DEPARTMENT OF HEALTH

[Filed March 5, 2019, 11:22 a.m.]

Preproposal statement of inquiry was filed as WSR 17-22-034.

Title of Rule and Other Identifying Information: Chapter 246-834 WAC, Midwifery, the department of health (department) is revising sections of the midwifery chapter in order to clarify licensure rules and to update the legend drugs and devices rules for safety: WAC 246-834-060 Initial application, 246-834-250 Legend drugs and devices, 246-834-400 Expired license, and 246-834-450 Inactive license.

Hearing Location(s): On April 17, 2019, at 12:00 p.m., at the Department of Health, Town Center 2, Room 145, 111 Israel Road S.E., Tumwater, WA 98501.

Date of Intended Adoption: April 24, 2019.

Submit Written Comments to: Kathy Weed, P.O. Box 47852, Olympia, WA 98504, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by April 17, 2019.

Assistance for Persons with Disabilities: Contact Kathy Weed, phone 360-236-4883, fax 360-236-2901, TTY 360-833-6388 or 711, email kathy.weed@doh.wa.gov, by April 10, 2019.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules update requirements for initial application, expired or inactive credentials, and legend drugs and devices. Proposed language will modernize the initial applications section, update legend drugs and devices section to include drugs contemporarily used in out of hospital births to increase patient safety, and clarify rule language for expired and inactive licenses.

Reasons Supporting Proposal: The legend drug and devices section has not been updated since 2005, and the other sections have dated or unclear language. The proposed language will streamline initial applications for licensees, expand access to legend drugs and devices used in out of hospital births necessary to protect mother and newborn safety, and clarify requirements for licensees who are looking to reactivate expired or inactive licenses to increase the number of active midwives practicing in Washington. The proposed rule amendments are based on input from stakeholders, specifically midwifery practitioners and state associations.

Statutory Authority for Adoption: RCW 18.50.135 and 18.50.115.

Statute Being Implemented: RCW 18.50.135 and 18.50.115.

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

Name of Proponent: The department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Kathy Weed, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4883.

A school district fiscal impact statement is not required under RCW 28A.305.135.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kathy Weed, P.O. Box 47852, Olympia, WA 98504, phone 360-236-4883, fax 360-236-2901, TTY 360-833-6388 or 711, email kathy.weed@doh.wa.gov.

This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:

Is exempt under RCW 19.85.025(3) as the rules are adopting or incorporating by reference without material change federal statutes or regulations, Washington state statutes, rules of other Washington state agencies, shoreline master programs other than those programs governing shorelines of statewide significance, or, as referenced by Washington state law, national consensus codes that generally establish industry standards, if the material adopted or incorporated regulates the same subject matter and conduct as the adopting or incorporating rule.

Explanation of exemptions: WAC 246-834-060 is exempt under RCW 34.05.310 (4)(c).

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. With the exception of WAC 246-834-060, which is exempt from analysis, the remaining sections of rule were analyzed. The analysis determined that the proposed rule would not impose more-than-minor costs on businesses in an industry.

John Wiesman, DrPH, MPH

AMENDATORY SECTION(Amending WSR 15-20-049, filed 9/30/15, effective 10/31/15)

WAC 246-834-060Initial application requirements for licensure as a midwife.

(1) An applicant for a midwife license shall submit to the department the following:

(a) Initial application on forms provided by the department.

(b) Fees required in WAC 246-834-990.

(d) Proof of at least three years of midwifery training, per RCW 18.50.040 (2)(a), unless the applicant qualifies for a reduced academic period.

(e) ((A current plan for consultation, emergency transfer and transport.

(f))) Proof of completion of seven clock hours of HIV/AIDS education as required in chapter 246-12 WAC, Part 8.

(((g)))(f) Proof of successful completion of the midwifery jurisprudence exam, as offered by the department.

(2) In addition to the requirements in subsection (1) of this section, an applicant for a midwife license shall also:

(a) Have transcripts sent directly to the department from the applicant's midwifery school demonstrating that the applicant has received a certificate or diploma in midwifery. ((Those))An applicant((s)) applying under WAC 246-834-065 or 246-834-066 ((or 246-834-220)) may be exempted from this requirement.

(b) Have verification of passing the North American Registry of Midwives (NARM) examination. Results must be sent directly to the department from NARM.

(3) Once all application requirements in this section are met, and additional requirements in WAC 246-834-065 or 246-834-066 ((or 246-834-220)) if applicable, the department will schedule the applicant for the Washington state specific component exam.

AMENDATORY SECTION(Amending WSR 05-06-118, filed 3/2/05, effective 4/2/05)

WAC 246-834-250Legend drugs and devices.

(1) Licensed midwives may purchase and use legend drugs and devices as follows:

(a) Dopplers, syringes, needles, phlebotomy equipment, sutures, urinary catheters, intravenous equipment, amnihooks, airway suction devices, electronic fetal ((monitoring, toco monitoring, neonatal and adult resuscitation equipment, oxygen, glucometer, and centrifuge; and

(b)))monitors, tocodynamometer monitors, oxygen and associated equipment, glucose monitoring systems and testing strips, neonatal pulse oximetry equipment, hearing screening equipment, and centrifuges;

(b) Nitrous oxide as an analgesic, self-administered inhalant in a 50 percent blend with oxygen, and associated equipment, including a scavenging system;

(2) Pharmacies may issue breast pumps, compression stockings and belts, maternity belts, diaphragms and cervical caps, glucometers and testing strips, iron supplements, prenatal vitamins, and recommended vaccines as specified in subsection (3)(e) through (j) of this section ordered by licensed midwives.

