Rule-Making Activity

The Department of Health is considering a chapter review to reorganize sections and amend rules regarding J-1 Physician Visa waivers. The department is exploring updates to help meet the greatest needs across Washington State. The department will also look for increased clarity in the organizational structure, application criteria, and requirements for letters of support.

Amelia Boyd

PO Box 47866 Olympia, WA 98504-7866

360-918-6336

amelia.boyd@wmc.wa.gov

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. 

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).

The Podiatric Medical Board is considering updates to reduce licensure barriers for podiatric physician and surgeons and amending reciprocity requirements in WAC 246-922-055 to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) codified at RCW 18.130.077.

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).

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

Email:  podiatric@doh.wa.gov

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.

Policy Statement CHS-04-08-24: The Washington State Department of Health (DOH) issued a policy statement on enforcement discretion of certain requirements in chapter 246-341 WAC applicable to Opioid Treatment Program licensing and certification. Filed as WSR 24-12-021 on May 24, 2024.

The Washington Medical Commission has adopted amendments to WAC 246-919-330 to eliminate the outdated requirement for consecutive years of training in no more than two programs. This change removes a barrier for qualified applicants to obtain licensure. This permanent rule will supersede the emergency rule filed on March 8, 2024, as WSR 24-07-019.

The Washington Medical Commission has adopted amendments to WAC 246-919-330 to eliminate the outdated requirement for consecutive years of training in no more than two programs. This change removes a barrier for qualified applicants to obtain licensure. This permanent rule will supersede the emergency rule filed on March 8, 2024, as WSR 24-07-019.

The Pharmacy Quality Assurance Commission is proposing amendments to WAC 246-945-015 and adding four new sections to chapter 246-945 WAC establishing prescription label accessibility standards to ensure meaningful access to prescription information for patients with visual impairments or print disabilities, and for limited English Proficient patients.

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.

Clarifying terms and information about prescription history for the PMP. The Department of Health (department) is considering clarifying that prescribers can request the history of prescriptions they have written. The department is considering changes to WAC 246-470- 010, 246-470-030, and 246-470-050 and potentially other related sections in chapter 246-470 WAC to help clarify rules including terms and definitions relating to the Prescription Monitoring Program.

The Washington State Department of Health (DOH) is proposing updates to WAC 246-470-010, 246-470-030, and 246-470-050 to add definitions and language consistency, and to clarify prescribers’ ability to request their prescribing history.

The Washington State Department of Health (DOH) adopted clarifying terms and added definitions of "delivery," "dispense," and "ultimate user." DOH also adopted language to clarify a prescriber’s ability to request the history of prescriptions the prescribers have written to decrease confusion regarding requirements of dispensers and prescribers.

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-345 and potentially establishing a new section in chapter 246-945 WAC to clarify the expectation of pharmacies related to prescription transfers upon patient request. Other amendments to facilitate the timely transfer of prescription may also be considered.

The Pharmacy Quality Assurance Commission is proposing to amend WAC 246-945-345 and add a new section, WAC 246-945-346 to establish the expectations of pharmacies related to noncontrolled and controlled substance prescription transfers upon patient request.

The State Board of Health (board) is considering creating a new chapter (chapter 246-370 WAC) of draft rules for school environmental health and safety. The board will consider establishing minimum statewide health and safety standards for schools, formalizing school environmental health and safety inspection procedures, and repealing chapters 246-366 and 246-366A WAC.

The Department of Health is considering establishing chapter 246-385 WAC as a new chapter of rules to set inspection and operational standards for private detention facilities, health and safety standards for detained persons, and issuance of civil penalties pursuant to Second Substitute House Bill 1470 (2SHB 1470), chapter 419, Laws of 2023.

The Washington State Department of Health (DOH) is proposing to add NSF/ANSI 40 testing to WAC 246-272A-0110.

The Examining Board of Psychology is adopting emergency rules to amend WACs 246-924-010, 246-924-046, 246-924-053, 246-924-095, and 246-924-100, establish 246-924-048 and 246-924-0481, and repeal 246-924-047 in chapter 246-924 WAC to implement parts of 2SHB 1724 (chapter 425, Laws of 2023). These emergency rules continue emergency rules initially filed on June 18, 2024, under WSR 24-14-079. The rules also incorporate an additional amendment, reducing the minimum amount of direct, face-to-face individual supervision from 2 hours per 20 hours of pre-internship experience to 1 hour per 20 hours. These emergency rules will be continued while permanent rules filed under WSR 24-11-005 on May 2, 2024, are in progress.

