Purpose: WAC 246-834-050 Examination requirements for licensure as a midwife, 246-834-060 Initial application requirements for licensure as a midwife, and 246-834-160 Student midwife permit. This is the second emergency rule for these amendments. This emergency rule continues without change [changing] the amendments filed in the first emergency rule, filed on April 22, 2020, under WSR 20-10-001. In response to the coronavirus disease 2019 (COVID-19) pandemic the department of health (department) is amending requirements for examination for midwifery applicants. In the permanent rule, applicants must take and pass three examinations to become a licensed midwife: (1) The national examination given by the North American Registry of Midwives (NARM); (2) the jurisprudence given by the department; and (3) the state licensing examination given by the department. This emergency rule removes the requirement for the NARM since it is not currently administered. Also, the department is amending the passing score for the Washington state licensure exam from eighty percent to seventy-five percent.

Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

Reasons for this Finding: The state of emergency in Washington state due to the COVID-19 pandemic, continues to lead to a shortage of midwives as expectant families are moving away from planned hospital births. Washington midwives have seen a significant uptick, both in late transfers and planned out of hospital births, as the population shifts toward midwifery care.

The NARM examination is given at testing sites that are closed due to shelter in place and social distancing practices. Attempts by NARM to provide remote proctoring are proving to be difficult or impossible for applicants. Maintaining the NARM as a licensing requirement would essentially put a stop to licensing midwives when that profession is greatly needed.

Using social distancing practices, the midwifery program will maintain the requirement of the paper-based Washington state licensure examination. Amending the passing score for the Washington state licensure examination to seventy-five percent will allow a greater number of candidates to successfully pass the examination on the first attempt. Approximately sixty-five percent of candidates pass the Washington state licensure examination on the first attempt. Amending the passing score to seventy-five percent would allow for approximately eighty percent of candidates to successfully pass the Washington state licensure examination on their first attempt, reducing the number of times they must go to the testing site. Even though the passing score is temporarily being lowered, the exam is still rigorous and ensures public safety by testing the scientific and practical fitness of candidates to practice midwifery.

An applicant for midwifery licensure shall successfully pass:

(1) ((The midwifery examination offered by the North American Registry of Midwives (NARM);

(2))) The Washington state licensure examination with a minimum passing score of ((eighty))seventy-five percent; and

(((3)))(2) The midwifery jurisprudence examination with a passing score of one hundred percent, as offered by the department.

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

(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. An applicant applying under WAC 246-834-065 or 246-834-066 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 if applicable, the department will schedule the applicant for the Washington state specific component exam.

(1) A student midwife permit may be issued to any individual who has:

(a) Successfully completed an accredited midwifery program as specified in WAC 246-834-135, or is foreign trained as specified in WAC 246-834-065(1);

(b) Obtained a minimum period of midwifery training of at least three academic years as required by WAC 246-834-140;

(d) Documentation of undertaking the care of not less than fifty women in each of the prenatal, intrapartum and early postpartum periods as required by RCW 18.50.040 (2)(c); and

(e) ((Satisfactorily completed the NARM examination required by WAC 246-834-050; and

(f))) Filed a completed application for student midwife permit under WAC 246-834-060 and accompanied by a nonrefundable fee as specified in WAC 246-834-990.

(2) The student midwife permit authorizes the individuals to practice and observe women in the intrapartum period under the supervision of a licensed midwife under 18.50 RCW, an allopathic physician under chapter 18.71 RCW, an osteopathic physician under chapter 18.57 RCW or certified nurse midwife under chapter 18.79 RCW.

(3) Once all application requirements including clinical components are completed the applicant may be eligible to sit for the Washington state licensure examination.