Preproposal statement of inquiry was filed as WSR 17-08-062.
Title of Rule and Other Identifying Information: WAC 246-836-080 Continuing competency program, the board of naturopathy (board) is proposing to amend the rule section regarding continuing education for naturopathic physicians.
Hearing Location(s): On November 16, 2018, at 9:00 a.m., at the Department of Health, Creekside at Center Point, Suite 310, Room 309, 20425 72nd Avenue South, Kent, WA 98032.
Date of Intended Adoption: November 16, 2018.
Submit Written Comments to: Susan Gragg, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by November 9, 2018.
Assistance for Persons with Disabilities: Contact Susan Gragg, phone 360-236-4941, TTY 360-833-6388 or 711, email firstname.lastname@example.org, by November 9, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The board is proposing amendments to WAC 246-836-080 concerning continuing education (CE) requirements for licensed naturopathic physicians. Currently, naturopathic physicians report twenty hours of CE every year. The board has heard from some licensees and stakeholders that they find the current requirements to be unclear, vague, and outdated. The proposed rule amendments would clarify acceptable CE by identifying approved CE providers and acceptable ways for naturopathic physicians to satisfy the requirements, such as allowing a portion to be fulfilled through courses relevant to other health professions if the content is consistent with naturopathic scope of practice. The proposed rule amendments would also change the CE reporting cycle by increasing the number of hours required. The board's proposal would change the requirements from twenty hours every year to sixty every two years; those sixty hours would include a requirement for fifteen hours of pharmacy content.
Reasons Supporting Proposal: The board recognizes that there are many CE programs intended to improve clinical practice and patient care that may not satisfy the requirements of the rule as it is currently written, and while the proposed amendments would increase the number of hours required, they also provide more options currently ineligible for CE credit. These options would give licensees the choice to participate in activities more in line with their individual practices. In addition, the proposed increase from one year to a two year reporting cycle gives providers greater flexibility in choosing courses. The proposed amendments would also bring the naturopathic physician CE requirement more in line with requirements for naturopathic physicians in other states.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Washington state board of naturopathy, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Susan Gragg, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4941.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The rules do not impact businesses; these rules pertain only to providers.
Blake T. Maresh
(1) General provisions. Each licensed naturopathic physician must complete ((twenty))sixty hours of continuing education ((per))every two years, as provided in chapter 246-12 WAC, Part 7.
(2)(a) A license holder's first ((twenty))sixty hour continuing education requirement is due on the ((second))third renewal date after the license is issued. After that, it is due ((annually))every other year on the licensee's renewal date.
(((3)))(b) A licensee may begin to accrue continuing education from the date of initial licensure and apply it toward the fulfillment of their first continuing education requirement.
(c) License reissuance. When applying for reissuance of an expired license, a naturopathic physician must attest to sixty hours of continuing education for the two years preceding the reissuance application. Upon reissuance, the licensee's continuing education sequence will resume based on the last active license continuing education cycle.
(3) Licensees must complete a minimum of fifteen continuing education hours over two years on the subject of pharmacology consistent with naturopathic scope of practice in this state. Course content, or a portion thereof, must be designated as pharmacology by an entity listed in subsection (5)(a)(i) or (b)(i) of this section. Examples of eligible pharmacology course content include:
(a) Legend substances as defined in RCW 69.41.010; (b) Controlled substances in chapter 69.50 RCW;
(c) Biopharmacology, which is the study of medicinal or drug products manufactured in, extracted from, or semi-synthesized from biological sources;
(d) Pharmacognosy, which is the study of medicinal drugs derived from plants or other natural sources;
(e) Contraindications or interactions of drug-to-drug, drug-to-herb, or drug-to-nutrient; or
(f) Other subjects approved by the board.
(4) Suicide prevention requirements. As part of continuing education, a licensed naturopathic physician must complete a board-approved one-time training that is at least six hours long in suicide assessment, treatment, and management. This training must be completed by the end of the first full continuing education reporting period after January 1, 2016, or the first full continuing education reporting period after initial licensure, whichever is later.
(a) Until July 1, 2017, a board-approved training must be an empirically supported training in suicide assessment, including screening and referral, suicide treatment, and suicide management, and meet any other requirement in RCW 43.70.442
(b) Beginning July 1, 2017, training accepted by the board must be on the department's model list developed in accordance with rules adopted by the department that establish minimum standards for training programs. The establishment of the model list does not affect the validity of training completed prior to July 1, 2017.
(c) A board-approved training must be at least six hours in length and may be provided in one or more sessions.