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.

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 Examining Board of Psychology is considering amending, repealing, and creating new sections in chapter 246-924 WAC. Rule amendments will be considered to implement recent legislation to reduce barriers to entering and remaining in the behavioral health care workforce; streamline and shorten the credentialing process; establish a psychological associate license; amend the licensure process for experienced psychologists licensed outside of Washington.

Additionally, this rulemaking project will continue work started under WSR 23-06-041, under which the board began considering amendments related to licensure requirements, changes to the national examination, supervision requirements, the role of technology and telepsychology in the profession, and additional options for sanctions.

The Washington State Department of Health (DOH) is considering creating a new chapter within Title 246 WAC regarding public records. DOH is considering amending and relocating its existing public records rules in chapter 246-08 WAC and adopting new rules as necessary. Changes under consideration are a result of changes in statutes, changes in internal operations, staffing reorganization, and an effort to provide clear, concise, and reasonable rules.

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 (department) is adopting an increase in fees to cover the costs of operating the Radiation Machine Facility Program. The department is also adopting changes to machine categories within the fee schedule to allow the department to better track and manage X-ray machines across Washington. This will allow the department to be more efficient in regulatory and inspection processes.

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 is considering amending radioactive material licenses and licensee's fees to cover operating costs for the following: Small business discount provision and optional fee payment schedule applicable to radioactive materials licensees; Fees for specialized radioactive material licenses; Fees for medical and veterinary radioactive material use Fees for industrial radioactive material licenses; Fees for laboratory radioactive material licenses; and Fees for licensing and compliance actions.

The Washington State Department of Health (DOH) is proposing a 31% fee increase for radioactive materials licenses to cover operating costs but not proposing any new license categories. DOH is proposing to remove the 50% discount for additional sites and the 25% small business discount because they are unfunded. 

The Washington State Department of Health (DOH) adopted increases in radioactive material licensing fees in chapter 246-254 WAC to cover operating costs for: small business discount provision and optional fee payment schedule applicable to radioactive materials licensees; specialized radioactive material licenses; medical and veterinary radioactive material use; industrial radioactive material licenses; laboratory radioactive materials licenses; and licensing and compliance actions. When adopted rules increase the fees 31% across all of the licenses, do not add any new license categories, removes the 50% discount for additional sites, and removes the 25% small business discount.

The Department of Health adopted amendments to chapter 246-926 WAC to clarify, streamline, and modernize the regulations of cardiovascular invasive specialists, diagnostic radiologic technologists, therapeutic radiologic technologists, nuclear medicine technologists, radiologist assistants, and x-ray technicians. This includes removing outdated provisions, updating outdated terms and citations, clarifying credentialing and competency requirements, clarifying allowable duties for radiological technologists and x-ray technicians, repealing, and adding new sections of rule, and renaming the chapter to better reflect all types of professions credentialed under the chapter. The adopted rules establish enforceable licensing requirements and safety mechanisms for patients receiving imaging services.

The Washington State Department of Health (DOH) updated the federal regulations publication date from 2023 to the most recently adopted 2024 version previously adopted by reference. This amendment makes no changes to any requirements previously adopted but is required for DOH to receive delegation of the Radionuclide Air Emissions Program from the U.S. Environmental Protection Agency.

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.

Nina D. Helpling

Department of Health

PO Box 47820 Olympia, WA 98504-7820

radruleupdates@doh.wa.gov

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 Washington State Department of Health (DOH) is proposing an amendment to the federal rule publication date to conform to adopt national standards in WAC 246-247-035 for U.S. Environmental Protection Agency (EPA) requirements for radionuclide emissions.

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 Washington State Board of Nursing is proposing new sections of rule, WAC 246-840-835 and 246-840-935, and amendments to WAC 246-840-930 and 246-840-940 to implement Substitute House Bill (SHB) 1124 (chapter 14, Laws of 2022) to expand the delegation of glucose monitoring and testing to all settings where Nursing Assistant -Registered and Nursing Assistant-Certified individuals work. Additionally, the board is proposing changes to supervision and valuation timeframes to align with SHB 1124.

