Rule-Making Activity

The Department of Health is proposing to amend the behavioral health agency regulations in chapter 246-341 WAC to implement Second Substitute Senate Bill (2SSB) 5120 (chapter 433, Laws of 2023) establishing 23-hour crisis relief centers in Washington state. The department is also proposing amendments to align the regulations with statutory changes passed by the 2023 legislature and to make non-substantive changes.

The Washington State Department of Health (DOH) adopted an amendment to WAC 246-320-111 to clarify the regulatory requirements for licensed acute care hospitals that wish to discharge or transfer a patient to a 23-hour crisis relief center.

The Department of Health is proposing to amend WAC 246-320-111, Hospital Responsibilities, to implement Second Substitute Senate Bill (2SSB) 5120 (chapter 433, Laws of 2023), an act concerning the establishment of 23-hour crisis relief centers in Washington state. The proposed amendments establish requirements for licensed acute care hospitals that wish to discharge or transfer a patient to a 23-hour crisis relief center.

The Washington State Department of Health (DOH) is considering amending the behavioral health agency regulations in chapter 246-341 WAC, including but not limited to WAC 246-341-0903, to implement Engrossed Second Substitute Senate Bill (E2SSB) 5853 (chapter 367, Laws of 2024), an act relating to extending the crisis relief center (CRC) model to provide behavioral health crisis services for minors.

The Washington State Department of Health (DOH) adopted amendments to chapter 246-341 WAC establishing regulations for 23-hour crisis relief centers. The amendments adopt standards for certification of CRCs, including standards for determining medical stability before an emergency medical services drop-off, the number of licensed or certified recliner chairs allowed in the facility, and physical environment standards for the construction review process. The standards are being proposed as a new type of certification in chapter 246-341 WAC, the behavioral health agency licensing and certification requirements.

The Washington State Department of Health (DOH), in collaboration with the Acupuncture and Eastern Medicine Advisory Committee, is proposing to amend WAC 246-803-040, education and training for point injection therapy, to allow a minimum of eight hours of didactic education to occur through live interactive webinar.

Submit Written Comments to: Vicki Brown, P.O. Box [47852], Olympia, WA [98504-]7852, email vicki.brown@doh.wa.gov, fax 360-236-2901, by July 14, 2023.

Assistance for Persons with Disabilities: Contact Vicki Brown, phone 360-236-4865, fax 360-236-2901, TTY 711, email vicki.brown@doh.wa.gov, by June 30, 2023.

The Washington State Department of Health (DOH) is proposing amendments to WACs 246-320-199 and 246-322-990 to update fees for acute care hospitals licensed under chapter 246-320 WAC and private psychiatric hospitals licensed under chapter 246-322 WAC. DOH is also proposing changes to clarify and standardize language.

The Washington State Department of Health (DOH) adopted amendments to WAC 246-320-199 and 246-322-990 to update fees for acute care hospitals licensed under chapter 246-320 WAC and private psychiatric hospitals licensed under chapter 246-322 WAC. DOH adopted the revised fees and other language amendments to address funding needs and to clarify and standardize language.

The Dental Quality Assurance Commission is adopting amendments to requirements for the administration of anesthetic agents for dental procedures to reflect changes in patient care standards since the rule was adopted. The amendment includes changes and additions to pediatric protocols, emergency and on-call protocols, education, training, and medications including prescribing, administration and dosage.

Standards of care have changed since the current rule was adopted and a complete review was necessary. Creating a pediatric sedation endorsement is necessary to provide safeguards for the unique sedation needs of pediatric patients.

The adopted rule amendments require 24 hour on-call availability, update basic life support education requirements, add requirements for emergency protocols and training, clarify requirements for record keeping and emergency medications, establish requirements for self-inspections for all dentists when anesthetic is administered, update requirements for on-site inspections for dentists with moderate sedation with parenteral agents or general anesthesia permits, create a pediatric sedation endorsement, require vital sign monitoring for pediatric patients, clarify the requirement to obtain vital signs on American Society of Anesthesiologist classification ASA I age 13 and under will be at the dentist’s discretion, clarify requirements for prescribing for patient dosage prior to the appointment and specify that electrocardiogram (EKG) monitoring is not required when a pediatric patient is uncooperative or the emotional condition means monitoring is not possible or the patient does not tolerate the monitoring pads.

The commission made the following edits upon adoption:

• The date in WAC 246-817-765 (1) was changed from “January 1, 2024” to “January 1, 2025”.
• The word “and” was added to WAC 246-817-765(3)(c)(ii)(B)(V). 
• The word “or” was removed from WAC 246-817-740(1)(a) and (1)(b).

