Rule-Making Activity

Emergency Rule

The Department of Health adopted amendments to WAC 246-809-095, 246-809-110, 246-809-130, 246-809-210, 246-809-310, 246-809-320, 246-809-330, 246-809-610, 246-809-630, 246-809-632, 246-809-650, and 246-809-730 to establish two hours of health equity continuing education (CE) requirements every four years for substance use disorder professionals. The adopted rules do not change the total CE hours. The hours are counted under existing, unspecified CE requirements for the profession.

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,

Interpretive Statement – Health Equity Continuing Education for Midwives, HSQA OHP MW01

Health equity continuing education (CE) requirements for licensed Midwives under chapter 246-834 WAC. Training requirements in WAC 246-12-800 through WAC 246-12-
830 will apply to a Midwife licensee starting January 1, 2024. Filed December 22, 2023.

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.

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.

Emergency Rule

The Department of Health amended WAC 246-850-140 to adopt the health equity model rules, WAC 246-12-800 through 246-12-830, for orthotists and prosthetists to comply with RCW 43.70.613. WAC 246-850-140 was amended to include at minimum two hours of CE in health equity every four years for orthotists and prosthetists. The health equity CE requirement will be added to the existing number of CE hours required for orthotists and prosthetists without changing the existing total number of required CE hours. The health equity CE requirement is counted under existing, unspecified CE requirements for the profession.

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.

Purpose:Medical Assistants updated credentialing and licensure requirements in WAC 246-827-0010, 246-827-0110, 246-827-0120, 246-827-0140, 246-827-0200, 246-827-0300, 246-827-0400, and 246-827-0610. The Department of Health(department) is adopting revisions to medical assistant (MA) rules to remove outdated language, remove English languagerequirements, and update credentialing requirements. Outdated language includes removing language concerning theobsolete Health Care Assistant credential. Removing English requirements will remove unnecessary barriers for otherwisewell-qualified medical assistant staff to enter the workforce. RCW 18.360.010 was updated by House Bill (HB) 1378 (chapter44, Laws of 2021) to allow medical assistant supervision using audio and video technology during a telemedicine visit. Thedepartment is adding a new section to detail regulation for telemedicine supervision in response to HB 1378. Amendmentsremove irrelevant or confusing rule language, which will make the rules more easily understood. Updating credentialingrequirements to remove licensure barriers will allow experienced medical assistants to enter the Washington workforce.

The Board of Osteopathic Medicine and Surgery adopted a new rule, WAC 246-873-045, to establish health equity continuing education (CE) requirements. The adopted rules do not change the total CE hours. They require two hours in health equity CE every four years, which is absorbed into the existing number of required CE hours. The health equity CE requirement is counted under existing, unspecified CE requirements for the profession.

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.

In 2020, the Pharmacy Quality Assurance Commission consolidated multiple chapters of rules into chapter 246-945 WAC that covers the practice of pharmacy. This adopted rule amends WAC 246-945-040(1) to incorporate Title 21 of the CFR by reference for the purpose of capturing any changes made to Title 21 after WAC 246-945-040 went into effect on July 1, 2020. Language was also added to the rule for the purpose of providing individuals directions for acquiring copies of the reference material listed for public inspection.

Amelia Boyd

PO Box 47866

Olympia, WA 98504

360-918-6336

amelia.boyd@doh.wa.gov

The Washington Medical Commission (commission) adopted health equity continuing education requirements in new sections, WAC 246-918-195 and WAC 246-919-445. The commission has adopted the Department of Health’s health equity model rules, WAC 246-12-800 through 246-12-830, to adopt rules requiring a licensee to complete health equity CE training at least once every four years. The adopted rule does not change the 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.

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.

Purpose: Provides prescribing requirement exemptions in specific circumstances. WAC 246-853-661, Exclusions. The Board of Osteopathic Medicine and Surgery (board) is adopting amendments to expand the types of patients who are exempt from opioid prescribing rules. The adopted language aligns with the Washington Medical Commission's recently adopted rules to ensure consistency and alignment with best practices.

The Chiropractic Quality Assurance Commission adopted rules concerning chiropractic X-ray technicians including: updates to course requirements; who can be approved to instruct the course; and set new requirements for obtaining, maintaining and returning from expired status. The commission also adopted health equity continuing education requirements. Amends WAC 246-808-201, creates new sections WAC 246-808-203, WAC 246-808-205, WAC 246-808-207, WAC 246-808-209, and WAC 246-808-211, and repeals WAC 246-808-215.

The Department of Health adopted amendments to WACs 246-810-027 and 246-810-0298 and creating a new section, WAC 246-810-0299, to establish two hours of health equity continuing education (CE) requirements every four years for certified counselors and certified advisers. The health equity CE requirement is counted under existing, unspecific CE requirements for the profession and does not change the total number of CE hours required. Additionally, clarify and streamline rule language without changing its effect.

