Sunrise Process - Guidelines for Health Professions in Washington

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The Sunrise Process in the State of Washington

Health Professions Credentialing

Updated May, 2005

Page Contents

Introduction and Background
The Sunrise Review Process
Submission of the Applicant Report
Interested Party Participation and Public Hearing
Department Report
Definitions
Approximate Timeline for Sunrise Review
Criteria for Evaluating Continuing Education Requirements
Applicant Report Cover Sheet and Format

Introduction and Background

In Washington State, the Department of Health makes recommendations to the Legislature on health profession credentialing proposals. This is done only at the request of the chairs of legislative committees, usually the House Health Care Committee or Senate Health and Long Term Care Committee. The process is called a "sunrise review" and requirements are contained in RCW 18.120.030.

The legislature's intent is that all individuals should be permitted to provide health services unless there is an overwhelming need for the state to protect the interests of the public by restricting entry. Changes of practitioner's scope of practice should benefit the public. Enhancement of professional status or qualification for third party reimbursement alone are unacceptable justifications for regulation.

The Sunrise Act states (RCW 18.120.010) that a health profession should be regulated or scope of practice expanded only when:

F Unregulated practice can clearly harm or endanger the health, safety or welfare of the public, and the potential for the harm is easily recognizable and not remote or dependent upon tenuous argument;

F The public needs and can reasonably be expected to benefit from an assurance of initial and continuing professional ability;

F The public cannot be effectively protected by other means in a more cost-beneficial manner.

If the legislature finds that it is necessary to regulate a health profession not previously regulated by law, the least restrictive method of regulation should be implemented, consistent with the public interest.

In fulfilling its role as advisor to the legislature, department recommendations are not limited to whether the applicant group should be credentialed and the level of credentialing. The department is free to recommend on other portions of the proposal. Examples are:

F Whether the applicant group should be combined with other credentialed or applicant groups;

F Whether the proposed scope of practice should be broadened or narrowed;

F Whether the proposed licensing board or other proposed regulatory entity is appropriate and represents consumer interests;

F Whether there are specific changes to the text of any proposed legislation; and

F Whether other types of regulation are more appropriate.

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The Sunrise Review Process

The legislature annually notifies the department of the proposals to review. The department contacts the applicant to describe the sunrise process. The actual review process does not begin until the applicant submits the applicant report to the department. The conclusion of the process is the department's final report to the legislature, which is advisory only. No specific legal rights are granted or taken away because of the sunrise process.

Submission of the Applicant Report

The applicant report should be submitted by August 1 in order for the department to complete its review in time for the next legislative session. If needed, the applicant may request a meeting with department staff to receive clarification about expectations for the applicant report and specifics of the particular proposal.

A concise, narrative format is encouraged. In order for the department to conduct a quality review of the proposal, the applicant report needs to demonstrate that the proposal meets the sunrise standards and provide other information related to both the statutory criteria and issues raised by the department in correspondence with the applicant. Click here for Applicant Report Coversheet and Outline.

The department will endeavor to review each proposal following the timeline detailed in these guidelines. However, any deviation, including those caused by the applicant or the department, does not invalidate the process.

The department will give the applicant follow-up questions and comments within 14 days after receipt of the applicant report. The applicant will be given 14 days to respond to any written questions or concerns raised about the applicant report.

Interested Party Participation and Public Hearing

The department will send out the applicant report and notice of hearing to all interested parties. Interested parties are invited to submit written comments prior to the hearing, after the hearing, and after the report has been drafted.

A public hearing will be held approximately 40 days after the applicant report is received. A public hearing is intended to take testimony from interested parties and gather information for department recommendations. The applicant makes a presentation of information contained in the applicant report and other information within the scope of the review.

Interested parties may provide verbal or written testimony, which will be included in the final report to the legislature. There will be a 10-day open comment period following the public hearing for interested parties or the applicant to provide additional information in writing.

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Department Report

The department report will consist of:

background on the proposal
department findings based on rationale
department advisory recommendations

The report will summarize comments submitted during the process. The department intends to represent the full range of ideas and opinions available, not to individually represent every statement received. This means an individual’s letter may not necessarily be quoted or reproduced, but it does mean all viewpoints are taken into consideration during the formulation of recommendations.