Substitute Senate Bill (SSB) 6086, passed in 2020, allows a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications for the treatment of Opioid Use Disorder (OUD) or its symptoms. The Pharmacy Quality Assurance Commission adopted rules that establish the minimum standards for OUD medication remote dispensing sites. Adopted rules reflect standards, restrictions and requirements set in statute.

The minimum standards must address who may access medications at the remote dispensing site pursuant to a valid prescription or chart order. The minimum standards must also require that the pharmacy is responsible for stocking and maintaining a perpetual inventory of the OUD medications stored in or at the remote dispensing site (referred to as the “supplying pharmacy” in the rule language).

Current rules in chapter 246-945 WAC cover requirements for drugs stored outside of a pharmacy but restrict their location to a facility that is otherwise able to store and possess drugs (i.e., a licensed pharmaceutical firm). The adopted rule, WAC 246-945-457, is necessary to establish enforceable minimum standards as directed by SSB 6086 for OUD medication remote dispensing sites. As the statute specifically requires rulemaking, no other alternatives were considered.

Effective Date of Rule: May 7, 2023.

Purpose: WAC 246-840-365 Inactive and reactivating an ARNP license and 246-840-367 Expired license. The nursing care quality assurance commission (commission) is adopting amendments to WAC 246-840-365 and 246-840-367 to remove nonevidence-based licensure requirements for inactive and reactivating advanced registered nurse practitioner (ARNP) licenses.

Amendments to WAC 246-840-365 and 246-840-367 are currently enacted under emergency rule, and the commission is adopting the amendments into permanent rule. The requirements include completion of 250 hours of advanced clinical practice for each designation within the past two years. If the ARNP has not satisfied the advanced clinical practice requirements, the requirements include completion of at least 250 hours of supervised advanced clinical practice hours and the need to obtain an interim permit to complete the practice hours.

For ARNPs whose license has been expired for less than two years, the rule removes the requirement for ARNPs who do not meet required advanced clinical practice requirements to complete 250 hours of supervised advanced clinical practice for every two years the ARNP has been out of practice and the need to obtain an interim permit to complete the practice hours.

Housekeeping amendments remove "of chapter 246-12 WAC, Part 2" in subsection (1)(a) and replaces [it] with "for initial and renewal credentialing of practitioners as identified under WAC 246-12-020 through 246-12-051[.]"

The commission is adopting amendments to current rules identified as barriers to the provision of services both in emergency response and during regular operations.

Citation of Rules Affected by this Order: Amending WAC 246-840-365 and 246-840-367.

Statutory Authority for Adoption: RCW 18.79.010, 18.79.110, and 18.79.250.

Adopted under notice filed as WSR 23-01-134 on December 20, 2022.

A final cost-benefit analysis is available by contacting Jessilyn Dagum, P.O. Box 47865, Olympia, WA 98504-7864 [7865], phone 360-236-3538, fax 360-236-4738, TTY 711, email ncqac.rules@doh.wa.gov, website www.nursing.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: January 27, 2023.

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 Pharmacy Quality Assurance Commission is proposing to add a new subsection to WAC 246-945-055 to utilize the commission’s authority, to delete substances designated as a Schedule IV controlled substance. The commission is also proposing to create a new section, WAC 246-945-05001, to establish a list of exempted substances from RCW 69.50.204, RCW 69.50.206, RCW 69.50.208, RCW 69.50.210, and RCW 69.50.212, including fenfluramine.

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.

Effective August 9, 2024, the Washington State Department of Health is rescinding emergency rules which suspend the requirement for home care aides to complete testing within two years of training (filed as WSR 24-13-001 on June 5, 2024). The emergency rules are being rescinded because permanent rules filed as WSR 24-15-025 supersede the emergency rule.

The Washington State Department of Health (DOH) rescinded the Interpretive Statement titled Health Equity Continuing Education for Midwives, HSQA OHP MW01, which was filed December 22, 2023, and published in WSR 24-02-024. WA-DOH is rescinding this interpretive statement because it was permanently incorporated into WAC 246-834-355 as published in WSR 24-10-091 filed April 30.

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 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.