents by assuring NHAs have met current practice standards.
Proposal Changes the Following Existing Rules: The proposed amendments to WAC 246-843-150 change the continuing education reporting schedule from a three-year to a two-year reporting cycle.
The proposed amendments to WAC 246-843-180 will require an NHA with an expired license who has been in active practice in another jurisdiction to provide proof of active practice to return to active status and will require an NHA with an expired license who has not been in practice in any jurisdiction for five years or more to take the current national examination to return to active status.
The proposed amendments to WAC 246-843-330 will require an NHA with an inactive license who has been in active practice in another jurisdiction to provide proof of active practice to return to active status and will require an NHA with an inactive license who has not been in active practice in any jurisdiction for five years or more to take the current national examination.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
| Old Requirements | New Requirement |
| The Continuing Education Cycle | |
| Continuing education runs on a three year cycle at fifty-four hours every three years or eighteen hours per year. | Continuing education runs on a two year cycle at thirty-six hours every two years or eighteen hours per year. |
| Preceptors for administrator in training programs are granted one hour per month of continuing education credit | |
| Preceptor credit was limited to twenty-four hours per three year period. | Preceptor credit will be limited to sixteen hours per two year period or an average of eight hours per year. |
| Expired licenses | |
| If a license has been on expired status for over three years the licensee must complete an abbreviated application form, pay applicable fees and attest to completion of the two most recent years of continuing education in order to return to active status. | If a license has been on expired status for over five years and the licensee has been in active practice in another state, the licensee must complete an abbreviated application form, pay applicable fees, attest to completion of the two most recent years of continuing education and provide proof of active practice in order to return to active status. |
| If a license has been on expired status for over five years and the licensee has not been in active practice in another state, the licensee must complete an abbreviated application form, pay applicable fees, attest to completion of the two most recent years of continuing education and successfully complete the current licensing exam in order to return to active status. | |
| Inactive licenses | |
| If a license has been on inactive status the licensee must pay applicable fees and attest to completion of the two most recent years of continuing education in order to return to active status. | If a license has been on inactive status for less than five years the licensee must pay applicable fees and attest to completion of the two most recent years of continuing education in order to return to active status. |
| If a license has been on inactive status for over five years and the licensee has been in active practice in another state, the licensee must pay applicable fees, attest to completion of the two most recent years of continuing education and provide proof of active practice in order to return to active status. | |
| If a license has been on inactive status for over five years and the licensee has not been in active practice in another state, the licensee must pay applicable fees, attest to completion of the two most recent years of continuing education and successfully complete the current licensing exam in order to return to active status. | |
| TOTAL | TOTAL | Average employment | |||
| SIC | DESCRIPTION | UNITS | Employment | Smallest 90% | Largest 10% |
| 8051 | Skilled nursing care facilities | 281 | 26,407 | 15 | 144 |
A nursing home administrator required to take the national
exam to get an active license would pay a total cost of $1325 as
follows:
$245 per examination ($185 exam fee and $60 testing fee)
$130 for NAB study guide
$170 to fill out examination paperwork -- 1/2 day at $3901 average per day NHA salary
$390 to study for exam -- 1 day at $3902 average per day3 NHA salary
$390 travel to exam site and take 3-hour exam -- 1 day at $3904 average per day5
$1325 to take the exam
Based on past years, the Department of Health (DOH)
estimates that 2,000 practitioners may be subject to the
requirements of the proposed rules. This figure includes 460
people with active licenses, 140 with inactive license and 1400
with expired license -- many of which will not require an active
license.
Approximately one person per year with expired license who has not practiced in any jurisdiction for more than five years will request active license. Approximately one person per year with inactive license who has not practiced in any jurisdiction for more than five years will request active license. Each practitioner must obtain a separate, individual credential. If a nursing home covers the licensing reactivation costs for these two people, then they will incur this additional cost.
DOH used input from the Board of Nursing Home Administrators rather than a survey or a committee to obtain cost data.
Other than the costs above, there are no new costs such as reporting, record keeping, compliance costs, professional services, equipment, supplies, labor, increased administrative costs, lost sales or revenue.