The Board of Nursing Home Administrators (board) is considering amendments to WAC 246-843-090, 246-843-095, and 246-843-230 to consider aligning with the National Association of Long Term Care Administrator Boards AIT program which could make the instructions easier to understand and make language consistent with other states’ AIT programs. The board is also considering amending language for endorsement requirements to align with RCW 18.130.077.

The Department of Health is considering changes to requirements for adult elective PCI programs in response to a rulemaking petition. The petition requests amendment of WAC 246-310-720(2), to eliminate the requirement that existing PCI programs in the planning area must meet the minimum volume standard before a new elective PCI program may be approved. The department will also consider amendments to other PCI rules, as part of this rule project.

Amending WAC 246-840-010, 246-840-340, 246-840-342, and other related sections in chapter 246-840 WAC. The Washington State Board of Nursing is considering amendments to education requirements for ARNP licensure in response to the Joint Administrative Rules Review Committee’s (JARRC) recommendation.

The Washington State Board of Nursing is proposing amendments to education requirements in WAC 246-840-010, 246-840-340, and 246-840-342 in response to the Joint Administrative Rules Review Committee’s (JARRC) recommendation.

Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) made changes impacting behavioral health agencies, including amending the definition of "mental health professional" (MHP) and creating two new agency affiliated counselor (AAC) credentials. These changes were first implemented by emergency rule under WSR 23-16-031, filed on July 21, 2023, and are being continued without change.

Eric Hernandez
360-236-2956

Submit Written Comments to: Becky McElhiney, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2850,

The Department of Health is proposing to update and clarify Applied Behavior Analysis, chapter 246-805 WAC to: clarify licensure requirements, supervision, examinations, educational programs, training, and continuing education. This proposal also establishes reciprocity, temporary licenses and updates fees.

The Veterinary Board of Governors is adopting an amendment to WAC 246-935-060 Eligibility for examination as a veterinary technician, to clarify that a registered apprenticeship program is an approved post-secondary educational pathway to qualify for licensure exams as a veterinary technician.

The Department of Health is adopting an amendment to WAC 246-916-060 to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021), codified as RCW 43.70.613. The department is adopting the health equity model rules, WAC 246-12-800 through 246-12-830, for the athletic trainer profession to comply with the statute.

The Washington State Department of Health (DOH) in collaboration with the Athletic Training Advisory Committee adopted a new section in chapter 246-916 WAC in response to Substitute House Bill (SHB) 1275 (chapter 143, Laws of 2023). This rule authorizes athletic trainers to purchase, store, and administer certain medications as prescribed by an authorized health care practitioner for the practice of athletic training in accordance with the training program, and creates enforceable standards and sets training requirements.

The Department of Health, in consultation with the Athletic Training Advisory Committee, is proposing to create a new section of rule, WAC 246-916-070 Medications, to define terms used and establish education and training requirements for athletic trainers in response to Substitute House Bill 1275, (chapter 143, Laws of 2023).

The Washington State Department of Health (DOH), in collaboration with the Athletic Training Advisory Committee, will consider amending WAC 246-916-010 and 246-916-030 to update substantial equivalency and initial licensure rules to comply with recent legislation.

The Department of Health, in consultation with the Board of Hearing and Speech, is proposing a new section of rule, WAC 246-828-991, to implement House Bill (HB) 1001, (chapter 53, Laws of 2023). HB 1001 entered Washington into the ASLP-IC interstate licensure compact for audiologists and speech-language pathologists and gives member states the discretion to charge a fee for granting compact privileges. The proposed rule specifies the fees and renewal cycle for compact practice privileges in Washington state.

The Washington State Department of Health (DOH) in consultation with the Board of Hearing and Speech, is adopting a new section of rule, WAC 246-828-991, to implement House Bill (HB) 1001 (chapter 53, Laws of 2023) which entered Washington state into the Audiologist and Speech-Language Pathology Interstate Compact (ASLP-IC) for audiologists and speech-language pathologists and gave member states the discretion to charge a fee for granting compact privileges. This amendment is being considered to ensure that there is sufficient funding to recover the costs of issuing a license for compact privileges in Washington state.

The Board of Hearing and Speech (board) adopted a new rule, WAC 246-828-505, and amended WAC 246-828-510 to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The board adopted and exceeded the health equity model rule minimum standards. The board’s adopted rules require two hours of health equity education to be completed every three years as part of the current CE requirements for the professions. The adopted rules do not increase total CE hours but require two hours of health equity CE be absorbed into the existing CE hour requirements. This exceeds the minimum two hours of health equity education required every four years in the model rules.

