Rule-Making Activity

Nina Helping
360-236-3065

The Podiatric Medical Board (board) is proposing amendments to WAC 246-922-300 and 246-922-310 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill 5229 (ESSB 5229).

The Department of Health is proposing amendments to existing sections and the addition of two new sections to chapter 246-976 WAC relating to EMS Data Systems reporting to the Washington EMS Information System (WEMSIS) system to meet the requirements of Section 19 of Substitute Senate Bill 5380 (chapter 314, Laws of 2019).

The Department of Health in consultation with the Board of Nursing, formerly known as the Nursing Care Quality Assurance Commission, is proposing to increase the nursing center surcharge fee and proposing to create a new fee for a multistate nursing license in WAC 246-840-990. The proposed rule implements Substitute Senate Bill (SSB) 5499, Multistate Nurse Licensure Compact (Chapter 123, Laws of 2023).

The Department of Health is proposing amendments to update and align requirements with current national standards, make rules more clear, concise, and organized, propose changes to address barriers to initial and renewal application processes, and respond to new legislative requirements. WAC 246-976-010 through 246-976-182, 246-976-260 through 246-976-310, 246-976-330 through 246-976-395, 246-976-920, 246-976-960, 246-976-970 and proposing new WAC 246-976-026, 246-976-139, and 246-976-261.

The Washington State Board of Nursing is proposing new sections of rule, WAC 246-840-835 and 246-840-935, and amendments to WAC 246-840-930 and 246-840-940 to implement Substitute House Bill (SHB) 1124 (chapter 14, Laws of 2022) to expand the delegation of glucose monitoring and testing to all settings where Nursing Assistant -Registered and Nursing Assistant-Certified individuals work. Additionally, the board is proposing changes to supervision and valuation timeframes to align with SHB 1124.

The Board of Hearing and Speech is proposing new WAC 246-828-505 and amendments to WAC 246-828-510 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill 5229 (ESSB 5229 chapter 276, Laws 2021).

The Department of Health is proposing health equity model rules for dental hygienists 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.

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 include 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 manifests 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. 

The Department of Health is considering amending chapter 246-980 WAC to implement Engrossed Second Substitute House Bill 1694, (chapter 424, Laws of 2023) and Engrossed Second Substitute Senate Bill 5278, (chapter 323, Laws of 2023). These laws reduce barriers to hire home care aides.

The Department of Health (department) is proposing to establish a retired active fee for the nursing home administrator license in WAC 246-843-990.

The Washington State Board of Nursing is proposing amendments to clarify specific licensing requirements for out-of-state Registered Nurse (RN) and Licensed Practical Nurse (LPN) applicants.

The Department of Health is proposing amending WAC 246-290-100, Water system plans, to add the climate resilience element as a requirement for public water systems with one thousand or more connections. The proposal also makes editorial changes to align with the Code Reviser’s 2023 Bill Drafting Guide.

Samantha Pskowski
360-789-2358
 

The board, formerly known as the Nursing Care Quality Assurance Commission, is proposing a new section of rule and revisions to existing rule in WAC 246-840-220 and 246-840-222 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021).

The Pharmacy Quality Assurance Commission is proposing to amend WAC 246-945-507 to add four intramammary antibiotics to the list of approved legend drugs in chapter 246-945 WAC in response to request from Washington State Department of Fish and Wildlife.

The State Board of Health is proposing amendments to address changes to existing requirements, including requirements governing local management plans, repairs, registration of proprietary treatment products, minimum lot sizes, treatment levels, and licensing of operations and maintenance providers. The proposed rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues. The proposed rule also makes several editorial updates to improve clarity and repeals obsolete rules.

The Washington Medical Commission is proposing amendments to the commission’s opioid prescribing rules for allopathic physicians and physician assistants to exclude patients with sickle cell disease, to clarify tapering considerations, and to clarify the use of biological specimen testing. Amending WAC 246-918-801, WAC 246-918-870, WAC 246-918-900, WAC 246-919-851, WAC 246-919-920, and WAC 246-919-950.

The Board of Denturists (board) is proposing a new section of rule, WAC 246-812-462 - Prefabricated implant abutments, to set out the requirements for the placement of prefabricated implant abutments. The board is also proposing amending the infection control standards purpose statement in WAC 246-812-50 to ensure written policies and procedures are maintained.

The Pharmacy Quality Assurance Commission is proposing to add a new subsection to WAC 246-945-055 to utilize the commission’s authority, to delete substances designated as a Schedule IV controlled substance. The commission is also proposing to create a new section, WAC 246-945-05001, to establish a list of exempted substances from RCW 69.50.204, RCW 69.50.206, RCW 69.50.208, RCW 69.50.210, and RCW 69.50.212, including fenfluramine.

The Washington Medical Commission is proposing amendments to WAC 246-919-330 to remove two requirements that have become a barrier to licensure. The purpose of this proposal is to amend the rules to align them with current practices and remove barriers to licensure for qualified applicants entering the physician workforce.

