Rule-Making Activity

Rule making notices will be delivered via GovDelivery. To receive notices, interested persons may sign up for any or all of the lists. Please go to: https://public.govdelivery.com/accounts/WADOH/subscriber/new. After signing in, please click open the box labeled "Health Systems Quality Assurance." Next click open the box labeled "Health Professions." From there, check the Medical Cannabis Program box. You may also check any other box of the professions listed that you may be interested in.

Shannon Angell

PO Box 47860

Olympia, WA 98504-7860

Phone: 360-236-2820

Email: shannon.angell@doh.wa.gov

The Department of Health is considering updating public water system fees to generate sufficient income to cover costs of the program. This may include updating or restructuring existing fees or creating new fees.

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-055 to remove fenfluramine from the list of Schedule IV substances and adding a new section to chapter 246-945 WAC to establish a list of schedule IV exemptions. Fenfluramine is a medication used in the treatment of seizures associated with certain syndromes and as an appetite suppressant and was removed from the Drug Enforcement Administration’s (DEA) federal Controlled Substances Act (CSA) in December of 2022.

The Board of Physical Therapy is considering amendments to update initial licensure and endorsement requirements in consideration of Second Substitute House Bill (2SHB) 1724, (chapter 425, Laws of 2023). The board will also consider making general updates to the licensing and endorsement process, examine the jurisprudence examination requirement, and review for housekeeping changes.

Section 8 of 2SHB 1724 requires boards and commissions to waive any examination requirements in an effort to expedite the licensing process for applicants who meet the requirements under 2SHB 1724. The board will review the initial licensure and endorsement requirements to bring them into alignment with 2SHB 1724, and review the current license requirements for consistency and relevancy. The board will consider additional housekeeping updates.

The Department of Health is considering amending existing rules WAC 246-225-020 and 246-225-030 and creating new rules in chapter 246-225 WAC, X-Rays in the Healing Arts, to address technological advances in radiation therapy and fluoroscopic X-ray, establish machine performance and quality control standards, and to address plan review shielding requirements. Amendments to radiation therapy rules considered by the department will apply only to machine generated ionizing radiation, and not radiopharmaceuticals or radioactive materials.

The Department of Health is considering amending WAC 246-10-501 to include applicants for interstate license compacts, milk banks, and 988-line crisis call centers to the list of applicant types who are eligible for brief adjudicated proceedings as a due process recourse if their application is denied.

Shad Bell

360-236-4711

The Occupational Therapy Practice Board is considering amendments to implement Second Substitute House Bill (2SHB) 1724 (Chapter 425, Laws of 2023) to remove barriers to licensure and endorsement. Additionally, the board will consider amendments to align with the national certifying board and standards of ethics and professional conduct.

Section 8 of 2SHB 1724 directs boards and commissions to waive certain requirements to licensure for specific types of applicants. The intent of the bill was to change licensure requirements to remove barriers to entering and remaining in the health care workforce, and to streamline and shorten the credentialing process. Rulemaking may be necessary to amend licensure requirements to align with the new legislation. Additionally, the board consistently receives inquiries on whether an OT can work off the evaluation of another profession such as a physical therapist. The board is considering adding rule language that makes it clear that an OT must complete their own evaluation of the client, and will consider adding language that aligns continued competency rules with the national certifying board.

Amelia Boyd

The Board of Hearing and Speech is considering amendments to WAC 246-828-020, WAC 246-828-510, and WAC 246-828-617 to update requirements for speech-language pathology assistant certification. The board may also consider making related updates or new sections to clarify and streamline licensure in chapter 246-828 WAC.

