Rule-Making Activity

The Department of Health in consultation with the Board of Nursing, formerly known as the Nursing Care Quality Assurance Commission, is proposing to increase the nursing center surcharge fee and proposing to create a new fee for a multistate nursing license in WAC 246-840-990. The proposed rule implements Substitute Senate Bill (SSB) 5499, Multistate Nurse Licensure Compact (Chapter 123, Laws of 2023).

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.

The Washington State Department of Health (DOH) adopted rules necessary to create a licensure program for music therapists. Individuals working as a music therapist are required to be licensed by January 1, 2025. The adopted rules establish the new profession’s licensure requirements which include education, training, and examination requirements for initial licensure; continuing education requirements; fees for licensing, examination, and renewal; and other qualifications as determined by the secretary.

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.

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 Naturopathy is considering amendments to licensure requirements relating to the jurisprudence examination as a condition for licensure and to clarify, update, and simplify rules to comply with Second Substitute House bill (2SHB) 1724, (chapter 425, Laws of 2023) codified as RCW 18.130.077.

The Board of Naturopathy has adopted amendments to WAC 246-836-020, Requirements for licensure, and WAC 246-836-040, Jurisprudence examinations to clarify, update, and simplify rules to align with RCW 18.130.077. To account for changes to the credentialing system the board is delaying the effective date to September 1, 2025.

The Board of Naturopathy adopted new rules that identify Botulinum Toxin (Botox) as a legend approved drug, clarify procedures that are within the scope of practice of naturopathic medicine, set training requirements, and establish minimum standards for the performance of nonsurgical cosmetic procedures by naturopathic physicians licensed in Washington state. The adopted rules also amend WAC 246-836-210 by removing the current exclusion for the use of Botox for cosmetic purposes.

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 Board of Naturopathy adopted amendments to WAC 246-836-080, to clarify continuing education (CE) requirements pertaining to pharmacology CE and to implement health equity CE requirements mandated by Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021), codified as RCW 43.70.613. The adopted amendments clarify acceptable forms of documentation to verify the pharmacology CE requirements and implement the Department of Health’s model health equity CE requirements.

The Board of Naturopathy is proposing amendments to licensure requirements in WAC 246-836-020 and WAC 246-836-040 relating to jurisprudence examinations as a condition for licensure for naturopathic physicians and to clarify, update, and simplify rules to comply with RCW 18.130.077.

The Washington Medical Commission is considering amending WAC 246-919-601 to exempt the use of nitrous oxide in office-based surgical settings under certain circumstances. Additionally, the commission is considering adding a new subsection to further address the use of nitrous oxide in such settings.

The State Board of Health (SBOH) is considering amending the reporting requirements for COVID-19 in chapter 246-101 WAC, in response to feedback from local health jurisdictions and changes in the national notifiable condition designation by the Council for State and Territorial Epidemiologists. SBOH will not consider other changes to these rules at this time.

Kaitlyn Dohahoe
360-236-4205

The Washington State Board of Nursing (board) is considering amendments to education and experience requirements in WAC 246-840-517 and other related sections in chapter 246-840 WAC for nurse administrators of baccalaureate nursing education programs in response to E2SSB 5582 (Chapter 126, Laws of 2023) codified as RCW 18.79.150.

Shad Bell

360-236-4711

Shad Bell
360-236-4711

The Board of Nursing is considering amendments to nursing assistant rules to implement skills testing in training programs, make changes to the specialty curricula rule requirements, and other related rules as appropriate.

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 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 Washington State Board of Nursing withdrew the CR-101 for nursing assistant skills testing, chapter 246-841A WAC, which was filed on September 27, 2024, and published as WSR 24-20-087. The board withdrew this CR-101 because its scope is limited to integrating skills testing to nursing assistant training programs. However, additional critical topics must be addressed, including changes to the specialty curricula rule requirements in WAC 246-841A-440(1)(c). 

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.

Shad Bell
360-236-4711

Shad Bell

Jessilyn Dagum

The Washington State Board of Nursing is proposing a new section of rule, WAC 246-840-5341, and amendments to WAC 246-840-534 to implement Engrossed Second Substitute Senate Bill (E2SSB) 5582 (chapter 126, Laws of 2023).

The Washington State Board of Nursing adopted a new section of rule, WAC 246-840-5341 to establish the requirements for use of simulation-based learning experiences as a substitute for required clinical and direct patient care experiences in licensed practical nurse (LPN), registered nurse (RN), or RN to Bachelor of Science in Nursing (BSN) education programs. The board also adopted amendments to the current simulation rule, WAC 246-840-534, to clarify the use of simulation at a 1:1 ratio.

