Rule-Making Activity

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.

Nina D. Helpling

Department of Health

PO Box 47820 Olympia, WA 98504-7820

radruleupdates@doh.wa.gov

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.

Eric Hernandez
360-236-2956

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Repealed: None 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 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.

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.

Shad Bell

The Board of Nursing is adopting a new chapter and amendments which represent a collaboration between the Board of Nursing and the Department of Health to address necessary changes in the nursing assistant rules and to consolidate, renumber, eliminate redundancy, and consolidate to address necessary changes in the nursing assistant rules. 246-841 WAC, 246-842 WAC, 246-841A WAC.

Emergency Rule

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.

Shannon Angell

PO Box 47850 Olympia WA 98504-7850

360-236-2820

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).

Kaitlyn Dohahoe
360-236-4205

Heather Cantrell

Agency:Department of Health - Board of Physical Therapy 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.
☐ Other (specify) (If less than 31 days after filing, a specific finding under RCW 34.05.380(3) is required and should 
be stated below)
Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☐ Yes ☒ No If Yes, explain: 
Purpose: Changing English test passing scores and removing a requirement related to an accredited program for licensure 
as a physical therapist. The Board of Physical Therapy (board) is adopting amendments to WAC 246-915-120 – Foreign 
educated applicants to change the Test of English as a Foreign Language (TOEFL) minimum passing scores. Washington 
state’s current passing score requirements were originally established based on the Federation of State Boards of Physical 
Therapy (FSBPT) passing score recommendation. The FSBPT’s minimum passing score recommendations have since been 
updated. To align with the FSBPT’s recommendation, the board is adopting this rule to lower the minimum passing score for 
the writing and speaking tests and raise the minimum passing score requirements for the reading and listening tests. The 
board is also adopting amendments to remove the requirement that an applicant’s first professional degree must only be from 
a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited program, in order to allow applicants who 
went on to pursue additional professional degrees in physical therapy through a CAPTE accredited program to pursue 
licensure outside of the foreign-educated pathway. 
Citation of rules affected by this order:
New: None 
Repealed: None 
Amended: WAC 246-915-120 
Suspended: None 
Statutory authority for adoption: RCW 18.74.023 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-08-031 on March 28 2023 (date).
Describe any changes other than editing from proposed to adopted version: None. 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by 
contacting:
Name: Allyson McIver 
Address: PO Box 47877 Olympia, WA 98504-7877 
Phone: 360-236-2878 
Fax: 360-236-2901 
TTY: 711 
Email: physical.therapy@doh.wa.gov 
Web site: doh.wa.gov 
Other:

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 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.

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.

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. 

Shad Bell
360-236-4711

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

naturopathy@doh.wa.gov

360-236-4941

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.

The Board of Osteopathic Medicine and Surgery and the Department of Health are removing references to Osteopathic Physician Assistants by adopting changes to WAC 246-853-290, 246-853-300, 246-853-630, 246-853-640, 246-853-662, 246-853-750, and 246-853-990. The adopted amendments will remove obsolete language and align the rules with recent statute changes.

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 Veterinary Board of Governors is adopting an amendment to WAC 246-935-060 Eligibility for examination as a veterinary technician, to clarify that a registered apprenticeship program is an approved post-secondary educational pathway to qualify for licensure exams as a veterinary technician.

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.

THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Joshua Munroe, Pharmacy Quality Assurance Commission, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2987, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY January 3, 2023.

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.

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.

Stuart Glasoe
 

Jessilyn Dagum

Agency: Department of Health 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.

Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☒ No
Purpose: The Department of Health (department) adopts revisions to the Death with Dignity Act requirements in chapter 
246-978 WAC that reflect (1) the amendments made during the 2023 legislative session and (2) the writing style described in 
the 2023 Bill Drafting Guide.
Engrossed Substitute Senate Bill (ESSB) 5179 did the following:
• In RCW 70.245.010, made changes to multiple definitions.
o “Attending physician” became “attending qualified medical provider”.
o “Consulting physician” became “consulting qualified medical provider”.
o Added independent clinical social worker, advanced social worker, mental health counselor, psychiatric 
advanced registered nurse practitioner to the “counseling” definition.
o Removed the definition of “physician”.
o Added a definition of “qualified medical provider” that includes physician, physician assistant, and advanced 
registered nurse practitioner.
• Changed the terms used throughout chapter 70.245 RCW to match the terms defined in RCW 70.245.010.
• In RCW 70.245.030, removed the long-term care facility witness requirement in subsection (4).
• In RCW 70.245.150, expanded how participating providers may send forms to the department. Now the department 
can accept forms electronically and by fax.
WAC 246-978-010 duplicates the definitions in statute, which means that the department must update definitions every time 
the legislature changes the definitions. The department adopts replacement of duplicate definitions with a cross-reference to 
statute and removal of definitions no longer in use.
WAC 246-978-020 describes how participating providers must report to the department as required by RCW 70.245.150(2). 
The department adopts three changes:
• Replacing “physician” with “qualified medical provider”.
• Replacing the mailing address with “electronically, by mail, or fax”.
• Removing the publication number after the form name.
WAC 246-978-030 duplicates language in RCW 70.245.150(2). The department repeals WAC 246-978-030 to remove the 
duplication and prevent potential conflicts between statute and rule.
WAC 246-978-040 describes who can be a witness for a patient living in a long-term care facility. ESSB 5179 repealed the 
witness requirement for a long-term care facility described in RCW 70.245.030(4). The department repeals WAC 246-978-
040 because statute no longer requires it.
The department also adopts style changes throughout chapter 246-978 WAC that do not change the meaning of the rule. 
Page 2 of 3
Citation of rules affected by this order:
New: 
Repealed: WAC 246-978-030; WAC 246-978-040 
Amended: WAC 246-978-010; WAC 246-978-020 
Suspended: 
Statutory authority for adoption: ESSB 5179 (Chapter 38, Laws of 2023); Chapter 70.245 RCW 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-12-093 on June 06, 2023 (date).
Describe any changes other than editing from proposed to adopted version: None

RCW 70.114A.065 directs the Department of Health (DOH) and the Department of Labor and Industries (L&I) to adopt joint rules for the licensing, operation, and inspection of temporary worker housing. DOH and L&I have assessed the emergency rule requirements, along with input from interested parties and adopted key provisions to address prevention of future outbreaks and the spread of any airborne infectious disease.

The Pharmacy Quality Assurance Commission has adopted 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>. This will capture the revisions to the USP <795> and <797>, which have been made official since WAC 246-945-100 became effective on July 1, 2020.

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.

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

Email:  podiatric@doh.wa.gov

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.