Rule-Making Activity

The Washington Medical Commission is extending its emergency rule that amends WAC 246-919-330 to eliminate the outdated requirement for consecutive years of training in no more than two programs.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.

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.

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 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.

This emergency rule temporarily removes the requirement for home care aide applicants to become certified within two years of completing training. These rules continue emergency rules initially filed on October 17, 2022, under WSR 22-21-102 and continued on February 14, 2023, under WSR 23-05-083 and on June 13, 2023, under WSR 23-13-068. They are being continued while permanent rulemaking is in progress to consider training timelines for home care aides.

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 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.

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.

Second Substitute House Bill 1724 (chapter 425, Laws of 2023) made several immediate changes impacting behavioral health agencies, including amending the definition of “mental health professional” (MHP) and to establish two new credentials, the certified agency affiliated counselor (C-AAC) and the licensed agency affiliated counselor (L-AAC). This emergency rule continues without changes to the original emergency rule package while permanent rule making is in progress.

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.

To combat the ongoing opioid epidemic, The Pharmacy Quality Assurance Commission has adopted an emergency rule amending WAC 246-945-030 and adding a new section, WAC 246-945-034. These rules classify the 3mg and 4mg naloxone hydrochloride nasal spray as approved by the FDA for OTC distribution in Washington state. This filing reflects an FDA update which broadened the classification of allowed Naloxone products as OTC status. Filed as WSR 24-01-021 (PDF).

In March 2023, the United States Food and Drug Administration (FDA) approved the first 4 mg naloxone hydrochloride nasal spray as an over-the-counter (OTC) drug and has approved other naloxone nasal sprays since that time. Naloxone is an opioid antagonist used for the emergency treatment of known or suspected opioid overdose. Currently, WAC 246-945-030 incorporates the 39th edition of the Approved Drug Products with Therapeutic Equivalence Evaluations, or "Orange Book," which has naloxone listed as a prescription drug. The Pharmacy Quality Assurance Commission (commission) considers the ongoing opioid epidemic to be a public health emergency in Washington state. In order to combat this epidemic in Washington, the commission is amending WAC 246-945-030 and adding a new section, WAC 246-945-034, classifying the 3mg and 4mg naloxone hydrochloride nasal spray as approved by the FDA for OTC distribution as an OTC drug in Washington state.

The timeline for the availability of naloxone nasal spray is set by the manufacturers, although some are already available.

This emergency rule prepares Washington state for the moment that the drug becomes available by manufacturers. The proposed new section of chapter 246-945 WAC would also allow for expansion of different formularies if the FDA makes further changes. This preparation would allow for a faster release of the drug throughout the state, meaning this life saving drug would be in the hands of Washingtonians faster. Increasing patient access to the drug is critical to reduce opioid overdoses.

This emergency rule filing allows for the 3mg and 4mg dosage versions of naloxone spray to be prescribed as over-the-counter products. The previous emergency rule filing on this topic, filed as WSR 23-17-059 on August 11, 2023, only allowed the 4 mg nasal spray under the brand name Narcan to be prescribed as an OTC product, but the FDA broadened the classification of allowed naloxone products since that previous filing.

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.

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.

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.

Amelia Boyd

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.

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 Department of Health is considering requiring acute care hospitals to report hospital maintenance and operation data to the department through the Washington Healthcare Emergency and Logistics Tracking Hub (WA HEALTH), a statewide data management system. The department will also consider requiring behavioral health agencies and facilities to report hospital maintenance and operation data to the department through WA HEALTH.

The Board of Osteopathic Medicine and Surgery is considering amendments to update the examination requirements for licensure of osteopathic physicians in response to Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) and to reduce potentially unnecessary licensure barriers.

2SHB 1724 requires regulatory authorities to review licensure standards for health professionals in other states to determine substantial equivalency to Washington licensure standards in order to streamline and expedite credentialing processes. In response to this requirement, and to reduce potentially unnecessary licensure barriers, the board is considering amendments to the osteopathic physician examination requirements.

Shad Bell

360-236-4711

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 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 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.

Shad Bell
360-236-4711

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.

John Hilger
360-236-2929

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.

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 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.

Shad Bell
360-236-4711

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.

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 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.