Rule-Making Activity

The Department of Health is rescinded the CR-103E for the Sixth Emergency rule for proprietary treatment products and the use of substitution products under WAC 246-272A-0110, published as WSR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.

The Department of Health rescinded the CR103E filed as WSR 24-07-062 amending behavioral health agency licensing and certification requirements because it was incomplete.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 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. 

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. 

Emergency Rule

Shannon Angell

PO Box 47850 Olympia WA 98504-7850

360-236-2820

The Department of Health is considering adding a new section of rule to address the medication administration requirements for the medical assistant-registered credential to align with recent legislation and considering updating the medical assistant-certified training and certification requirements to expand the types of apprenticeship programs accepted to meet the training requirements to allow experienced medical assistants to enter the Washington workforce more easily. Engrossed Substitute House Bill (ESHB) 1073 (Chapter 134, Laws of 2023). WAC 246-827-0010, 246-827-0200, and 246-827-0240, new section WAC 246-827-0340.

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 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, 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 Department of Health is proposing a new section, WAC 246-310-825 kidney disease treatment centers — temporary emergency situation exemption, and amending existing kidney disease treatment center rules, WAC 246-310-800 through 246-310-833, to implement Substitute Senate Bill (SSB) 5569 (chapter 48, Laws of 2023).

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.

The Washington State Board of Nursing adopted amendments to WAC 246-840-030 and WAC 246-840-090 clarifying specific licensing requirements for out-of-state registered nurse and licensed practical nurse applicants.

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.

Purpose: WAC 246-500-055. The State Board of Health (Board) adopted amendments to WAC 246-500-055 to clarify rule 
language in subsection (2)(f) and Table 500-A, and to correct a typographical error in subsection (2)(b) without changing the 
rule’s effect. Minimal housekeeping changes were also made to subsections (2)(c), (2)(d), and (4). WAC 246-500-055 
establishes the requirements that natural organic reduction facilities (NOR) must meet for this particular reduction method. 
These minor revisions were made to the rule based on feedback from interested parties and Board staff. The adopted rule is 
necessary to allow facilities to continue with their processes and ensure initial testing requirements described in the rule are 
clear. 
Citation of rules affected by this order:
New: None 
Repealed: None 
Amended: WAC 246-500-055 
Suspended: None 
Statutory authority for adoption: RCW 43.20.050(2)(f) 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-04-100 on January 31, 2023.
Describe any changes other than editing from proposed to adopted version: 
There have been no changes to the proposed rule language filed under WSR 23-04-100. 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by 
contacting: 
This rule was exempt from a cost-benefit analysis under 34.05.328(5)(b)(iv). The adopted amendment corrected 
typographical errors and clarified language in the rule without changing its effect. 

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.

Interpreting the requirements of RCW 70.41.420, which describes the establishment, composition, and responsibilities of hospital staffing committees. Interpretive Statement CHS-01-17-24. Effective Date: January 1, 2024

Emergency Rule

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 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 continues rules to establish alternate certification time frames for individuals working toward certification as a home care aide or nursing assistant. This emergency rule continues the previous emergency rule (WSR 24-02-051) without change. Due to lasting impacts caused by the coronavirus disease 2019 (COVID-19) pandemic, many long-term care workers are still unable to obtain training and certification as home care aides or NA-Cs within statutory time frames.

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.

The Department of Health adopted amendments to WAC 246-811-220, 246-811-240, and 246-811-280 and adopts a new rule section, WAC 246-811-290, 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. Additionally, the department adopts minor amendments to update and clarify rule language.

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

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.

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.

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.

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.

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.

The Board of Massage in coordination with the Department of Health adopted amendments to WAC 246-830-475. The adopted rule complies with the model rules and requires two hours of health equity education to be completed as part of the current continuing education requirements every two years.

The Washington State Board of Nursing (board) adopted health equity continuing education requirements in WAC 246-840-220 and WAC 246-840-222 to comply with RCW 43.70.613. The board’s adopted rule adds two hours of health equity education to be completed as part of the current continuing education requirements every year. This exceeds the two hours of health equity education to be completed every four years required in the Department of Health’s model rules. The proposed rule requires two hours in health equity CE every year which can be counted under existing CE requirements for the profession. 

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 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 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.

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 Department of Health is considering updates to rules regarding acute care and private psychiatric hospital fees to address funding needs under WAC 246-322-990. An update may be necessary to adequately fund the hospital inspection, investigation, and licensing programs to protect patients.

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 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 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 department adopted emergency rules on August 30, 2023 (WSR# 23-18-044) and a second emergency rule December 29, 2023 (WSR# 24-02-060) 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 BIL. This emergency rule is being adopted to extend the existing emergency rule without making changes to the previous emergency rules.