IV. Is the cost disproportionate? This rule may have a disproportionate impact on small nursing homes and the board has therefore taken steps to minimize the costs of the rule.
A worst-case scenario for disproportionate impact would be that two nursing homes, one large and one a small business, would pay for the examination. Since only two people will encounter the current examination requirement each year, only two businesses can experience the impact of this change.
The cost for the exam, $1325, is the same for both large and small companies.
• The cost per employee for large businesses with an average of one hundred forty-four employees is $9.20 per employee.
• The cost per employee for small businesses with an average of fifteen employees is $88 per employee.
V. What cost minimizing features were included? List everything you have done AND if you have not done any of the following explain why it was not legal and feasible.
A. Reducing, modifying, or eliminating substantive regulatory requirements;
There has been no reduction, modification or elimination of substantive regulatory requirements. Reporting CE on a periodic basis is a standard practice to assure continuing competency of licensees. The requirement to be tested after a five-year lapse of practice is a reasonable requirement and is less onerous than requiring an administrator-in-training (AIT) program at a nursing home for much less pay than a licensed NHA. An AIT works under supervision of a qualified preceptor who works full time as the NHA at the same nursing home therefore a nursing home would pay the AIT as well as pay the NHA in charge. An AIT program would assure that such licensee meets minimal state standards but passing the national examination assures that such licensee meets minimal national standards of knowledge needed to be in charge of a nursing home.
B. Simplifying, reducing, or eliminating record keeping and reporting requirements;
Record keeping is not changed from current requirements. Licensees reporting CE every two years rather than every three years on a randomly selected basis is an insignificant workload and the Department of Health will not require additional fees. The frequency of reporting is increased to 1.5 times what is currently required but does not change the number of hours per year. There is no record keeping or reporting requirements associated with taking the national exam.
C. Reducing the frequency of inspections;
Department will continue to audit continuing education reporting on randomly selected licensees. Currently, an average of three licensees are audited each month. This activity will not require additional fees or time on the part of the licensee. There is no inspection related to taking the national exam.
D. Delaying compliance timetables;
Delay of compliance with CE reporting would conflict with established department credentialing rules. Delay of compliance to take the national exam is not feasible because each NHA with an expired or inactive license cannot anticipate an employment opportunity in Washington state.
E. Reducing or modifying fine schedules for noncompliance; or
There is no reduction or modification to fines for noncompliance of CE rules. No fine is assessed to reactivate an expired or inactive status.
VI. Any other mitigation techniques.
There are no other mitigation techniques used to minimize cost.
VII. How will you involve small business in the rule making?
Notice of proposed rules will be mailed to interested persons and licensees with active, inactive or expired licenses.
How did the department involve the public in the development of the proposed rule? Notices of public meetings were mailed to approximately 850 addresses. Two public meetings for public input were held. There were no attendees at these meetings. The Board of Nursing Home Administrators meeting agenda has included the topic for several open meetings. Agenda was mailed to interested persons on the mailing list. There was no controversial response from anyone.
1 Bureau of Labor Statistics - mean hourly wage of $48.67 for chief executives.
2 Bureau of Labor Statistics - mean hourly wage of $48.67 for chief executives.
3 A single eight-hour day of study was based on input from the Board of Nursing Home Administrators.
4 Bureau of Labor Statistics - mean hourly wage of $48.67 for chief executives.
5 A single eight-hour day of study was based on input from the Board of Nursing Home Administrators.
A copy of the statement may be obtained by writing to Barbara A. Hayes, Health Services Consultant, Board of Nursing Home Administrators, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4921, fax (360) 664-9077.
RCW 34.05.328 applies to this rule adoption. The proposed rule is significant because it adopts a new or makes significant amendments to a policy or regulatory program. The agency has conducted the additional analysis required.
Hearing Location: CenterPoint Corporate Park, Creekside Building No. 3, 1st Floor, 20435 72nd Avenue South, Kent, WA 98032, on August 9, 2002, at 3:00 p.m.
Assistance for Persons with Disabilities: Contact Barbara Hayes at (360) 236-4921, by July 26, 2002, TDD (800) 833-6388.
Submit Written Comments to: Barbara A. Hayes, fax (360) 664-9077, by July 26, 2002.
