Rule-Making Activity

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.

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 adopted amendments to revise radiation protection standards, packaging, and transportation of radioactive material.  This rule is required to comply with RCW 70A.388.040, State Radiation Control Agency, and RCW 70A.388.110, Federal-state agreements.

The Department of Health adopted national standards sources of radionuclide emissions by reference. This rulemaking updates the reference to national standards for sources of radionuclide emissions federal regulations to the most recent version, adopted in 2023.

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 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 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.

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 Department of Health is Proposing amendments for substance use disorder and their trainees, to reduce barriers to certification. This includes removing the requirement to verify educational coursework for applicants with a national certification, making pharmacists eligible for the alternative training pathway in, and removing the obsolete AIDS training from the list of probationary license requirements.

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 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.

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.

The Pharmacy Quality Assurance Commission is considering creating a new section(s) in chapter 246-945 WAC related to the regulation of the practices of “white bagging” and “brown bagging” or any other transfer of a prescription or drug for the purpose of re-dispensing or subsequent administration to a patient. Concerns have been raised over ensuring the integrity and quality of these medications is maintained if such practices are used by prescribers, hospitals, or patients because these practices can create an unknown chain of custody.

The Chiropractic Quality Assurance Commission is adopting the Department of Health equity model rules to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The adopted rule establishes minimum standards for chiropractors of two hours of health equity continuing education (CE) every four years. The rule as adopted does not change the total number of CE hours but requires two hours in health equity CE every four years within the existing number of CE hours required.

The Board of Naturopathy is proposing amendments to ensure clear CE requirements including designation of pharmacology CE credits, classification of CE categories, and implementation of the health equity CE requirements, mandated by Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021).

The Chiropractic Quality Assurance Commission is proposing changes to rules concerning chiropractic X-Ray technicians' course requirements including who can instruct the course, and updating the requirements for obtaining, maintaining, and returning from expired status. The commission is also adopting health equity continuing education requirements to reflect requirements in Engrossed Substitute Senate Bill 5229 (ESSB) (chapter 276, Laws of 2021). WAC 246-808-201, 246-808-203, 246-808-205, 246-808-207, 246-808-209, WAC 246-808-211 and repealing 246-808-215. 

The Board of Hearing and Speech is proposing amendments to WAC 246-828-100 (Hearing instruments fitting and dispensing – Minimum standards of practice) to reflect changes to relevant federal rules by the Food and Drug Administration (FDA) regarding the sale of over-the-counter (OTC) hearing aids (21 C.F.R. Parts 800, 801, 808, and 874 (2022)).

The Dental Quality Assurance Commission is proposing amending WAC 246-246-817-440, Dental continuing education requirements, and WAC 246-817-445, Dental Anesthesia Assistant continuing education requirements, to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229.

The Board of Denturists (board) is proposing a new section of rule, WAC 246-812-462 - Prefabricated implant abutments, to set out the requirements for the placement of prefabricated implant abutments. The board is also proposing amending the infection control standards purpose statement in WAC 246-812-50 to ensure written policies and procedures are maintained.

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).

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 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.

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).

WAC 246-918-076 (Physician Assistants) and WAC 246-919-397 (Physicians), How to obtain a temporary practice permit—Military spouse. The Washington Medical Commission will consider amending these WACs in response to Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023), Military spouse employment act.

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 Podiatric Medical Board (board) is proposing amendments to WAC 246-922-300 and 246-922-310 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill 5229 (ESSB 5229).

The Examining Board of Psychology (board) proposes amending WAC 246-924-230 to establish health equity CE requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229 (Chapter 276, Laws of 2021). Additionally, the board is proposing amendments to WACs 246-924-240, 246-924-250, 246-924-255, 246-924-300, and 246-924-330. These amendments improve clarity and remove outdated language.

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.

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.

The Veterinary Board of Governors is considering updates and revisions to WAC 246-935-050 animal health care tasks, WAC 246-935-040 responsibilities of a Veterinarian supervising a licensed Veterinary Technician or unregistered assistant, WAC 246-935-010 definitions (Veterinary Technicians), and WAC 246-937-010 definitions (registered Veterinary Medication Clerks).

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.

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. 
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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

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.