(d) The hours spent completing the training in suicide assessment, treatment, and management under this subsection count toward meeting any applicable continuing education requirements.
(e) Nothing in this subsection is intended to expand or limit the naturopathic scope of practice.
(((4)))(5) Categories of creditable continuing education.
(a) Category 1. A licensee is required to obtain a minimum of twenty hours over two years in this category; however, all sixty hours may be earned in this category. Category 1 credit hours and activities include:
(i) Live-attended, both in-person and remote-attendance, education related to the naturopathic scope of practice in this state approved or offered by the following sources:
(A) American Association of Naturopathic Physicians (AANP);
(B) Washington Association of Naturopathic Physicians (WANP);
(C) North American Naturopathic Continuing Education Accreditation Council (NANCEAC) through the Federation of Naturopathic Medicine Regulatory Authorities (FNMRA); or
(D) Naturopathic medicine academic institutions and scholarly organizations approved by the board according to WAC 246-836-150.
(ii) Prerecorded education meeting the requirement in (a)(i) of this subsection related to the naturopathic scope of practice in this state. To qualify for credit under this section the course must require the licensee to pass an examination in order to complete the course.
(iii) Completion of a one year residency accredited by the council on naturopathic medical education (CNME) meets the full two year continuing education requirement.
(iv) Licensees completing a medical marijuana continuing education course approved by the department may claim the hours designated by the course provider for this activity. This activity can only be claimed once during a two year continuing education cycle.
(v) Licensees completing the suicide prevention requirement in subsection (4) of this section may claim six hours for this activity. This activity can only be claimed once during a two year continuing education cycle.
(b) Category 2. Category 2 credit hours and activities include:
(i) Live-attended, both in-person and remote-attendance, education relevant to various other health professions, however licensees may only claim those hours that have content consistent with naturopathic scope of practice in this state. Hours must be obtained through an entity that is accredited or nationally recognized, examples of which include, but are not limited to, courses accredited by:
(A) The accreditation council for continuing medical education (ACCME);
(B) The American Nurses Credentialing Center (ANCC); or
(C) The accreditation council for pharmacy education (ACPE).
(ii) Prerecorded education meeting the requirement in (b)(i) of this subsection, however only content related to naturopathic scope of practice in this state may be claimed. To qualify for credit under this section the course must require the licensee to complete an examination in order to complete the course.
(iii) Teaching, lecturing, or serving as a residency director, which shall equate one full-time work week to one continuing education hour.
(iv) Publishing in a peer-reviewed, scientific journal or textbook. Ten credit hours may be claimed for each paper, exhibit, publication, or chapter. Credit shall be claimed as of the date materials were presented or published.
(c) Category 3. A licensee may claim up to a maximum of five hours over two years in this category. Category 3 credit hours and activities include:
(i) Online study not otherwise specified above;
(ii) Multimedia education (CD/DVD);
(iii) Certification or recertification in basic life support (also known as cardiopulmonary resuscitation);
(iv) Self-study including, but not limited to, board examination preparation or reading papers and publications where an assessment tool is required upon completion; and
(v) Courses in nonclinical practice topics, such as:
(A) Health promotion;
(B) Health care cost management;
(D) Regulatory affairs; or
(E) Professional ethics, disciplinary prevention, or jurisprudence. Licensees completing the board's jurisprudence examination may claim two hours for this activity. This activity can only be claimed once during a two year continuing education reporting cycle.
(vi) In-person attendance at a board of naturopathy business meeting. Each meeting counts for one hour. Acceptable documentation is the licensee's presence recorded in the board's minutes.
(6) Documentation. A licensee must submit documentation upon request or audit. Acceptable documentation includes:
(a) Certificates of completion;
(c) Letters from instructors; or
(d) Other records, which must include participant's name, course title, course content, dates, provider(s) name(s), and signature of sponsor or instructor.
(e) For self-study activities that do not offer documentation, licensees should keep lists with hours spent reading publications, papers, or articles; or hours spent preparing for specialty board examinations.
(7) Waiver or extension. In ((emergency))emergent or unusual situations, such as personal or family illness, the board may ((in its discretion, for good cause shown,)) waive all or part of the continuing education requirement for a particular ((one year))continuing education reporting period for an individual licensee if the board determines there is good cause. The board may also grant the licensee an extension period in order to meet the full requirement if the board determines there is good cause. Licensees requesting an extension must include a detailed plan on how they will obtain the deficient hours. Hours obtained for an extension can only be applied to the extension and cannot be used for any other continuing education reporting cycle. The board may require ((such)) verification of the ((emergency))emergent or unusual situation as is necessary ((to prove its existence)).