Agency: Department of Health and the Board of Physical Therapy
Subject of possible rule making: Physical Therapists intramuscular needling requirements. The Board of Physical 
Therapy (board) and Department of Health (department) are considering rulemaking in chapter 246-915 WAC, Physical 
Therapists and Physical Therapist Assistants, to clarify statutory requirements for education and training and define an 
intramuscular needling endorsement. The board and department may consider associated training and education 
requirements, updating definitions, establishing a fee for the intramuscular needling endorsement, and creating a process 
to apply for the endorsement.
Statutes authorizing the agency to adopt rules on this subject: Second Substitute House bill (2SHB) 1039 (chapter 
198, Laws of 2023), RCW 18.74.023, 43.70.110, 43.70.250, and 43.70.280
Reasons why rules on this subject may be needed and what they might accomplish: 2SHB 1039 expands the 
scope of practice of physical therapists to perform intramuscular needling, also known as dry needling. Rules may be 
needed to clarify statutory requirements for education and training to receive an initial endorsement to perform 
intramuscular needling. The board and the department will also consider establishing the steps to apply for the 
endorsement, including establishing a fee.
Identify other federal and state agencies that regulate this subject and the process coordinating the rule with 
these agencies: None
Process for developing new rule (check all that apply):
☐ Negotiated rule making
☐ Pilot rule making
☐ Agency study
☒ Other (describe) Collaborative rulemaking
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule 
before publication by contacting:
(If necessary)
Name: Allyson McIver Name:
Address: PO Box 47852, Olympia, WA 98504-7852 Address:
Phone: 360-236-2878 Phone:
Fax: 360-236-2901 Fax:
TTY: 711 TTY:
Email: physical.therapy@doh.wa.gov Email:
Web site: doh.wa.gov Web site:
Other: Other:
Additional comments: Interested parties can participate in the drafting of the proposed rules. The department and the
board will be conducting rules workshops with interested parties and subject matter experts. The department will use 
existing GovDelivery lists and other known contact information to inform interested parties of opportunities to provide input
Page 2 of 2
on proposed rule language. To find out more information about our rulemaking, visit www.doh.wa.gov. To subscribe to 
GovDelivery, please visit www.doh.wa.gov, and select the "Subscribe" button at the bottom of the page, select Health 
Professions, and then Physical Therapy Program. You may also check the box next to one or more of the other 
professions listed to receive information related to that specific profession.
Date: July 18, 2023
Name: Kathryn Dale, PT, DSc and Kristin Peterson, JD for 
Umair A. Shah, MD, MPH
Title: Chair, Physical Therapy Board and Chief of Policy 
for Secretary of Health

The Board of Optometry is considering amendments to optometrist continuing education and examination requirements in WAC 246-851-090 through 246-851-230 and WAC 246-851-490 to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) and to consider increasing the number of allowable online credits.

Shad Bell

360-236-4711

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-155, WAC 246-945-156, and adding a new section to chapter 246-945 WAC. These changes would grant renewal extensions to pharmacy interns and would extend temporary pharmacy intern practice permits for spouses of military personnel in accordance with Second Substitute House Bill 1009 (chapter 165, Laws of 2023).

Shad Bell
360-236-4711

The Dental Quality Assurance Commission is considering adding residential habilitation centers, nursing homes, and long-term hospitals to the list of opioid prescribing exclusions in WAC 246-817-905 Exclusions.

John Hilger
360-236-2929

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).

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 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 Pharmacy Quality Assurance Commission is considering amending WAC 246-945-345 and potentially establishing a new section in chapter 246-945 WAC to clarify the expectation of pharmacies related to prescription transfers upon patient request. Other amendments to facilitate the timely transfer of prescription may also be considered.

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 Department of Health is considering changes to requirements for adult elective PCI programs in response to a rulemaking petition. The petition requests amendment of WAC 246-310-720(2), to eliminate the requirement that existing PCI programs in the planning area must meet the minimum volume standard before a new elective PCI program may be approved. The department will also consider amendments to other PCI rules, as part of this rule project.

The Board of Physical Therapy is considering amendments to update initial licensure and endorsement requirements in consideration of Second Substitute House Bill (2SHB) 1724, (chapter 425, Laws of 2023). The board will also consider making general updates to the licensing and endorsement process, examine the jurisprudence examination requirement, and review for housekeeping changes.

The Department of Health is considering establishing chapter 246-385 WAC as a new chapter of rules to set inspection and operational standards for private detention facilities, health and safety standards for detained persons, and issuance of civil penalties pursuant to Second Substitute House Bill 1470 (2SHB 1470), chapter 419, Laws of 2023.

Rescission of Policy Statement P004, Regulatory Standards Applicable to Remote Dispensing Sites. Filed February 8, 2024.