Date of intended adoption: 9/20/23 (Note: This is NOT the effective date)
Submit written comments to: Assistance for persons with disabilities:
Name: Ted Dale Contact Ted Dale
Address: Office of Health Professions 
PO Box 47850
Olympia, WA 98504 
Phone: 360-236-2991
Email: https://fortress.wa.gov/doh/policyreview Fax: N/A
Fax: N/A TTY: 711
Page 2 of 4
Other: www.doh.wa.gov Email: ted.dale@doh.wa.gov
By (date) 9/13/23 Other: www.doh.wa.gov
By (date) 8/30/23 
Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12-800 through 246-12-830.
The department is proposing to amend WAC 246-810-027 and create new section WAC 246-810-0299 to implement ESSB 
5229. The department is proposing adopting the health equity model rules, WAC 246-12-800 through 246-12-830, for 
certified counselors and certified advisers to comply with RCW 43.70.613. 
The proposed rule adds two hours of health equity education, as required in the model rules, to be completed as part of the 
current continuing education requirements every four years. The proposed rule does not change 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.
Additionally, the department is proposing amendments to clarify and streamline WACs 246-810-027 and 246-810-0298.
These proposed amendments will remove unnecessary or outdated details about the required suicide prevention trainings.
Reasons supporting proposal: 
The goal of health equity CE is to equip health care workers with the skills to recognize and reduce health inequities in their 
daily work. The content of health equity trainings includes implicit bias trainings to identify strategies to reduce bias during
assessment and diagnosis in an effort to address structural factors, such as bias, racism, and poverty, that manifest as health 
inequities. 
Two hours of training allows individuals to gain a foundation in health equity that can have an immediate positive impact on 
the professional’s interaction with those receiving care. Health equity training enables health care professionals to care 
effectively for patients from diverse cultures, groups, and communities, varying race, ethnicity, gender identity, sexuality, 
religion, age, ability, socioeconomic status, and other categories of identity. The two hours of health equity CE credits may be 
earned as part of the health professional’s existing CE requirements, therefore not requiring completion of additional CE 
hours.
 
Statutory authority for adoption: RCW 43.70.613 and 18.19.050 
Statute being implemented: RCW 43.70.613, ESSB 5229 (chapter 276, Laws of 2021)

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:

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

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.

WAC 246-282-006, Washington state Vibrio parahaemolyticus control plan. Vibrio parahaemolyticus (Vp) is a naturally occurring bacteria found in marine waters. Molluscan bivalve shellfish acquire Vp through filter feeding. Humans who consume raw or undercooked shellfish containing Vp can develop an intestinal disease called vibriosis. Chapter 246-282 WAC establishes the minimum performance standards for growing, harvesting, processing, packing, storage, transporting, and selling of shellfish for human consumption.

These rules do not apply to persons who conduct activities limited to retail food service, personal use, and transporting as a common carrier of freight. WAC 246-282-006 establishes the control plan for the months of May 1st through September 30th and are an extension of the NSSP Model Ordinance (U.S. Food and Drug Administration National Shellfish Sanitation Program, Guide for the Control of Molluscan Shellfish). Due to current early season high temperatures, this emergency rule making is necessary to protect public health by modifying the existing strictest harvest control requirements which currently start July 1st by setting even more protective measures immediately.

The State Board of Health (board) filed a Preproposal Statement of Inquiry (CR-101) on February 23, 2022, WSR 22-06-034 regarding permanent amendments to the existing rules to address harvest control measures and may also include updating definitions, seed size and other technical and editorial changes as needed. Until permanent rule making can be completed, the board has delegated emergency rule making authority to the Department of Health if heat-wave conditions occur prior to July 1To reduce the threat to public health, amending the “time of harvest to cooling requirements” to a more protective control season immediately is necessary.

The current Vp Control Plan, last revised in 2015, establishes a control season between May 1st and September 30th and authorizes enforcement of the rule’s strictest time-to cooling requirements for harvested oysters starting July 1 of the Vp control season. However, recent events demonstrate the need for more flexible rules.

From June 26 to July 2, 2021, the National Weather Service in Seattle reported a long-duration, unprecedented heat wave throughout the Pacific Northwest. Shellfish-related Vp illnesses increased sharply. Therefore, due to current early season temperatures and mid-day low tides, this emergency rule is necessary to protect public health.

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.