Participants will have 10 days to respond to the draft report. This allows the opportunity for rebuttals or corrections to the record. The draft is then reviewed, modified, and approved by the Assistant Secretary of Health Systems Quality Assurance and the Secretary of the department. The final report is transmitted via the Office of Financial Management to the Legislature and copies are sent to interested parties and the applicant.

Definitions

Applicant group	Any health professional group or organization, any individual, or any other interested party which proposes that any health professional group be credentialed for the first time, change their level of credentialing, or increase their scope of practice.
Applicant group report	The written document from the applicant group submitted to the department responding to the review criteria contained in RCW 18.120.030.
Assistant Secretary	Assistant Secretary for Health Systems Quality Assurance, Department of Health.
Certification	A voluntary process by which the state grants recognition to an individual who has met certain qualifications. A non-certified person may perform the same tasks, but may not use "certified" in the title. A certified person is subject to the Uniform Disciplinary Act (Chapter 18.130 RCW).
Credentialing	The formal state recognition of a profession through registration, certification or licensure.
Department	The Washington State Department of Health, Post Office Box 47850, Olympia, Washington 98504-7850, (360) 236-4612.
Harm	Physical, emotional, mental, social, or financial impairment resulting from the functions rendered or failed to be rendered by the group seeking regulation. Harm also includes the potential for fraudulent practice should a group not be regulated.
Legislative Committee	The standing legislative committees designated to consider health professions regulation proposals are usually the House Health Care Committee and the Senate Health and Long-Term Care Committee.
Licensure	A method of regulation by which the state grants permission to persons who meet predetermined qualifications to engage in a health profession which would otherwise be unlawful in the absence of the permission. Licensure protects the scope of practice and the title. A licensee is subject to the Uniform Disciplinary Act (Chapter 18.130 RCW).
Office of Financial Management	The Office of Financial Management (OFM) in the Office of the Governor is responsible for reviewing all reports from agencies to the Legislature. The department’s sunrise review reports must be approved by OFM.
Public Disclosure	In accordance with RCW 42.56.040 - 42.560.550 (Public Records Disclosure), written material developed in the course of a review is available for public inspection and copying. This includes the Applicant Group Report, other information supporting or opposing the proposal, the department staff analysis, and the final recommendation to the legislature. A reasonable charge is made for copying written materials and for tape recordings of the public hearings.
Registration	A process by which the state maintains an official roster of names and addresses of the practitioners in a given profession; the location, nature and operation of the health activity practiced; and, if required, a description of the service provided. A registrant is subject to the Uniform Disciplinary Act (Chapter 18.130 RCW).
Scope of Practice	The types of procedures, service or tasks a professional may legally perform.
Sunrise Standards	The standards applied by the sunrise statute to determine when a health profession should be regulated: (a) Unregulated practice can clearly harm or endanger the health, safety or welfare of the public, and the potential for harm is easily recognizable and not remote or based on tenuous argument; (b) The public needs and can reasonably be expected to benefit from an assurance of initial and continuing professional ability; (c) The public cannot be effectively protected by other means in a more cost-beneficial manner.
Uniform Disciplinary Act	State law (Chapter 18.130 RCW) that provides for the disciplining of practitioners for unprofessional conduct.

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Approximate Timeline for Sunrise Review

Day 1	Applicant report is received
Day 5	Applicant report and hearing notice are distributed to interested parties
Day 5-14	Department reviews applicant report and prepares follow-up questions for applicant
Days 14-28	Applicant prepares responses to supplemental questions
Days 2-40	Department staff conduct necessary independent research on proposal. Interested parties review applicant report and submit written comments
Day 40	Approximate date of public hearing
Days 40-50	Public comment period on hearing information
Day 75	Department circulates draft report to interested parties for "rebuttal"
Day 85	Rebuttal statements due
Days 85 to 111	Secretary of Department of Health reviews and approves final draft
Day 111	Department report submitted to Office of Financial Management

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Criteria for Evaluating Continuing Education Requirements (RCW 18.120.050)

In the event a proposal includes a requirement for continuing education, RCW 18.120.050 will be used as a guide in developing the department's recommendation:

"Requirements for licensees to engage in continuing education as a condition of continued licensure has not been proven to be an effective method of guaranteeing or improving the competence of licensees or the quality of care received by the consumer. The legislature has serious reservations concerning the appropriateness of mandated continuing education. Any legislative proposal that contains a continuing education requirement should be accompanied by evidence that such a requirement has been proven effective for the profession addressed in the legislation.

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06/04/07 08:40 AM

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