The pharmacy quality assurance commission (commission) is rescinding the policy statement Regulatory Standards Applicable to Remote Dispensing Sites, which was filed on July 2, 2020, and published as WSR 20-15-011.

The department of health is rescinding this policy statement because rulemaking was completed allowing a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications used for the treatment of opioid use disorder or its symptoms. The CR-103P was filed under WSR 24-01-098 and went into effect on January 18, 2024.

Individuals requiring information on this rule should contact Joshua Munroe, rules and legislative consultant, phone 360-502-5058, email PharmacyRules@doh.wa.gov. 

The Department of Health withdrew the CR-101 published as WSR 23-04-061 and the CR-102 published as WSR 23-23-186 for WAC 246-282-990, Shellfish fees, because the 2024 Legislature passed a budget proviso that gives the department funding to contract with an independent third-party consultant to study the commercial shellfish regulatory program and make recommendations on fees. The budget proviso prohibits the department from increasing commercial shellfish fees during fiscal year 2025. Filed as WSR 24-08-079 and WSR 24-08-079A.

The Department of Health rescinded the CR103E filed as WSR 24-07-062 amending behavioral health agency licensing and certification requirements because it was incomplete. The emergency rule was refiled correctly under WSR 24-07-100. Filed March 20, 2024.

The Department of Health is rescinded the CR-103E for the Sixth Emergency rule for proprietary treatment products and the use of substitution products under WAC 246-272A-0110, published as WSR 24-04-071 because a permanent rule WSR 24-06-046 filed on March 1, 2024 makes the emergency rule redundant.

Withdrawal of WSR 23-12-089, for chapter 246-562 WAC Physician Visa Waivers. The department is expanding the scope of the rule making project under a new CR-101.

This memo serves as notice that the Department of Health is withdrawing CR-101, filed January 8, 2021, published under WSR 21-03-011, and CR-102 filed on May 24, 2023, published under WSR 23-11-166. The department is withdrawing this CR-101 and CR-102 because the comments received from interested parties during the public comment process indicated substantial opposition to the rule as proposed.

As a result, the department will continue to use its existing authority and rules to determine the need for new trauma centers and the optimal distribution of trauma services to ensure equitable access to trauma care. Individuals requiring information on this rule should contact Anthony Partridge, Program Manager, at anthony.partridge@doh.wa.gov.

Rescission of interpretive statement NCIS2.00 for WAC 246-840-4659 because a permanent rule has been adopted in its place. The rule clarifies the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. Filed on January 31, 2024.

The board engaged in rulemaking to clarify the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. The proposed rule was adopted by the board in a rule hearing on May 12, 2023. The permanent rule was filed on June 29, 2023 as WSR 23-14-082.

The Emergency rule amending specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) has been rescinded with an effective date of November 4, 2023, because it has been replaced by permanent rules in chapter 246-841A WAC.

The board is rescinding this emergency rule which amended specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) effective November 4, 2023, because it is no longer necessary.

Rescission of Interpretive Statement BON 21-01, Continuing Education Pharmacology Documentation. Filed February 8, 2024.

The board is rescinding this interpretive statement because the board has adopted amendments to WAC 246-836-080 Continuing competency program, that clarify what forms of documentation are acceptable to verify meeting the pharmacology continuing education requirements. Thus, the interpretive statement is no longer necessary.

Individuals requiring information on this rule should contact Rachel Phipps, program manager, phone 564-233-1277, email naturopathy@doh.wa.gov.

This policy statement provided guidance to donor milk banks and insurance carriers consistent with RCW 43.70.645 until the department adopted permanent rules. The policy statement served as the milk bank safety standards established by the department for inpatient use for the purpose of RCW 43.70.645 and 48.43.815, clarified and added a definition addressing donor human milk obtained from a milk bank for the purposes of ensuring inclusion of donor milk provided by renumerated donors and ensuring inclusive language use.

The department is rescinding this policy statement because it is superseded by permanent rules that were adopted August 22, 2023, filed as WSR 23-17-149 with an effective date of September 22, 2023, making the policy statement obsolete.

Individuals requiring information on this should contact Me'kyel Bailey, lead policy advisor, email mekyel.bailey@doh.wa.gov, or phone 360-754-9161. Filed February 5, 2024.