(((2)))(3) In addition to prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho (D) immune globulin (((human))), and local anesthetic medications as listed in RCW 18.50.115, licensed midwives may obtain and administer the following medications:

(a) Intravenous fluids limited to Lactated Ringers, 5% Dextrose with Lactated Ringers heparin and 0.9% sodium chloride for use in intravenous locks;

(b) Sterile water for intradermal injections for pain relief;

(d) Epinephrine for use in maternal anaphylaxis and resuscitation and neonatal resuscitation, pending transport;

(e) Measles, Mumps, and Rubella (MMR) vaccine to nonimmune postpartum women((, HBIG and HBV for neonates born to hepatitis B+ mothers));

(f) Tetanus, diphtheria, acellular pertussis (Tdap) vaccine for use in pregnancy;

(g) Hepatitis B (HBV) birth dose for any newborn administration;

(h) HBIG and HBV for any neonates born to hepatitis B+ mothers;

(i) Influenza vaccine for use in pregnancy;

(j) Any vaccines recommended by the CDC advisory committee on immunization practices for pregnant or postpartum people or infants in the first two weeks after birth, as it existed on the effective date of this section;

(k) Terbutaline ((for nonreassuring fetal heart tones and/or cord prolapse))to temporarily decrease contractions pending emergent intrapartal transport;

(((g)))(l) Antibiotics for intrapartum prophylaxis of Group B beta hemolytic Streptococcus (GBS) per current CDC guidelines; and

(((h)))(m) Antihemorrhagic drugs to control postpartum hemorrhage((, such as misoprostel per rectum (for use only in postpartum hemorrhage)))including, but not limited to, oxytocin, misoprostol, methylergonovine maleate ((in the absence of hypertension,))(oral or intramuscular), and prostaglandin F2 alpha (((hemobate), intramuscular)).

(((3)))(4) The client's records ((shall))must contain documentation of all medications administered.

(((4)))(5) The midwife must have a procedure, policy or guideline for the use of each drug and device. A midwife may not administer a legend drug or use a legend device for which he or she is not qualified by education, training, and experience.

AMENDATORY SECTION(Amending WSR 17-15-024, filed 7/7/17, effective 8/7/17)

WAC 246-834-400Expired license.

(1) If a midwife's license under this chapter has been expired for less than three years ((or less)), to reinstate the license the practitioner shall meet the requirements of chapter 246-12 WAC, Part 2.

(2) If a midwife's license under this chapter has expired and the practitioner has been engaged in the active practice of midwifery in another United States jurisdiction or territory, or other location approved by the department, to reinstate the license the practitioner shall:

(a) Submit verification of active practice; and

(b) Meet the requirements of chapter 246-12 WAC, Part 2.

(3) If a midwife's license under this chapter has been expired for ((more than)) three years or more but less than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:

(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of ten births; and

(b) Meet the requirements of chapter 246-12 WAC, Part 2.

(4) If a midwife's license under this chapter has been expired for more than five years at time of application, and the practitioner has not been actively engaged in midwifery, the practitioner shall:

(a) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of fifteen births;

(b) Retake and successfully pass the Washington state licensing examination; and

(5) A proposed preceptor shall:

(a) Hold an active license without restriction, current discipline, or conditions as a midwife under chapter 18.50 RCW, a certified nurse midwife under chapter 18.79 RCW, an allopathic physician under chapter 18.71 RCW, or an osteopathic physician under chapter 18.57 RCW;

(b) Have actively practiced at least three consecutive years or attended at least one hundred fifty births; and

AMENDATORY SECTION(Amending WSR 17-15-024, filed 7/7/17, effective 8/7/17)

WAC 246-834-450Inactive license.

(1) A licensed midwife may obtain an inactive license((. Refer to))by meeting the requirements of chapter 246-12 WAC, Part 4.

(2) An inactive license must be renewed every year on the midwife's birthday according to WAC 246-12-100 and by paying the fee required under WAC 246-834-990.

(3) A midwife with an inactive license may return to active status.

(a) A midwife with an inactive license for three years or less who wishes to return to active status must meet the requirements of chapter 246-12 WAC, Part 4.

(b) A midwife with an inactive license for more than three years, who has been in active practice in another United States jurisdiction or territory or other location approved by the department and wishes to return to active status must:

(i) Submit verification of active practice; and

(ii) Meet the requirements of chapter 246-12 WAC, Part 4.

(c) A midwife with an inactive license for more than three years but less than five, who has not been in active practice and wishes to return to active status must:

(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of ten births; and

(ii) Meet the requirements of chapter 246-12 WAC, Part 4.

(d) A midwife with an inactive license for more than five years who has not been in active practice and wishes to return to active status must:

(i) Work as a birth assistant under the supervision of a department-approved preceptor for a minimum of fifteen births;

(ii) Retake and successfully pass the Washington state licensing examination; and

(iii) Meet the requirements of chapter 246-12 WAC, Part 4.

(4) A proposed preceptor shall:

(b) Have actively practiced at least three consecutive years or attended at least one hundred fifty births; and