Date of Intended Adoption: August 9, 2002.
April 10, 2002
Barbara A. Hayes
Health Services Consultant 3
OTS-4338.7
AMENDATORY SECTION(Amending WSR 00-01-074, filed 12/13/99,
effective 1/13/00)
WAC 246-843-150
Continuing education requirements for
renewal of active license.
(1) Licensed nursing home
administrators must demonstrate completion of ((fifty-four))
thirty-six hours of continuing education every ((three)) two
years as provided in chapter 246-12 WAC, Part 7.
(2) Licensees practicing solely out of Washington state are exempt from WAC 246-843-130(1) and must meet all other requirements.
(3) A preceptor for an administrator-in-training program may
be granted continuing education credit of one hour per month of
the AIT program. Credit as a preceptor is limited to
((twenty-four)) sixteen hours of continuing education in any
((three)) two-year period.
[Statutory Authority: Chapter 18.52 and 34.05 RCW. 00-01-074, § 246-843-150, filed 12/13/99, effective 1/13/00. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-843-150, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.52.100. 91-24-050 (Order 217B), § 246-843-150, filed 11/27/91, effective 12/28/91; 91-06-060 (Order 141B), recodified as § 246-843-150, filed 3/1/91, effective 4/1/91. Statutory Authority: RCW 18.52.100(14) and 18.52.110(2). 84-07-051 (Order PL 461), § 308-54-150, filed 3/21/84. Statutory Authority: RCW 18.52.110. 80-04-069 (Order 338), § 308-54-150, filed 3/26/80; Order PL 260, § 308-54-150, filed 12/10/76; Order PL 107, § 308-54-150, filed 3/3/71.]
(2) ((If)) To return to active status when the license has
expired for over three years but less than five years, the
practitioner must((:
(a) Reapply for licensing under current requirements;
(b) Meet the requirements of chapter 246-12 WAC, Part 2)) meet the requirements of WAC 246-12-040 (2)(c).
(3) To return to active status when the license has been expired for five years or more:
(a) If the practitioner has been in active practice as a licensed nursing home administrator in another jurisdiction during that time, the practitioner must:
(i) Meet the requirements of WAC 246-12-040 (2)(c); and
(ii) Provide proof of active practice; or
(b) If the practitioner has not been in active practice as a licensed nursing home administrator in another jurisdiction during that time, the practitioner must:
(i) Meet the requirements of WAC 246-12-040 (2)(c); and
(ii) Successfully complete the current licensing examination.
[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-843-180, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.52.061. 93-13-004 (Order 371B), § 246-843-180, filed 6/3/93, effective 7/4/93. Statutory Authority: RCW 18.52.100. 91-24-022 (Order 216B), § 246-843-180, filed 11/25/91, effective 12/26/91; 91-06-060 (Order 141B), recodified as § 246-843-180, filed 3/1/91, effective 4/1/91. Statutory Authority: RCW 18.52.100(14). 86-01-086 (Order PL 576), § 308-54-180, filed 12/18/85. Statutory Authority: RCW 18.52.100. 80-08-066 (Order 348), § 308-54-180, filed 7/1/80; Order PL 260, § 308-54-180, filed 12/10/76; Order PL 107, § 308-54-180, filed 3/3/71.]
(2) To return to active status from inactive status if the license has been on inactive status for less than five years, the practitioner must meet the requirements of WAC 246-12-110.
(3) To return to active status from inactive status if the license has been on inactive status for five years or more:
(a) If the practitioner has been in active practice as a licensed nursing home administrator in another jurisdiction during that time, the practitioner must:
(i) Meet the requirements of WAC 246-12-110; and
(ii) Provide proof of active practice; or
(b) If the practitioner has not been in active practice as a licensed nursing home administrator in another jurisdiction during that time, the practitioner must:
(i) Meet the requirements of WAC 246-12-110; and
(ii) Successfully complete the current licensing examination.
[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-843-330, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.52.100. 91-24-050 (Order 217B), § 246-843-330, filed 11/27/91, effective 12/28/91; 91-06-059 (Order 149B), § 246-843-330, filed 3/1/91, effective 4/1/91.]