The Washington State Department of Health (DOH) is proposing updates to WACs 246-341-0200, 246-341-0300, 246-341-0342, 246-341-1000, and 246-341-1100 and repealing WACs 246-341-1005 through 246-341-1025. The proposed amendments and repeals are to address general cleanup, streamline the licensing and certification requirements, remove duplicate requirements, align OTP regulations with the Code of Federal Regulations (CFR), and implement Second Engrossed Second Substitute Senate Bill (2E2SSB) 5536 (chapter 1, Laws of 2023, 1st Special Session). 

The Washington State Department of Health (DOH) is considering amendments to update Behavioral Health Agency (BHA) and Residential Treatment Facility (RTF) fees and consider changes to clarify and standardize language.

The Washington State Department of Health (DOH) is considering amending the behavioral health agency regulations in chapter 246-341 WAC to implement Second Substitute Senate Bill (2SSB) 6228 (chapter 366, Laws of 2024), which requires behavioral health agencies to report specific data on individuals who are released from treatment early.

The Washington State Department of Health (DOH) adopted certification standards for the new profession created by SSB 5189 (chapter 270, Laws of 2023). DOH established requirements including: the application process; education and curriculum; supervised experience; continuing education; professional standards; the educational program approval process; and fees.

The Washington State Department of Health (DOH) is proposing the establishment of certification standards for the new Behavioral Health Support Specialist (BHSS) profession created by Substitute Senate Bill (SSB) 5189 (chapter 270, Laws of 2023). The proposed rules include the application process, education, supervised experience, professional standards, the educational program approval process, and fees.

The Washington State Department of Health (DOH) is proposing amendments to WAC 246-835-010 and WAC 246-835-025 to update the definition of "culturally congruent care" and to clarify education and training requirements related to "culturally congruent care" and "culturally congruent ancestral practices."

The Department of Health is considering amendments to WAC 246-835-010 and WAC 246-835-025 to clarify the definition of “culturally congruent care” and to ensure education and training requirements related to “culturally congruent care” are clear.

The Department of Health is considering amendments to the birth doula certification requirements in WAC 246-835-040, Applicants currently certified in other states or territories, to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023).

The Washington State Department of Health (DOH) is proposing amendments to WAC 246-835-040 to implement recent legislation to reduce barriers to entering and remaining in the birth doula workforce and to shorten the credentialing process.

Rescission of Interpretive Statement BON 21-01, Continuing Education Pharmacology Documentation. Filed February 8, 2024.

The board is rescinding this interpretive statement because the board has adopted amendments to WAC 246-836-080 Continuing competency program, that clarify what forms of documentation are acceptable to verify meeting the pharmacology continuing education requirements. Thus, the interpretive statement is no longer necessary.

Individuals requiring information on this rule should contact Rachel Phipps, program manager, phone 564-233-1277, email naturopathy@doh.wa.gov.

Policy Number: OD 24-01. Allowances for in-person continuing education for licensed optometrists who have a continuing education reporting date in year 2024. Effective Date: March 1, 2024.

Becky McElhiney

PO Box 47852 Olympia, WA 98504-7852
360-236-4766

Agency:Department of Health - Board of Physical Therapy 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.
☐ Other (specify) (If less than 31 days after filing, a specific finding under RCW 34.05.380(3) is required and should 
be stated below)
Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☐ Yes ☒ No If Yes, explain: 
Purpose: Changing English test passing scores and removing a requirement related to an accredited program for licensure 
as a physical therapist. The Board of Physical Therapy (board) is adopting amendments to WAC 246-915-120 – Foreign 
educated applicants to change the Test of English as a Foreign Language (TOEFL) minimum passing scores. Washington 
state’s current passing score requirements were originally established based on the Federation of State Boards of Physical 
Therapy (FSBPT) passing score recommendation. The FSBPT’s minimum passing score recommendations have since been 
updated. To align with the FSBPT’s recommendation, the board is adopting this rule to lower the minimum passing score for 
the writing and speaking tests and raise the minimum passing score requirements for the reading and listening tests. The 
board is also adopting amendments to remove the requirement that an applicant’s first professional degree must only be from 
a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited program, in order to allow applicants who 
went on to pursue additional professional degrees in physical therapy through a CAPTE accredited program to pursue 
licensure outside of the foreign-educated pathway. 
Citation of rules affected by this order:
New: None 
Repealed: None 
Amended: WAC 246-915-120 
Suspended: None 
Statutory authority for adoption: RCW 18.74.023 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-08-031 on March 28 2023 (date).
Describe any changes other than editing from proposed to adopted version: None. 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by 
contacting:
Name: Allyson McIver 
Address: PO Box 47877 Olympia, WA 98504-7877 
Phone: 360-236-2878 
Fax: 360-236-2901 
TTY: 711 
Email: physical.therapy@doh.wa.gov 
Web site: doh.wa.gov 
Other:

The Department of Health is considering amending WAC 246-10-501 to include applicants for interstate license compacts, milk banks, and 988-line crisis call centers to the list of applicant types who are eligible for brief adjudicated proceedings as a due process recourse if their application is denied.

