Rule-Making Activity

The Pharmacy Quality Assurance Commission and Department of Health are filing jointly to reinstate medication assistance rules which establish criteria for medication assistance in community-based and in-home care settings in WACs 246-945-710, 246-945-712, 246-945-714, 246-945-716, 246-945-718, 246-945-720, 246-945-722, 246- 945-724, 246-945-726, and 246-945-728. This adopted emergency rule will extend WSR 23-23-032 filed on November 3, 2023, without change. 

Amending the definition of mental health professional and creating certified agency affiliated counselor and licensed agency affiliated counselor credentials. Amending WACs 246-341-0200 and 246-341-0515 in chapter 246-341 WAC, Behavioral Health Agency Licensing and Certification Requirements, and WACs 246-810-010, 246-810-015, and 246-810-990 in chapter 246-810 WAC, Counselors. 

Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) made several immediate changes impacting behavioral health agencies, including amending the definition of “mental health professional” (MHP) and creating two new agency affiliated counselor (AAC) credentials. Because 2SHB 1724’s amendments to the MHP definition and AAC credentials went into effect immediately and were designated as necessary for the immediate preservation of the public health, safety, or general welfare, the Department of Health (department) implemented these changes by emergency rule under WSR 23-16-031, filed on July 21, 2023.

This emergency rules continues without change the original emergency rule. The emergency rule:

• Amends chapter 246-341 WAC to address language that conflicts with 2SHB 1724, deleting an outdated definition of MHP requirements and updating an incorrect cross-reference.
• Amends chapter 246-810 WAC to expand existing language to establish two new credentials, the certified agency affiliated counselor (C-AAC) and the licensed agency affiliated counselor (L-AAC). The amendments align rule language with statute and revise the registered AAC fees to apply to all AAC types.

The emergency rules will be continued while permanent rule making is in progress under WSR 23-16-044, filed on July 25, 2023.

Reasons for this finding: The legislature established in 2SHB 1724, Section 33 that many sections of the bill are “necessary for the immediate preservation of the public peace, health, or support of the state government and its existing public institutions and take effect immediately.” Sections 13 through 20, which create the new AAC credentials and amends the definition of MHP, are among the sections that became effective immediately.

Under 2SHB 1724, RCW 71.05.020 was amended to define an MHP as an individual practicing within their credential’s scope of practice. Qualifying credentials include the certified and licensed AAC credential, but not the current AAC registration. Prior to the passage of 2SHB 1724, many MHPs performed assessments and made diagnoses with only a registration. After 2SHB 1724 became effective, however, they were required to obtain an AAC certification, AAC license, or other qualifying credential in order to continue providing these services. Establishing the new AAC credentials immediately by emergency rule and continuing these emergency rules allows MHPs to transition into the new credentials and continue providing essential behavioral health services while permanent rules are in progress.

If the department had waited to make these amendments through standard rule making, MHPs with an AAC registration would be both unable to continue assessing and diagnosing due to the changed MHP definition and unable to obtain a higher AAC credential that would allow them to continue that work. Continuing these emergency rules will allow MHPs who are AACs to continue serving Washington residents with behavioral health needs.

The Washington Medical Commission is extending its emergency rule that amends WAC 246-919-330 to eliminate the outdated requirement for consecutive years of training in no more than two programs. This change will remove a barrier for qualified applicants to obtain a physician license. This rule continues emergency rules filed on November 9, 2023, under WSR 23-23-071 while permanent rulemaking is in process.

Amending specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) in WAC 246-841-420, 246-841-470, 246-841-490, 246-841-500, 246-841-510 and 246-841-555. This is the 11th emergency rule. The amendments remain the same as the previous filing. Emergency rules allow additional pathways to complete necessary training to enter the workforce.

Amending specific training requirements for Nursing Assistant Registered (NAR) and Home Care Aides (HCA) in WAC 246-840-930 and 246-841-405.  This is the sixth emergency rule and continues the initial emergency rules filed.

The Department of health adopted emergency rules that temporarily remove the requirement for home care aide applicants to become certified within two years of completing training. WAC 246-980-100 (5)(c) requires that home care aide certification testing occur within two years of training. This emergency rule removes the two-year limit on the validity of training. 

The Department of Health (department) adopted an emergency rule on August 30, 2023 (WSR# 23-18-044) to amend chapter 246-296 WAC to redefine the term disadvantaged community, update loan terms, update application requirements, and clarify loan rating and ranking criteria to conform with requirements in the federal Bipartisan Infrastructure Law (BIL). This emergency rule is being adopted to extend the existing emergency rule without changes to the previous emergency rule.

The Department of Health continued emergency rules to establish 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. The emergency rules will allow workers impacted by the COVID 19 pandemic more time to complete requirements while training, testing, and credentialing capacity issues are being resolved.

The Department of Health is continuing emergency rules that established licensure for mental health counselors, marriage and family therapists, and social workers. These emergency rules implement Section 7 of Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023), which was codified as RCW 18.225.180.

