Rule-Making Activity

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.

The Washington State Board of Nursing (board) is considering amendments to WAC 246-840-015 through WAC 246-840-260 to clarify and update outdated language, rewrite and reformat existing rules to reflect current best practices, and restructure sections as necessary. This rulemaking is Phase 1 of the board’s formal review process. The board will consider additional topics to reduce barriers and simplify regulations for multistate licensure applicants, reduce barriers for applicants educated outside the United States, and explore limiting NCLEX attempts before remediation. The board also plans to address impacts from upcoming proposals from bills passed in the 2025 Legislative Session.

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.

Effective November 11, 2024, rescission of WSR 24-16-085, CR-103E, emergency rules for naloxone nasal spray as over-the-counter status, WAC 246-945-030 and 246-945-034. The commission is rescinding these emergency rules because permanent rulemaking has been completed to update these rules. The permanent rule was filed as WSR 24-21-069 on October 11, 2024, and becomes effective November 11, 2024. Memo to rescind emergency rule filed as WSR 24-21-081.

The Department of Health is rescinding this policy statement because the content was permanently incorporated into WAC 246-828-100 as published in WSR 24-01-087 on December 18, 2023. The policy statement is no longer needed. Filed April 23, 2024.

The Washington State Department of Health (department), Health Systems Quality Assurance Division, Office of Community Health Systems, Emergency Medical Services (EMS) Section is rescinding Policy Number EMS 20-01 | EMS Providers and Emergency Vaccinations, which was filed October 23, 2020, and published in WSR 20-22-030.

The policy is being rescinded because it is no longer needed. The department adopted permanent rules under WSR 24-15-104 on July 22, 2024, for chapter 246-976 WAC Emergency Medical Services and Trauma Care Systems. The rules became effective on September 30, 2024.

Filed January 9, 2025, as WSR 25-03-048.

The Washington State Department of Health (the department), Health Systems Quality Assurance Division, Office of Community Health Systems, Emergency Medical Services (EMS) Section is rescinding Policy Number EMS 21-01 | EMS Providers and Emergency Administration of Monoclonal Antibodies, which was filed December 7, 2021, and published in WSR 22-01-043.

The policy is being rescinded because it is no longer needed. The department adopted permanent rules under WSR 24-15-104 on July 22, 2024, for chapter 246-976 WAC Emergency Medical Services and Trauma Care Systems. The rules became effective on September 30, 2024. The amendments to the rule and updates to the scope of practice include requirements for EMS providers listed in the policy statement to administer monoclonal antibodies.

Filed January 9, 2025, as WSR 25-03-047.

This statement allowed currently operating organ transport services and organ transport vehicles in Washington state to continue operating while permanent rules were in development to implement the department’s licensing requirements under Substitute House Bill (SHB) 1271, chapter 290, Laws of 2023.

This policy is being rescinded because the department officially filed a CR-103P in WSR 24-17-005 on August 8, 2024, for chapter 246-976 WAC Organ transport service and vehicle license. The rules became effective on September 30, 2024, therefore the policy statement is no longer needed. Organ transport vehicle and service license requirements are established in WAC 246-976-360.

Filed December 20, 2024 as WSR 25-02-058.

This policy statement provided guidance to donor milk banks and insurance carriers consistent with RCW 43.70.645 until the department adopted permanent rules. The policy statement served as the milk bank safety standards established by the department for inpatient use for the purpose of RCW 43.70.645 and 48.43.815, clarified and added a definition addressing donor human milk obtained from a milk bank for the purposes of ensuring inclusion of donor milk provided by renumerated donors and ensuring inclusive language use.

The department is rescinding this policy statement because it is superseded by permanent rules that were adopted August 22, 2023, filed as WSR 23-17-149 with an effective date of September 22, 2023, making the policy statement obsolete.

Individuals requiring information on this should contact Me'kyel Bailey, lead policy advisor, email mekyel.bailey@doh.wa.gov, or phone 360-754-9161. Filed February 5, 2024.

The Washington Medical Commission is rescinding this policy statement because the state of Washington became the first state to enact ESSB 5481, the Uniform Telemedicine Act, and this statute just recently went into effect on June 6, 2024. As such, the commission’s Telemedicine policy, POL2021-02, became superseded by statutory law. Filed December 20, 2024.

The Washington State Department of Health (DOH) is considering amendments to RTF regulations in WAC 246-337-010 and WAC 246-337-990 along with private psychiatric hospital regulations in WAC 246-322-020 and WAC 246-322-990 to implement Substitute House Bill (SHB) 2075 (chapter 204, Laws of 2024). SHB 2075 directs DOH to issue RTF and private psychiatric hospital licenses to Indian health care providers by July 1, 2025, if the provider submits a tribal attestation and an attestation processing fee. Amendments may include other necessary changes to licensing regulations in chapters 246-322 and 246-337 WAC. DOH may also consider amending the Behavioral Health Agency (BHA) regulations in WAC 246-341-0367 regarding tribal attestation fees to align with RTF and private psychiatric hospital tribal attestation fees.

The Washington State Department of Health (DOH) is proposing a new rule in chapter 246-337 WAC and a new rule in chapter 246-322 WAC to establish fees necessary to receive and process an attestation that a tribal residential treatment facility or tribal private psychiatric hospital meets state minimum standards for licensure. The proposed rule also amends WAC 246-337-010 to clarify that the licensure process described in each section does not apply to tribes seeking licensure via attestation. Finally, DOH is proposing to update WAC 246-341-0367 regarding BHA tribal attestation fees to align with the proposed RTF and private psychiatric hospital tribal attestation fees.

