Rule-Making Activity

Purpose: The Dental Quality Assurance Commission (commission) is adopting amendments to update rules regarding health profession monitoring programs in line with the passage of Substitute Senate Bill (SSB) 5496. SSB 5496 updated terminology, definitions, and references for dentists in RCW 18.32.534 and clarified confidentiality protections in RCW 18.131.070 for health professional monitoring programs. The adopted rules in WAC 246-817-801, 236-817-810, 246-817- 820, and 246-817-830 make technical amendments to align with changes required from SSB 5496 without changing the effect.

The Board of Nursing Home Administrators adopted rule amendments and a new rule to expand and clarify licensure requirement for licensure and temporary practice permits by correcting and updating continuing education requirements, language and citations, and correcting a typographical error. The rule no longer requires HIV/AIDS education. The rules add health equity continuing education.

THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. 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 Joshua Munroe, Pharmacy Quality Assurance Commission, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2987, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY January 3, 2023.

Notice of Adoption: This policy Issued by the Pharmacy Quality Assurance Commissions clarifies the Commission’ approach to United States Pharmacopeia General chapters 795, 797, 800, and 825 as it relates to WAC 246-945-100 and RCW 18.64.270(2). Policy PO-10. Effective Date: November 1, 2023.

This policy clarifies the Pharmacy Quality Assurance Commission’s renewal extension process for pharmacy interns who have reached the renewal limitation set in WAC 246-945-155(3). Policy number: P012. Effective Date: February 1, 2024.

The Podiatric Medical Board has adopted sections WAC 246-922-300 and WAC 246-922-310 to comply with RCW 43.70.163. The board adopted the Department of Health’s health equity model rules, WAC 246-12-800 through 246-12-830, for podiatric physicians and surgeons. The adopted rule adds two hours of health equity education, as required in the model rules, to be completed as part of the current continuing competency requirements every four years. In addition, the board also adopted amendments that correct some confusing rule language to clarify that a resident in an approved postgraduate residency training program is not required to participate in podiatric continuing medical education. 

Stuart Glasoe
 

Jessilyn Dagum

Policy Number: AAC-23-01. The Department of Health clarified their position on implementation of new agency affiliated counselor credentials. Effective Date: July 23, 2023. Filed as WSR 23-23-116.

The Board of Osteopathic Medicine and Surgery and the Department of Health are removing references to Osteopathic Physician Assistants by adopting changes to WAC 246-853-290, 246-853-300, 246-853-630, 246-853-640, 246-853-662, 246-853-750, and 246-853-990. The adopted amendments will remove obsolete language and align the rules with recent statute changes.

Purpose: Engrossed Second Substitute Senate Bill (E2SSB) 5702 (chapter 236, Laws of 2022) requires the Department of Health (department) to develop minimum standards to ensure milk bank safety for donor human milk and human milk derived products. Milk banks are organizations that engage in the procurement, processing, storage, distribution or use of human milk contributed by donors. To ensure the safety of donor human milk and human milk derived products, the department is adopting safety standards in chapter 246-720 WAC to include donor screening, testing, milk handling and processing, and record keeping as required by the statute.

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 adopted a retired active fee for the nursing home administrator license. Concurrently, the Board of Nursing Home Administrators adopted a retired active status to allow an individual to practice in emergent or intermittent circumstances and pay a reduced renewal fee. This will allow individuals to fill in at nursing homes that need a temporary administrator while recruiting a new administrator to assist in emergency circumstances such as a pandemic.

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

Email:  podiatric@doh.wa.gov

The Board of Optometry adopted WAC 246-851-225, a new section requiring two hours of health equity continuing education (CE) every four years for licensed optometrists. Health equity CE programs must meet the standards created in the Department of Health model rules in WAC 246-12-800 through 246-12-830. The adopted rule does not add to the total CE hours required to renew the license.