Shad Bell

360-236-4711

The Washington State Department of Health (DOH) in consultation with the Washington State Board of Nursing, permanently adopted amendments to WAC 246-840-990 to make a housekeeping change to correct fee total amounts. There is no change to the fees being charged. The changes only correct a technical error in the total lines. 

The Washington State Department of Health (DOH), in consultation with the Washington State Board of Nursing, is proposing amendments to WAC 246-840-990 to make a housekeeping change to correct fee total amounts.

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.

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.

The Department of Health (department) is proposing to establish a retired active fee for the nursing home administrator license in WAC 246-843-990.

Rescission of interpretive statement NCIS2.00 for WAC 246-840-4659 because a permanent rule has been adopted in its place. The rule clarifies the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. Filed on January 31, 2024.

The board engaged in rulemaking to clarify the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. The proposed rule was adopted by the board in a rule hearing on May 12, 2023. The permanent rule was filed on June 29, 2023 as WSR 23-14-082.

The Washington State Department of Health (DOH) issued a policy statement providing clarity about the reporting requirements outlined in Substitute Senate Bill 5547, Nursing Pool Transparency. Effective Date: June 12, 2024.

Filed on August 1, 2024.

The Washington State Board of Nursing adopted rules amending WAC 246-840-750 through 246-840-780 and adding WAC 246-840-790 to establish new definitions, update existing terms, and add application requirements for a stipend for the substance use disorder monitoring program for nursing professionals in response to Substitute House Bill 1255 (chapter 141, Laws of 2023) codified in RCW 18.79.440.

The Washington State Board of Nursing adopted rules amending WAC 246-840-750 through 246-840-780 and adding WAC 246-840-790 to establish new definitions, update existing terms, and add application requirements for a stipend for the substance use disorder monitoring program for nursing professionals in response to Substitute House Bill 1255 (chapter 141, Laws of 2023) codified in RCW 18.79.440.

Shad Bell
360-236-4711

Shad Bell
360-236-4711

The Occupational Therapy Practice Board (board) adopted rule amendments to implement legislation to reduce barriers to entering and remaining in the occupational therapy workforce. Additionally, the board updated the continuing education requirements to align with national standards and the code of ethics requirements for consistency and clarity in occupational therapy services.

Purpose: WAC 246-847-991 Occupational therapy licensure compact (compact) privilege fees and renewal cycle. The Department of Health (department) is adopting a new section of rule, WAC 246-847-991, to implement Senate Bill (SB) 5518 (Chapter 152, Laws of 2022), which creates a new interstate licensure compact for occupational therapy and gives member states the discretion to charge a fee for granting compact privileges. The department is adopting a new rule to specify the compact fees and renewal cycle.

The Occupational Therapy Practice Board and the Washington State Department of Health adopted amendments to the temporary permit and fee rules in response to legislation.

The Occupational Therapy Practice Board and Washington State Department of Health (DOH) jointly are proposing rule amendments to WAC 246-847-117 to reduce barriers for military spouses holding a temporary practice permit while entering and remaining in the occupational therapy workforce. Additionally, amendments are proposed to WAC 246-847-990 to create a new fee to cover the cost of the temporary permit.

The Occupational Therapy Practice Board and the Department of Health are considering amending rules and establishing fees for temporary practice permits in response to the Washington Military Spouse Employment Act.

The Occupational Therapy Practice Board is proposing rule amendments to reduce barriers to entering and remaining in the occupational therapy workforce and to streamline and shorten the credentialing process. The board is proposing revisions to WAC 246-847-051, 246-847-068, 246-847-070, 246-847-080, 246-847-125, and adding a new section, 246-847-127. Additionally, the proposal amends WAC 246-847-065 to adjust continuing education requirements so they align with the national certifying board and WAC 246-847-170 to ensure care is provided ethically and professionally.

The Department of Health is considering adopting a new chapter to Title 246 that establishes general administrative procedures and fees for non-potable water systems.

The Washington Medical Commission is proposing amendments to the commission’s opioid prescribing rules for allopathic physicians and physician assistants to exclude patients with sickle cell disease, to clarify tapering considerations, and to clarify the use of biological specimen testing. Amending WAC 246-918-801, WAC 246-918-870, WAC 246-918-900, WAC 246-919-851, WAC 246-919-920, and WAC 246-919-950.

This is a supplemental notice. The first CR-102 was filed March 30, 2024, as WSR 24-07-106.

The Washington State Department of Health (DOH) in consultation with the Dental Quality Assurance Commission added facility types to the list of opioid prescribing exclusions for dentists. Amendments to WAC 246-817-905 expand the types of patients who are exempt from opioid prescribing rules.