New Chapter 246-836A WAC, WAC 246-836-300, and WAC 246-836 ...

Significant Legislative Rule Analysis New Chapter 246-836A WAC,

WAC 246-836-300, and WAC 246-836-310 Rules Concerning Colon Hydrotherapy January 26, 2022

Template Updated November 2015

SECTION 1:

Describe the proposed rule, including a brief history of the issue, and explain why the proposed rule is needed.

The proposed rules implement Senate Bill (SB) 5124 (chapter 179, Laws of 2021) and create a new profession in the State of Washington, known as colon hydrotherapist. The proposed rules establish the new profession's education and examination requirements, specify affiliation relationships, and certification requirements.

Background Colon hydrotherapy (also known as colonic irrigation or enema) has been a heath care practice whose beginnings go back hundreds of years. Its popularity in the United States reached an apex in the early-1900s. While not currently as popular as a treatment, this procedure is still sought by patients for treatment of constipation or for maintenance of general wellness of the lower digestive system.

Legislation passed during the 2021 session created the colon hydrotherapist profession under the authority of the Board of Naturopathy. The board proposes these rules to align with the requirements of chapter 18.36A RCW and legislative intent of SB 5124. Rules are needed to establish the regulatory framework for colon hydrotherapists. The proposed rules establish standards for affiliation relationships between naturopathic physicians and colon hydrotherapists. These standards include requirements for documentation of a plan of patient care communication, transfer for patients needing a higher level of care, and standards for patient referral while providing general, off-site supervision.

SECTION 2:

Is a Significant Analysis required for this rule?

The proposed rules require significant analysis as described in RCW 34.05.328(5)(c)(iii) because they adopt a new, or make significant amendments to a policy, or regulatory program. However, the board has determined that no significant analysis is required for the following sections:

WAC with no significant impact WAC 246-836A-010 ? Definitions

WAC 246-836A-100 ? Mandatory reporting

Justification

This section does not establish enforceable standards, but defines terms used throughout the rule set. This section does not meet the definition of a significant legislative rule. RCW 34.05.328(5)(c)(iii).

This section references, without change, the mandatory reporting rules in chapter 246-16 WAC. This section is exempt under RCW 34.05.328(5)(b)(iii).

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WAC 246-836A-110 ? Sexual misconduct

This section references, without change, the board's sexual misconduct rules. This section is exempt under RCW 34.05.328(5)(b)(iii).

SECTION 3:

Clearly state in detail the general goals and specific objectives of the statute that the rule implements. The general goal of the statute is to provide the people of this state protection by credentialing only appropriately educated and trained colon hydrotherapists.

The statute's objectives the rule implements are: 1. Establish criteria for education and training programs; 2. Establish approved examination criteria; 3. Establish affiliation relationship standards between colon hydrotherapists and naturopathic physicians; and 4. Establish a process for issuing a colon hydrotherapist certificate.

SECTION 4:

Explain how the department determined that the rule is needed to achieve these general goals and specific objectives. Analyze alternatives to rulemaking and the consequences of not adopting the rule. The board has assessed and determined that there are no feasible alternatives to rulemaking because standards for education, examination, and practice must be enforceable, and therefore must be in rule.

If these rules are not adopted, individuals could not be credentialed as colon hydrotherapists as there would be no criteria upon which certification could be based.

SECTION 5:

Explain how the department determined that the probable benefits of the rule are greater than the probable costs, taking into account both the qualitative and quantitative benefits and costs and the specific directives of the statute being implemented.

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As noted above, the portions of the proposal that are not significant or are exempt are excluded from this analysis (see section 2). The portions of the proposed rule sections that are significant and analyzed below are:

For Colon Hydrotherapists: ? WAC 246-836A-020 ? Colon hydrotherapist--Education and training ? WAC 246-836A-030 ? Colon hydrotherapist--Examination ? WAC 246-836A-040 ? Colon hydrotherapist--Application ? WAC 246-836A-050 ? Colon hydrotherapist--Affiliation relationships ? WAC 246-836A-060 ? Colon hydrotherapist--Activities allowed or prohibited ? WAC 246-836A-070 ? Minimum standards of practice for colon hydrotherapy ? WAC 246-836A-080 ? Recordkeeping and retention

For Naturopathic Physicians: ? WAC 246-836-300 ? Affiliation relationships for colon hydrotherapy ? WAC 246-836-310 ? Training affiliation relationships for colon hydrotherapy

Section Analysis

1. New Section WAC 246-836A-020 ? Colon hydrotherapist--Education and training

Rule Overview: This proposed section establishes the education and training requirements for colon hydrotherapy applicants. The training and education can be completed under a training affiliation with a naturopathic physician or under the three identified national organizations1.

A colon hydrotherapist applicant must complete a practicum component as part of the education and training requirements. Trainees complete the practicum component either under the direct visual supervision of the supervising naturopathic physician or as part of the national organization pathway.

Costs: Recognized national organizations with training programs approved by the board Information on the three recognized national organizations identified above are as follows:

1. The International Association for Colon Hydrotherapy (I-ACT) was founded in 1989 and prior to 2012, included the examination organization now known as the National Board for Colon Hydrotherapy (NBCHT). In 2012, these organizations separated to provide additional transparency and to allow the two entities to focus on their respective areas: I-ACT on setting education and training criteria for schools and instructors and NBCHT on providing the national examination for entry into the colon hydrotherapy profession.

1 International Association of Colon Hydrotherapists (I-ACT), the National Board for Colon Hydrotherapy (NBCHT), and the Global Professional Association for Colon Hydrotherapy (GPACT)

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2. The NBCHT does not currently provide education or training since separating from the I-ACT; however, while part of I-ACT, NBCHT certification included the same education and training.

3. The Global Professional Association for Colon Hydrotherapy (known as GPACT) provides practitioner training in colon hydrotherapy and, through membership status, certification as a colon hydrotherapist. They currently have 232 active members worldwide.

The costs for education and training from each of these organizations is as follows:

? Estimated costs to complete I-ACT accredited education and training are as follows: o Alder Brook Healing Arts in Oregon2, fees are $1,777 which include the

prerequisite I-Act membership, as well as all didactic and practicum

coursework. o Prime Pacific Health Innovations School in British Columbia3, fees are $1,895

($2,400 CAD; the website has no breakdown of costs). ? The costs for GPACT's lowest level of training and certification is currently $5054

which includes both didactic and practicum coursework.

Training Affiliation with a Naturopathic Physician This pathway training includes college-level courses in several topic areas, such as the history, theory, and practice of colon hydrotherapy; anatomy and physiology; professional ethics and patient boundaries; and business ethics and office procedures.

See below Table for the range of costs of required education.

Range

Anticipated

Anticipated maximum

Completion of education in:

minimum cost

cost

The history, theory, and practice of colon hydrotherapy Unknown 5 Unknown

to include risks and contraindications

Anatomy and physiology (must include the anatomy and $0 6

$1,500 7

physiology of the alimentary tract and the function and

disfunction of intestinal health)

Professional ethics and patient boundaries

$08

$55 9

Business ethics and office procedures

$0 10

$0

Equipment safety, infection prevention and control, and Unknown

Unknown

the handling and disposal of used equipment

2 3 4 5 When listed as unknown, the board has not provided estimates for education as there are multiple pathways to receive this education. 6 7 8 9 10

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