Notice of Adoption: This statement Issued by The Washington Medical Commission establishes the use of Nitrous Oxide in Office-Based Settings Under WAC 246-919-601, and regulates the use of analgesia, anesthesia, and sedation in office-based settings to exempt the use of nitrous oxide from the requirements of WAC 246-919-601. Interpretive Statement INS2023-02. Effective Date: October 20, 2023.

This policy clarifies the Pharmacy Quality Assurance Commission’s issuance of temporary practice permits to pharmacy interns who are spouses of military personnel. Policy number: P011. Effective Date: February 1, 2024.

The Examining Board of Psychology adopted amendments to WAC 246-924-230 to establish health equity continuing education (CE) requirements and implement Engrossed Substitute Senate Bill (ESSB) 5229 (Chapter 276, Laws of 2021). The adopted rule requires two hours in health equity CE every three years, rather than four years, and is absorbed into the existing number of CE hours required. It does not change the total number of CE hours required for the profession and aligns with licensed psychologists’ three-year CE cycle. Additionally, the board adopted amendments to improve clarity and remove obsolete language, including provisions that allowed the board to permit CE from another jurisdiction to fulfill Washington’s CE requirements and to waive CE requirements for a retired psychologist who wishes to maintain active licensure.

The Dental Quality Assurance Commission is adopting amendments to update rules regarding out-of-state licensure in line with Senate Bill 5113 (chapter 89, Laws of 2023) to include any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA) for faculty licensure.

Shad Bell
360-236-4711

Agency: Department of Health 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.

Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☒ No
Purpose: The Department of Health (department) adopts revisions to the Death with Dignity Act requirements in chapter 
246-978 WAC that reflect (1) the amendments made during the 2023 legislative session and (2) the writing style described in 
the 2023 Bill Drafting Guide.
Engrossed Substitute Senate Bill (ESSB) 5179 did the following:
• In RCW 70.245.010, made changes to multiple definitions.
o “Attending physician” became “attending qualified medical provider”.
o “Consulting physician” became “consulting qualified medical provider”.
o Added independent clinical social worker, advanced social worker, mental health counselor, psychiatric 
advanced registered nurse practitioner to the “counseling” definition.
o Removed the definition of “physician”.
o Added a definition of “qualified medical provider” that includes physician, physician assistant, and advanced 
registered nurse practitioner.
• Changed the terms used throughout chapter 70.245 RCW to match the terms defined in RCW 70.245.010.
• In RCW 70.245.030, removed the long-term care facility witness requirement in subsection (4).
• In RCW 70.245.150, expanded how participating providers may send forms to the department. Now the department 
can accept forms electronically and by fax.
WAC 246-978-010 duplicates the definitions in statute, which means that the department must update definitions every time 
the legislature changes the definitions. The department adopts replacement of duplicate definitions with a cross-reference to 
statute and removal of definitions no longer in use.
WAC 246-978-020 describes how participating providers must report to the department as required by RCW 70.245.150(2). 
The department adopts three changes:
• Replacing “physician” with “qualified medical provider”.
• Replacing the mailing address with “electronically, by mail, or fax”.
• Removing the publication number after the form name.
WAC 246-978-030 duplicates language in RCW 70.245.150(2). The department repeals WAC 246-978-030 to remove the 
duplication and prevent potential conflicts between statute and rule.
WAC 246-978-040 describes who can be a witness for a patient living in a long-term care facility. ESSB 5179 repealed the 
witness requirement for a long-term care facility described in RCW 70.245.030(4). The department repeals WAC 246-978-
040 because statute no longer requires it.
The department also adopts style changes throughout chapter 246-978 WAC that do not change the meaning of the rule. 
Page 2 of 3
Citation of rules affected by this order:
New: 
Repealed: WAC 246-978-030; WAC 246-978-040 
Amended: WAC 246-978-010; WAC 246-978-020 
Suspended: 
Statutory authority for adoption: ESSB 5179 (Chapter 38, Laws of 2023); Chapter 70.245 RCW 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-12-093 on June 06, 2023 (date).
Describe any changes other than editing from proposed to adopted version: None

RCW 70.114A.065 directs the Department of Health (DOH) and the Department of Labor and Industries (L&I) to adopt joint rules for the licensing, operation, and inspection of temporary worker housing. DOH and L&I have assessed the emergency rule requirements, along with input from interested parties and adopted key provisions to address prevention of future outbreaks and the spread of any airborne infectious disease.

