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) adopted a new chapter of rules to implement legislation. The rules establish standards for the designation of crisis centers as contact hubs within the 988 national suicide prevention and mental health crisis hotline system.

The Washington State Department of Health (DOH), in consultation with the Acupuncture and Eastern Medicine Advisory Committee, adopted amendments to WAC 246-803-040 requiring an acupuncturist or acupuncture and Eastern medicine practitioner performing point injection therapy to continue to complete 24 hours of training, however not all training must be in-person. A hybrid approach is being adopted which allows flexibility.

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) in consultation with the Acupuncture and Eastern Medicine Advisory Committee (committee) is considering amending WAC 246-803-103 and WAC 246-803-240 to allow the acceptance of the Occupational English Test providing Acupuncture and Eastern medicine practitioner licensing applicants who have completed the required National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) examinations in languages other than English. Other amendments relevant to application and examination requirements in chapter 246-803 WAC may also be considered.

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 Washington State Department of Health (DOH) withdrew the Administrative Procedures and Requirements for Credentialed Health Care Providers CR-101 for chapter 246-12 WAC, which was filed April 20, 2017, and published in WSR 17-10-007 and will consider amending the rules at a future date.

Filed February 20, 2025 as WSR 25-06-011.

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.

The Washington State Board of Nursing (board) adopted amendments to the 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. The board adopted amendments to define the term "graduate degree" as a master's or doctoral degree, for technical edits, and to provide for exemptions to education requirements for advanced registered nurse practitioner (ARNP) licensure as outlined in existing board procedures.

The Washington State Department of Health (DOH) is proposing amendments to chapter 246-810 WAC, to establish requirements for affiliated counselor credentials (AAC), including supervised experience, education, and coursework requirements; establish that student interns are eligible for the registered AAC; add federally qualified health centers as an approved practice setting for AACs after January 1, 2028; and clarify credential requirements for the certified counselor, certified adviser, and hypnotherapist professions.

The Washington State Department of Health (DOH) adopted rules establishing a new agency affiliated counselor credential and made other updates or amendments to chapter 246-810 WAC pursuant to E2SHB 1504, 2SHB1724, and E2SHB 2247.

The Washington State Department of Health (DOH) continues without changing the previously adopted emergency rules, which align the rule language with statute and revise fees. This rule amends WACs 246-810-010, 246-810-015, and 246-810-990 in chapter 246-810 WAC to amend the definition of mental health professional (MHP) and create two new AAC credentials. DOH implemented changes by emergency rule originally under WSR 23-16-031, filed on July 21, 2023, and has continued without change these same amendments. These emergency rules will be in effect until the permanent rules adopted on February 20, 2025, under WSR 25-06-010 become effective on July 1, 2025, which will permanently create the new agency affiliated counselor credentials.

The Washington State Department of Health (DOH) is proposing an amendment to the federal rule publication date to conform to U.S. Environmental Protection Agency (EPA) requirements.

The Washington Medical Commission adopted amendments to the opioid prescribing rules to exclude patients with sickle cell disease, to clarify tapering considerations, and to clarify the use of biological specimen testing. The rules amend WAC 246-918-801 Exclusions, WAC 246-918-870 Periodic Review - Chronic pain, and WAC 246-918-900 Tapering considerations - Chronic pain for physician assistants, as well as WAC 246-919-851 Exclusions, WAC 246-919-920 Periodic Review - Chronic pain, and WAC 246-919-950, Tapering considerations - Chronic pain for allopathic physicians.

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 Washington State Department of Health (DOH), in consultation with the Washington Medical Commission, is considering rulemaking to establish a new section in chapter 246-921 WAC to create licensing and regulation fees for anesthesiologist assistants.

The Washington Medical Commission is proposing a new chapter of rule, chapter 246-921 WAC Anesthesiologist Assistants, to implement Senate Bill (SB) 5184 (chapter 362, Laws of 2024) codified under chapter 18.71D RCW, which created the new anesthesiologist assistant license.

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 Washing State Department of Health (DOH) is proposing reducing licensure barriers and updating current rules to align with recent legislation. The proposed amendments to WAC 246-916-010 and 246-916-030 align with RCW 18.130.077.

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 Board of Health proposes updating hearing screening standards for schools in chapter 246-760 WAC. The changes would allow school districts to use otoacoustic emission devices as an alternative screening tool for students, clarify rule language, ensure consistency with vision screening sections, and align with current national standards.

The Washington State Department of Health (DOH) is considering amending rules and establishing a new section in chapter 246-341 WAC to implement a uniform enforcement tool for behavioral health agencies. 

The Washington State Department of Health (DOH) is proposing amendments to WAC 246-341-1108 to implement Second Substitute Senate Bill 6228 (chapter 366, Laws of 2024), that requires BHAs providing voluntary substance use disorder treatment services to report to DOH specific data on individuals who are voluntarily or involuntarily released from treatment early.

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 proposing rule amendments to update behavioral health agency fees in WAC 246-341-0365 and residential treatment facility fees in WAC 246-337-990. DOH is also proposing changes to clarify and standardize language.

The Washington State Department of Health (DOH) adopted amendments to Behavioral Health Agency (BHA) fees in WAC 246-341-0365 and Residential Treatment Facility (RTF) fees in WAC 246-337-990 to address funding requirements for inspection, investigation and licensing programs.

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 updates to chapter 246-341 WAC to provide greater access to care by streamlining the approval and certification process to operate an Opioid Treatment Program (OTP) and aligning state regulations with federal certification and treatment standards for OTPs. DOH also adopted updates to implement legislature that allows licensed OTPs to operate a mobile or fixed-site medication unit as part of, but geographically separate from, their existing licensed OTP. Amendments were also made to correct two internal citations from a previous rules project.

The Washington State Department of Health (DOH) adopted rules in chapter 246-809 WAC to implement recent legislation, including provisions of Second Substitute House Bill 1724 (chapter 425, Laws of 2023) and Engrossed Second Substitute House Bill 2247 (chapter 371, Laws of 2024), which establish an optional supervisor directory, set minimum supervision standards, create an optional stipend program, and allow applicants to practice under supervision for up to 120 days after submitting a completed application.