These rules continue without change the initial emergency rules filed on September 28, 2023 under WSR 23-20-055. The department will continue these emergency rules until directory and supervision standards are adopted through the permanent rule making process. The department filed the Preproposal Statement of Inquiry (CR-101) to begin the permanent rule making on December 27, 2023 under WSR 24-02-038.

This emergency rule filing allows for the 3mg and 4mg dosage versions of naloxone spray to be prescribed as Over-The-Counter (OTC) products. This rule is unchanged from the previous emergency rule under WSR 24-01-021 filed on December 8, 2023. This emergency rule will be continued until the permanent rulemaking is effective.

The Department of Health is extending an emergency rule to continue to require acute care hospitals in Washington state to support statewide health system readiness by reporting hospital maintenance and operation data to the department through Washington’s Healthcare and Emergency and Logistics Tracking Hub (WA HEALTH). This fourth emergency rule continues the emergency rule originally filed on August 31, 2022 as WSR 22-18-060.

The Washington State Board of Nursing (board) filed emergency rules amending WAC 246-840-030 and 246-840-090 to clarify existing licensure requirements for registered nurse (RN) and licensed practical nurse (LPN) applicants applying for initial licensure via an out-of-state traditional nursing education program approved by another U.S. nursing board, and applicants applying via interstate endorsement. The emergency rule language clarifies the board’s authority to protect the people of Washington by only licensing qualified, properly trained nurses who meet minimum educational standards.

This is the third emergency rule, initially filed as WSR 23-11-015 on May 5, 2023, and most recently filed as WSR 23-18-064 on September 1, 2023. The amended language has changed since the last emergency rule filing to increase clarity of licensure requirements for out-of-state applicants and improve the flow of the amended WAC sections.

The rules as currently written state that a nurse who has graduated from another state’s approved nursing program or from a substantially equivalent program may be licensed in Washington. The board became aware that certain nursing programs in Florida and elsewhere had fraudulent programs that did not meet the educational standards of any state. The emergency rule language clarifies the board’s authority to protect the people of Washington by only licensing qualified, properly trained 
nurses who meet minimum educational standards.

These emergency rules clarify that RN and LPN applicants, applying for licensure via interstate endorsement or for initial licensure via an out-of-state traditional nursing education program approved by another U.S. nursing board, must successfully complete a nursing education program in another U.S. state, which is approved by the nursing board in that state and substantially meets requirements for nursing education approved in Washington state. The amendments also reaffirm that the board retains the authority to evaluate and determine the sufficiency of academic preparation for all applicants. These amendments are preliminary steps to future permanent rule amendments and clarification identified by the board’s licensing subcommittee.

The Board of Physical Therapy is proposing to update the effective date in WAC 246-915A-010 for the Physical Therapy Compact per RCW 18.74.500 Article IX(2), updating the reference date to the most recent physical therapy licensure compact rules. This proposed rule will update the compact effective date to June 27, 2023. 

The Department of Health is proposing amendments to WAC 246-12-051 to update language changes made by Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023). The proposed changes will align the rules with statutory changes regarding licensure of military spouses who hold a license in another state.

The Board of Osteopathic Medicine and Surgery is proposing amendments to WAC 246-853-290, 246-853-300, 246-853-310, and 246-853-320 to update the rules regarding health profession monitoring programs. The proposed changes reflect updated language changes made by Substitute Senate Bill 5496 (chapter 43, Laws of 2022). In partnership with the Secretary of Health, technical amendments are also being proposed to WAC 246-853-990 to reflect changes to the updated rules and statute.

Updating reference to United States Pharmacopeia (USP) General Chapters 795 and 797. The Pharmacy Quality Assurance Commission (commission) is proposing 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>.

Purpose of the proposal and its anticipated effects, including any changes in existing rules: The proposed rule amends WAC 246-945-100 to update the rule to the most recent versions of the USP <795> and <797>. USP <795> and <797> were adopted into rule by reference effective on July 1, 2020. Since then, USP <795> and <797> have been updated.

Reasons supporting proposal: The existing reference in WAC 246-945-100 does not account for changes made to USP <795> and <797> that are official as of November 1, 2023 by USP. The proposed rule updates the references to the most recent versions. The proposed rule language qualifies for expedited rulemaking under RCW 34.05.353(1)(b) as the language incorporates by reference national standards without material change.

This proposal will remove citations to repealed WAC chapters, update citations to the current governing WAC chapter or specific rule(s) and make general grammatical corrections without making any material changes.

Submit Written Comments to: Nina Helpling, DOH, P.O. Box 47820, Olympia, WA 98504-7820, email tempworkerrule@doh.wa.gov, by July 7, 2023.

Assistance for Persons with Disabilities: Contact Nina Helpling, phone 360-236-3065, TTY 711, email nina.helpling@doh.wa.gov, by June 13, 2023.