The Pharmacy Quality Assurance Commission has adopted a revision to WAC 246-945-100, Compounding minimum standards, to update the rule to the most recent version of the USP – National Formulary <795> and <797>. This will capture the revisions to the USP <795> and <797>, which have been made official since WAC 246-945-100 became effective on July 1, 2020.

The Department of Health adopted amendments regarding Safe Medication Return to update rules about multiple program operators. Amendments also set a fee for proposal review and provide transparency for the department’s method of calculating program operator annual fees.

Emergency Rule

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.

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 adopted amendments to chapter 246-926 WAC to clarify, streamline, and modernize the regulations of cardiovascular invasive specialists, diagnostic radiologic technologists, therapeutic radiologic technologists, nuclear medicine technologists, radiologist assistants, and x-ray technicians. This includes removing outdated provisions, updating outdated terms and citations, clarifying credentialing and competency requirements, clarifying allowable duties for radiological technologists and x-ray technicians, repealing, and adding new sections of rule, and renaming the chapter to better reflect all types of professions credentialed under the chapter. The adopted rules establish enforceable licensing requirements and safety mechanisms for patients receiving imaging services.

WSBOH@sboh.wa.gov

The Board of Optometry amended WAC 246-851-440 through 246-851-470 to align with technical changes made by Substitute Senate Bill (SSB) 5496 (Chapter 43, Laws of 2022). Changes align the rules with currently accepted language for substance use disorders and related monitoring programs, and include technical clarifications as needed without changing the rule’s effect.

The Department of Health adopted amendments to reduce barriers to certification for Substance Use Disorder Professionals and Substance Use Disorder Professional Trainees. Changes include removing the requirement to verify educational coursework for applicants with a national certification in WAC 246-811-070, making pharmacists eligible for the alternative training pathway in WAC 246-811-076, and removing osteopathic physician assistants pursuant to Substitute House Bill 2378 (chapter 80, Laws of 2020). The rule also removes the obsolete AIDS training from the list of probationary license requirements pursuant to Engrossed Substitute House Bill 1551 (chapter 76, Laws of 2020).

Emergency Rule

The Dental Quality Assurance Commission adopted health equity continuing education requirements to meet the requirements of the Department of Health’s equity model rules, WAC 246-12-800 through 246-12-830. The amended rules add two hours of health equity education, to be completed as part of the current continuing education requirements every three years.

The State Board of Health has adopted amendments to chapter 246-272A WAC to implement changes to existing requirements. The adopted rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues and makes clarification updates. 

WAC 246-282-006, Washington state Vibrio parahaemolyticus control plan. Vibrio parahaemolyticus (Vp) is a naturally occurring bacteria found in marine waters. Molluscan bivalve shellfish acquire Vp through filter feeding. Humans who consume raw or undercooked shellfish containing Vp can develop an intestinal disease called vibriosis. Chapter 246-282 WAC establishes the minimum performance standards for growing, harvesting, processing, packing, storage, transporting, and selling of shellfish for human consumption.

These rules do not apply to persons who conduct activities limited to retail food service, personal use, and transporting as a common carrier of freight. WAC 246-282-006 establishes the control plan for the months of May 1st through September 30th and are an extension of the NSSP Model Ordinance (U.S. Food and Drug Administration National Shellfish Sanitation Program, Guide for the Control of Molluscan Shellfish). Due to current early season high temperatures, this emergency rule making is necessary to protect public health by modifying the existing strictest harvest control requirements which currently start July 1st by setting even more protective measures immediately.