The Podiatric Medical Board (board) adopted amendments to WAC 246-922-400, WAC 246-922-405, WAC 246-922-410, and WAC 246-922-415 to update language regarding health profession monitoring programs to align with changes made by Substitute Senate Bill (SSB) 5496 (chapter 43, Laws of 2022).

Amelia Boyd

PO Box 47866 Olympia, WA 98504-7866

360-918-6336

amelia.boyd@wmc.wa.gov

Department of Health adopted amendments to WAC 246-930-410 to establish health equity continuing education (CE) requirements. The adopted rule does not change the total CE hours required for SOTPs. It requires two hours in health equity CE every four years, which is absorbed into the existing number of CE hours required. Additionally, because an individual must hold an SOTP credential in addition to a credential for their primary health profession, the adopted rule does not require an SOTP to take an additional health equity CE training if they have already completed the training for their primary credential.

Describe any changes other than editing from proposed to adopted version: On its own initiative, the department has made minor edits to update formatting and increase clarity, including: (1) discontinuing the use of “and/or”; (2) removing bold formatting from rule text; (3) dividing subsection (4) into paragraphs for clarity; and (4) relocating a paragraph for greater visibility.
 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by contacting:

Lana Crawford 
P.O. Box 47852
Olympia, WA 98504-7852 

Phone: 564-669-1455 
TTY: 711

Email: Lana.Crawford@doh.wa.gov

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.

Joshua Munroe

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. 

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.

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 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.

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.

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.

The Department of Health adopted national standards sources of radionuclide emissions by reference. This rulemaking updates the reference to national standards for sources of radionuclide emissions federal regulations to the most recent version, adopted in 2023.

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.

Becky McElhiney

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

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.

This emergency rule temporarily removes the requirement for home care aide applicants to become certified within two years of completing training. These rules continue emergency rules initially filed on October 17, 2022, under WSR 22-21-102 and continued on February 14, 2023, under WSR 23-05-083 and on June 13, 2023, under WSR 23-13-068. They are being continued while permanent rulemaking is in progress to consider training timelines for home care aides.

Second Substitute House Bill 1724 (chapter 425, Laws of 2023) made several immediate changes impacting behavioral health agencies, including amending the definition of “mental health professional” (MHP) and to establish two new credentials, the certified agency affiliated counselor (C-AAC) and the licensed agency affiliated counselor (L-AAC). This emergency rule continues without changes to the original emergency rule package while permanent rule making is in progress.

To combat the ongoing opioid epidemic, The Pharmacy Quality Assurance Commission has adopted an emergency rule amending WAC 246-945-030 and adding a new section, WAC 246-945-034. These rules classify the 3mg and 4mg naloxone hydrochloride nasal spray as approved by the FDA for OTC distribution in Washington state. This filing reflects an FDA update which broadened the classification of allowed Naloxone products as OTC status. Filed as WSR 24-01-021 (PDF).

In March 2023, the United States Food and Drug Administration (FDA) approved the first 4 mg naloxone hydrochloride nasal spray as an over-the-counter (OTC) drug and has approved other naloxone nasal sprays since that time. Naloxone is an opioid antagonist used for the emergency treatment of known or suspected opioid overdose. Currently, WAC 246-945-030 incorporates the 39th edition of the Approved Drug Products with Therapeutic Equivalence Evaluations, or "Orange Book," which has naloxone listed as a prescription drug. The Pharmacy Quality Assurance Commission (commission) considers the ongoing opioid epidemic to be a public health emergency in Washington state. In order to combat this epidemic in Washington, the commission is amending WAC 246-945-030 and adding a new section, WAC 246-945-034, classifying the 3mg and 4mg naloxone hydrochloride nasal spray as approved by the FDA for OTC distribution as an OTC drug in Washington state.

The timeline for the availability of naloxone nasal spray is set by the manufacturers, although some are already available.

This emergency rule prepares Washington state for the moment that the drug becomes available by manufacturers. The proposed new section of chapter 246-945 WAC would also allow for expansion of different formularies if the FDA makes further changes. This preparation would allow for a faster release of the drug throughout the state, meaning this life saving drug would be in the hands of Washingtonians faster. Increasing patient access to the drug is critical to reduce opioid overdoses.

This emergency rule filing allows for the 3mg and 4mg dosage versions of naloxone spray to be prescribed as over-the-counter products. The previous emergency rule filing on this topic, filed as WSR 23-17-059 on August 11, 2023, only allowed the 4 mg nasal spray under the brand name Narcan to be prescribed as an OTC product, but the FDA broadened the classification of allowed naloxone products since that previous filing.