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.

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 Pharmacy Quality Assurance Commission is considering amending and creating new sections in chapter 246-945 WAC to include manufacturers and distributors of dialysate and dialysis devices in home dialysis program rules under the commission’s jurisdiction. The amendments under consideration are in response to statutory changes made by Substitute House Bill (SHB) 1675 (chapter 23, Laws of 2022).

The Washington State Board of Health (Board) is considering adding Guanidinoacetate methyltransferase deficiency (GAMT) and Arginase 1 deficiency (ARG1-D) to the list of mandatory conditions for newborn screening conducted by the Department of Health (Department).

The Board has the authority under RCW 70.83.050 to define and adopt rules for screening Washington-born infants for hereditary conditions. WAC 246-650-010 defines the conditions, and WAC 246-650-020 lists the conditions for which all Washington-born newborns are to be screened. GAMT deficiency and ARG1-D are rare inherited metabolic conditions that can result in severe disability and in some cases death if not detected and treated early. Early diagnosis of GAMT deficiency and ARG1-D through newborn screening is essential to save lives and to improve the quality of life for impacted infants and their families.

To be added to the listserv for notifications regarding this rulemaking, email Molly.Dinardo@sboh.wa.gov with the subject line "Newborn Screening – GAMT & ARG1-D."

The Department of Health is considering a chapter review to reorganize sections and amend rules regarding J-1 Physician Visa waivers. The department is exploring updates to help meet the greatest needs across Washington State. The department will also look for increased clarity in the organizational structure, application criteria, and requirements for letters of support.

Shad Bell
360-236-4711

The Department of Health is considering creating a new chapter of rules under Title 246 WAC to establish licensing regulations for music therapists, including fees. The department will consider any necessary rules for an advisory committee.

The Board of Osteopathic Medicine and Surgery is considering amending WAC 246-853-661 Exclusions, WAC 246-853-730 Periodic review, and WAC 246-853-755 Tapering requirements, to modernize the language, add clarity, and align rules with the Washington Medical Commission (WMC).

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-507 to add certain intramammary antibiotic formulation drugs to the list of approved legend drugs in response to a petition from a veterinarian at the Washington Department of Fish and Wildlife (WDFW).

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

The Occupational Therapy Practice Board and the Department of Health are considering amending rules and establishing fees for temporary practice permits in response to the Washington Military Spouse Employment Act.

The Department of Health is considering amending radioactive material licenses and licensee's fees to cover operating costs for the following: Small business discount provision and optional fee payment schedule applicable to radioactive materials licensees; Fees for specialized radioactive material licenses; Fees for medical and veterinary radioactive material use Fees for industrial radioactive material licenses; Fees for laboratory radioactive material licenses; and Fees for licensing and compliance actions.

The Department of Health is considering establishing a new chapter of rules, chapter 246-819 WAC, for the dental therapist profession to implement Engrossed Substitute House Bill (ESHB) 1678 (Chapter 460, Laws of 2023).

The Board of Osteopathic Medicine and Surgery is considering amending WAC 246-853-080 to update the continuing education (CE) requirements for licensure renewal of osteopathic physicians to clarify Washington-specific mandated CE requirements.

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

The Department of Health is considering amending, repealing, or creating new sections in chapter 246-809 WAC, to establish: a directory to help mental health counselor, marriage and family therapist, and social worker associates find supervisors; minimum standards for supervision of associates; and a stipend program to offset some costs of supervision for associates.

The Department of Health is considering amending requirements for respiratory care practitioner application, examination licensure, and out of state credentialing and temporary practice permits.

The Department of Health is considering amending fees in WAC 246-358-990 to cover operating costs in the Temporary Worker Housing program. The department will consider updating or restructuring existing fees and creating new fees. Rulemaking is being considered because the department conducted an initial assessment of the program and determined the current fee is not generating sufficient revenue to cover the program’s costs.

The Department of Health (department) is considering amending chapter 246-790 WAC to increase flexibility in allowed vendor types and update program requirements for vendors. The department is also considering amendments to the Participant Compliance rules to reflect virtual service options.

Jocelyn W. Jones
360-236-3020

Stuart Glasoe
360-236-4111

The Pharmacy Quality Assurance Commission is considering creating a new section(s) in chapter 246-945 WAC related to the regulation of the practices of “white bagging” and “brown bagging” or any other transfer of a prescription or drug for the purpose of re-dispensing or subsequent administration to a patient. Concerns have been raised over ensuring the integrity and quality of these medications is maintained if such practices are used by prescribers, hospitals, or patients because these practices can create an unknown chain of custody.

The Department of Health is considering amendments to genetic counselor licensure requirements in WAC 246-825-080 Licensure by endorsement, to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) to make disciplining authorities review and adjust licensure requirements to remove barriers to entering and remaining in the health care workforce, and to streamline and shorten the credentialing process.