The State Board of Health (board) filed a Preproposal Statement of Inquiry (CR-101) on February 23, 2022, WSR 22-06-034 regarding permanent amendments to the existing rules to address harvest control measures and may also include updating definitions, seed size and other technical and editorial changes as needed. Until permanent rule making can be completed, the board has delegated emergency rule making authority to the Department of Health if heat-wave conditions occur prior to July 1To reduce the threat to public health, amending the “time of harvest to cooling requirements” to a more protective control season immediately is necessary.

The current Vp Control Plan, last revised in 2015, establishes a control season between May 1st and September 30th and authorizes enforcement of the rule’s strictest time-to cooling requirements for harvested oysters starting July 1 of the Vp control season. However, recent events demonstrate the need for more flexible rules.

From June 26 to July 2, 2021, the National Weather Service in Seattle reported a long-duration, unprecedented heat wave throughout the Pacific Northwest. Shellfish-related Vp illnesses increased sharply. Therefore, due to current early season temperatures and mid-day low tides, this emergency rule is necessary to protect public health.

Substitute Senate Bill (SSB) 6086, passed in 2020, allows a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications for the treatment of Opioid Use Disorder (OUD) or its symptoms. The Pharmacy Quality Assurance Commission adopted rules that establish the minimum standards for OUD medication remote dispensing sites. Adopted rules reflect standards, restrictions and requirements set in statute.

The minimum standards must address who may access medications at the remote dispensing site pursuant to a valid prescription or chart order. The minimum standards must also require that the pharmacy is responsible for stocking and maintaining a perpetual inventory of the OUD medications stored in or at the remote dispensing site (referred to as the “supplying pharmacy” in the rule language).

Current rules in chapter 246-945 WAC cover requirements for drugs stored outside of a pharmacy but restrict their location to a facility that is otherwise able to store and possess drugs (i.e., a licensed pharmaceutical firm). The adopted rule, WAC 246-945-457, is necessary to establish enforceable minimum standards as directed by SSB 6086 for OUD medication remote dispensing sites. As the statute specifically requires rulemaking, no other alternatives were considered.

The Board of Optometry adopted changes to WAC 246-851-090 and WAC 246-851-125 through 246-851-230 related to CE requirements for licensed optometrists. Adopted amendments include online continuing education, new definitions, limits on types and categories of CE hours, reference to other required trainings, CE documentation requirements, clarifying self-study requirements, and certain allowances during a declared state of emergency.

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).

Purpose: WAC 246-847-991 Occupational therapy licensure compact (compact) privilege fees and renewal cycle. The Department of Health (department) is adopting a new section of rule, WAC 246-847-991, to implement Senate Bill (SB) 5518 (Chapter 152, Laws of 2022), which creates a new interstate licensure compact for occupational therapy and gives member states the discretion to charge a fee for granting compact privileges. The department is adopting a new rule to specify the compact fees and renewal cycle.

Policy Statement CH-24-03-014 (PDF). The Washington State Chiropractic Quality Assurance Commission issued a policy statement stating that an Individual’s holding a chiropractic license in “inactive” status, and endorsement or expired credential reissuance applicants are not required to take and pass the jurisprudence examination if the applicant holds an active credential recognized as having substantially equivalent standards. Effective Date: March 14, 2023.

The Washington State Board of Nursing (board) adopted amendments to WAC 246-840-095, 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).

Amelia Boyd

PO Box 47866

Olympia, WA 98504

360-918-6336

amelia.boyd@doh.wa.gov

The Board of Denturist adopted requirements in WAC 246-812-462 for the use of placement of prefabricated implant abutments. The adopted rule establishes the requirements that are to be followed for a licensed denturist to place a prefabricated implant abutment on an implant for the purpose of fabricating, repairing, relining, or rebasing a denture. The board also amended WAC 246-812-501 to ensure that a licensed denturist develop and maintain written infection control policies, procedures, and requirements for infection prevention and control that are appropriate for the denturist services provided by the facility.

