Rule-Making Activity

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.

Interpretive Statement – Health Equity Continuing Education for Licenses Behavior Analysts and Licensed Behavior Analysts, ABA 23-01

Health equity continuing education (CE) requirements for LBA’s and LABA’s under chapter 246-805 WAC. Training requirements in WAC 246-12-800 through WAC 246-12-830 will apply to a LBA and LABA licensee starting January 1, 2024. Filed December 22, 2023.

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.

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 Department of Health is proposing amending, repealing, and creating new rule sections in chapter 246-822 WAC, Dietitians and Nutritionists, to clarify, streamline, update, and modernize rules for licensing dietitians and nutritionists.

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.

Emergency Rule

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 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 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).

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 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.

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 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 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 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 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 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 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 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 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 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 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.

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 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.

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 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.

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 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 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.

Emergency Rule

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

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.

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. 

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.

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 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 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.

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.