Rule making notices will be delivered via GovDelivery. To receive notices, interested persons may sign up for any or all of the lists. Please go to: https://public.govdelivery.com/accounts/WADOH/subscriber/new. After signing in, please click open the box labeled "Health Systems Quality Assurance." Next click open the box labeled "Health Professions." From there, check the Medical Cannabis Program box. You may also check any other box of the professions listed that you may be interested in.

Shannon Angell

PO Box 47860

Olympia, WA 98504-7860

Phone: 360-236-2820

Email: shannon.angell@doh.wa.gov

Date of intended adoption: 9/20/23 (Note: This is NOT the effective date)
Submit written comments to: Assistance for persons with disabilities:
Name: Ted Dale Contact Ted Dale
Address: Office of Health Professions 
PO Box 47850
Olympia, WA 98504 
Phone: 360-236-2991
Email: https://fortress.wa.gov/doh/policyreview Fax: N/A
Fax: N/A TTY: 711
Page 2 of 4
Other: www.doh.wa.gov Email: ted.dale@doh.wa.gov
By (date) 9/13/23 Other: www.doh.wa.gov
By (date) 8/30/23 
Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12-800 through 246-12-830.
The department is proposing to amend WAC 246-810-027 and create new section WAC 246-810-0299 to implement ESSB 
5229. The department is proposing adopting the health equity model rules, WAC 246-12-800 through 246-12-830, for 
certified counselors and certified advisers to comply with RCW 43.70.613. 
The proposed rule adds two hours of health equity education, as required in the model rules, to be completed as part of the 
current continuing education requirements every four years. The proposed rule does not change total CE hours but requires 
two hours in health equity CE every four years, which is absorbed into the existing number of CE hours required. The health 
equity CE requirement is counted under existing, unspecified CE requirements for the profession.
Additionally, the department is proposing amendments to clarify and streamline WACs 246-810-027 and 246-810-0298.
These proposed amendments will remove unnecessary or outdated details about the required suicide prevention trainings.
Reasons supporting proposal: 
The goal of health equity CE is to equip health care workers with the skills to recognize and reduce health inequities in their 
daily work. The content of health equity trainings includes implicit bias trainings to identify strategies to reduce bias during
assessment and diagnosis in an effort to address structural factors, such as bias, racism, and poverty, that manifest as health 
inequities. 
Two hours of training allows individuals to gain a foundation in health equity that can have an immediate positive impact on 
the professional’s interaction with those receiving care. Health equity training enables health care professionals to care 
effectively for patients from diverse cultures, groups, and communities, varying race, ethnicity, gender identity, sexuality, 
religion, age, ability, socioeconomic status, and other categories of identity. The two hours of health equity CE credits may be 
earned as part of the health professional’s existing CE requirements, therefore not requiring completion of additional CE 
hours.
 
Statutory authority for adoption: RCW 43.70.613 and 18.19.050 
Statute being implemented: RCW 43.70.613, ESSB 5229 (chapter 276, Laws of 2021)

The Washington State Department of Health (DOH) in collaboration with schools is proposing to update WAC 246-105-060 to remove the school immunization status reporting date and replace it with, "Submit an annual immunization status report under RCW 28A.210.110 at a time and in a manner approved by the department."

John Hilger
360-236-2929

Under delegated authority, the Washington State Department of Health (DOH) adopted rule amendments in WAC 246-105-040 and WAC 246-105-060 to update references to the most recent Advisory Committee on Immunization Practices (ACIP) guidelines. The adopted rule also eliminated the specified data reporting date for schools and childcare centers and in place provides language that will allow flexibility in reporting timelines to better support schools and childcare centers. 

The Washington State Department of Health is considering revisions to WAC 246-808-990 to update chiropractic and X-ray technician licensure, registration, renewal, and other fees including clarifying updates.

The Chiropractic Quality Assurance Commission is adopting the Department of Health equity model rules to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The adopted rule establishes minimum standards for chiropractors of two hours of health equity continuing education (CE) every four years. The rule as adopted does not change the total number of CE hours but requires two hours in health equity CE every four years within the existing number of CE hours required.

Identifies the states and territories of the United States, the District of Columbia, Puerto Rico, or providence of Canada with "substantially equivalent" licensing standards, allowing applicants to apply for licensure via endorsement.

Effective Date: July 11, 2024. Filed August 28, 2024, as WSR 24-18-055.