Home Care Aide and Nursing Assistant-Certified Alternate Certification Time Frames. The Department of Health (department) is establishing alternate certification time frames for individuals working toward certification as a home care aide or nursing assistant-certified (NA-C) This includes amending WACs 246-980-025, 246-980-030, WAC 246-980-040, and WAC 246-980-065 and adopting a new rule section, WAC 246-980-011. Due to impacts from the coronavirus disease 2019 (COVID-19) pandemic, many long-term care workers are still unable to obtain training and certification as home care aides and NA-Cs within statutory time frames. By continuing alternate time frames established under Engrossed Substitute House Bill (ESHB) 1120 (Chapter 203, Laws of 2021), the department will allow workers impacted by the pandemic more time to complete requirements while training and testing capacity issues are being resolved.

These emergency rules continue emergency rules filed January 12, 2023 under WSR 23-03-066. These rules established alternate certification time frames for two different groups of long-term care workers: individuals working toward certification as a home care aide and individuals working toward certification as an NA-C. This extension is the same as the original filing, except that the dates of the alternate time frames have been updated to reflect ongoing training, testing, and certification challenges. Rules impacting home care aides were developed in collaboration with the Department of Social and Health Services (DSHS), while rules impacting NA-Cs were developed in collaboration with DSHS and the Nursing Care Quality Assurance Commission (NCQAC). The new rule, WAC 246-980-011, establishes alternate time frames for long-term care workers seeking certification as a home care aide or NA-C. Amendments to WACs 246-980-025, 246-980-030, 246-980-040, and 246-980-065 create cross-references to WAC 246-980-011 and, where applicable, to DSHS rules that establish alternate time frames for training and testing.

This emergency rule is necessary to avoid a critical shortage of long-term care workers as a result of the COVID-19 pandemic. During the COVID-19 pandemic, both training and testing were unavailable for several months in 2020 before resuming at limited capacity. This created a large backlog of long-term care workers unable to become certified as a home care aide or NA-C within statutory time frames. During the COVID-19 declared emergency, thousands of workers seeking certification were allowed to continue working under Governor’s Proclamations 20-52 and 20-65 (waivers), which waived credentialing requirements. Now that the waivers have been rescinded, however, uncertified workers will no longer be able to work and will still be unable to readily access the training and testing necessary for certification. Losing these workers would exacerbate the existing workforce shortage, forcing more medically vulnerable patients to rely on other care options, such as higher-level residential care settings. ESHB 1120, passed in 2021, gives the department authority to allow long-term care workers additional time to become certified if a pandemic or other declared state of emergency impacts their ability to complete certification timely. Pursuant to ESHB 1120, the department collaborated with DSHS and NCQAC to develop alternate, extended time frames for long-term care workers seeking certification as a home care aide or NA-C. These alternate time frames create a path to certification for uncertified home care aides and NA-Cs and allow workers to continue caring for clients while the testing and training backlog is being resolved.

The Veterinary Board of Governors has adopted amendments to physician health monitoring programs for substance use disorders of veterinarian professions to update language changes made by Substitute Senate Bill (SSB) 5496 (chapter 43, Laws of 2022). Amendments include terminology and definitions for currently accepted language and replacing "substance abuse" with "substance use disorder." The board also made amendments to correct citations and other general housekeeping changes.

The Department of Health (department) is adopting an increase in fees to cover the costs of operating the Radiation Machine Facility Program. The department is also adopting changes to machine categories within the fee schedule to allow the department to better track and manage X-ray machines across Washington. This will allow the department to be more efficient in regulatory and inspection processes.

Interpretive Statement – Health Equity Continuing Education for Dental Hygienists, HSQA OHP DH2301

Health equity continuing education (CE) requirements for Dental Hygienists under chapter 246-815 WAC. Training requirements in WAC 246-12-800 through WAC 246-12-
830 will apply to a Dental Hygiene licensee starting January 1, 2024. Filed December 22, 2023.