The Dental Quality Assurance Commission is proposing amending WAC 246-246-817-440, Dental continuing education requirements, and WAC 246-817-445, Dental Anesthesia Assistant continuing education requirements, to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229.

The Board of Physical Therapy and Department of Health are proposing amendments to clarify statutory requirements for education and training and define the endorsement for intramuscular needling, and to amend fees and renewal cycle, to implement Second Substitute House Bill 1039, (chapter 198, Laws of 2023) which expands the scope of practice of physical therapists to perform intramuscular needling.

Peter Beaton
 

The Board of Hearing and Speech is proposing amendments to WAC 246-828-100 (Hearing instruments fitting and dispensing – Minimum standards of practice) to reflect changes to relevant federal rules by the Food and Drug Administration (FDA) regarding the sale of over-the-counter (OTC) hearing aids (21 C.F.R. Parts 800, 801, 808, and 874 (2022)).

The Washington State Board of Nursing proposes amendments and an addition to rules relating to the board’s substance use disorder (SUD) monitoring program in response to Substitute House Bill (SHB) 1255 (chapter 141, Laws of 2023) including application requirements for a stipend.

The Chiropractic Quality Assurance Commission is proposing changes to rules concerning chiropractic X-Ray technicians' course requirements including who can instruct the course, and updating the requirements for obtaining, maintaining, and returning from expired status. The commission is also adopting health equity continuing education requirements to reflect requirements in Engrossed Substitute Senate Bill 5229 (ESSB) (chapter 276, Laws of 2021). WAC 246-808-201, 246-808-203, 246-808-205, 246-808-207, 246-808-209, WAC 246-808-211 and repealing 246-808-215. 

Becky McElhiney
360-236-4766

The Dental Quality Assurance Commission is proposing amending WAC 246-817-150 to remove specific references about granting licenses to University of Washington faculty and replacing this with a reference to a faculty of any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA).

The Washington State Board of Nursing is proposing amendments to WAC 246-840-095, Temporary Practice Permits, for LPN and RN effective dates, reducing the length of time a temporary practice permit is effective and updating criteria to issue a temporary practice permit in order to align the internal board process with rule language and implement Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023), Military Spouses—Professional Licensing and Employment.

The Board of Naturopathy is proposing amendments to ensure clear CE requirements including designation of pharmacology CE credits, classification of CE categories, and implementation of the health equity CE requirements, mandated by Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021).

The Department of Health is proposing amending, repealing, and creating new rule sections in chapter 246-822 WAC, Dietitians and Nutritionists, to clarify, streamline, update, and modernize rules for licensing dietitians and nutritionists.

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 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).

 IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Haleigh Mauldin, Pharmacy Quality Assurance Commission, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-890-0720, fax 360-236-2901, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY April 17, 2023.

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)

To align with federal rules, the Department of Health (department) is proposing removing the professions of naturopath licensed under chapter 18.36A RCW and midwife licensed under chapter 18.50 RCW from the list of licensed professionals that may perform a provider performed microscopic procedure (PPMP) in WAC 246-338-020. The department is proposing to clarify that both the laboratory director and testing personnel of PPMP must be licensed professionals. The department is also proposing a technical citation adjustment to a definition in WAC 246-338-010. 

The Examining Board of Psychology (board) proposes amending WAC 246-924-230 to establish health equity CE requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229 (Chapter 276, Laws of 2021). Additionally, the board is proposing amendments to WACs 246-924-240, 246-924-250, 246-924-255, 246-924-300, and 246-924-330. These amendments improve clarity and remove outdated language.

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 Department of Health is Proposing amendments for substance use disorder and their trainees, to reduce barriers to certification. This includes removing the requirement to verify educational coursework for applicants with a national certification, making pharmacists eligible for the alternative training pathway in, and removing the obsolete AIDS training from the list of probationary license requirements.

The Department of Health (department) is proposing amendments to chapter 246-834 WAC to implement Substitute Senate Bill 5765 (chapter 289, Laws of 2022), which created two levels of limited prescriptive license extension for midwives to prescribe, obtain, and administer medications and therapies for the prevention and treatment of common prenatal and postpartum conditions, family planning methods, medical devices and implants. This bill also gave the Secretary of Health the authority to establish education requirements in the chapter. The department is also proposing amendments to implement Engrossed Substitute Senate Bill 5229 (chapter 276, Laws of 2021) regarding health equity continuing education requirements.

The Pharmacy Quality Assurance Commission adopted health equity continuing education requirements to meet the requirements of the Department of Health’s equity model rules in WAC 246-12-800 through 246-12-830. The adopted rules add one hour of health equity education every two years, coinciding with the license renewal cycles for both pharmacists and pharmacy technicians.

WSBOH@sboh.wa.gov

The Board of Naturopathy adopted new rules that identify Botulinum Toxin (Botox) as a legend approved drug, clarify procedures that are within the scope of practice of naturopathic medicine, set training requirements, and establish minimum standards for the performance of nonsurgical cosmetic procedures by naturopathic physicians licensed in Washington state. The adopted rules also amend WAC 246-836-210 by removing the current exclusion for the use of Botox for cosmetic purposes.

Emergency Rule