The Washington State Department of Health (DOH) and Pharmacy Quality Assurance Commission is proposing housekeeping amendments to the following WAC sections to fix incorrect references: WAC 246-320-211 pharmaceutical services for Hospital licensing regulations; WAC 246-330-200 pharmaceutical services for ambulatory surgical facilities; WAC 246-335-310 definition; WAC 246-335-722 pharmaceutical services; WAC 246-335-738 pharmaceutical services area sections for In-home services agencies; and WAC 246-337-105 medication management for residential treatment facilities. 

The Washington State Department of Health (DOH) is proposing rule amendments to reduce barriers to entering and remaining in the respiratory care practitioner (RCP) workforce and to streamline and shorten the credentialing process. This will also include amendments to the temporary permit rules to reduce barriers for military spouses entering and remaining in the RCP workforce and proposed amendments to WAC 246-928-560, 246-928-570, and adding a new section, WAC 246-928-575, for applicants with a current national certification.

The Department of Health is considering amending requirements for respiratory care practitioner application, examination licensure, and out of state credentialing and temporary practice permits.

The Washington State Department of Health (DOH) amended WAC 246-928-560 and adopted a new section, WAC 246-928-575, for applicants with a current national certification to align licensure and endorsement requirements with recent legislation. The rules reduce barriers to entering and remaining in the respiratory care practitioner workforce and reduce barriers for military spouses entering and remaining in the workforce.

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.

Jocelyn W. Jones
360-236-3020

Stuart Glasoe
360-236-4111

Peter Beaton
 

The Washington State Department of Health (DOH) is proposing to amend WAC 246-282-005(1)(a) to adopt by reference the 2023 version of the National Shellfish Sanitation Program’s (NSSP) Guide for the Control of Molluscan Shellfish (guide). This rulemaking is necessary to update the publication date of the NSSP guide adopted by reference from 2019 to the 2023 version.

The Washington State Department of Health (DOH) amended WAC 246-282-005(1)(a) to adopt by reference the 2023 version of the National Shellfish Sanitation Program’s Guide for the Control of Molluscan Shellfish to ensure that the most current health and safety requirements are in rule as required by the statute.

The Washington State Board of Health (Board) is considering adding Guanidinoacetate methyltransferase deficiency (GAMT) and Arginase 1 deficiency (ARG1-D) to the list of mandatory conditions for newborn screening conducted by the Department of Health (Department).

The Board has the authority under RCW 70.83.050 to define and adopt rules for screening Washington-born infants for hereditary conditions. WAC 246-650-010 defines the conditions, and WAC 246-650-020 lists the conditions for which all Washington-born newborns are to be screened. GAMT deficiency and ARG1-D are rare inherited metabolic conditions that can result in severe disability and in some cases death if not detected and treated early. Early diagnosis of GAMT deficiency and ARG1-D through newborn screening is essential to save lives and to improve the quality of life for impacted infants and their families.

To be added to the listserv for notifications regarding this rulemaking, email Molly.Dinardo@sboh.wa.gov with the subject line "Newborn Screening – GAMT & ARG1-D."

Stuart Glasoe
 

The State Board of Health changed to the effective date of the Environmental Health and Safety Standards for Primary and Secondary Schools, for one year due to legislative direction in the supplemental state operating budget Engrossed Substitute Senate Bill (ESSB) 5187 prohibiting implementation until the legislature acts to formally fund implementation of the standards. The effective date of the rules is now September 1, 2025.

The Washington State Department of Health (DOH) is proposing to create a new chapter of rule that establishes radiation safety standards for the use of ionizing radiation for security purposes, while making every reasonable effort to maintain exposures to radiation as low as reasonably achievable to protect public health and safety. 

The Washington State Department of Health (DOH) adopted a new chapter of rules, chapter 246-230 WAC, that establishes radiation safety standards for the use of ionizing radiation for security purposes, while making every reasonable effort to maintain exposures to radiation as low as reasonably achievable to protect public health and safety.

The Department of Health (department) is considering amending chapter 246-790 WAC to increase flexibility in allowed vendor types and update program requirements for vendors. The department is also considering amendments to the Participant Compliance rules to reflect virtual service options.

WSBOH@sboh.wa.gov

Samantha Pskowski
360-789-2358
 

The Washington State Board of Health is considering amending the auditory screening sections of chapter 246-760 WAC, Auditory and Visual Standards – School Districts, to align with current national evidence-based practices and assess potential options regarding whether to include otoacoustic emission (OAE) screening technology in the Board’s rules. The Board may also consider other technical or editorial changes as needed.

The State Board of Health is proposing amending WAC 245-500-050, WAC 246-500-053, and WAC 246-500-055 to align with changes in Substitute House Bill 1974 (chapter 57, Laws of 2024), codified in RCW 68.50.230. These rules establish the requirements for remains reduced through cremation, alkaline hydrolysis, and natural organic reduction.

The State Board of Health is proposing amendments to address changes to existing requirements, including requirements governing local management plans, repairs, registration of proprietary treatment products, minimum lot sizes, treatment levels, and licensing of operations and maintenance providers. The proposed rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues. The proposed rule also makes several editorial updates to improve clarity and repeals obsolete rules.

The State Board of Health has adopted amendments to chapter 246-272A WAC to implement changes to existing requirements. The adopted rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues and makes clarification updates. 

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.

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.

The Washington State Board of Nursing proposes amendments and an addition to rules relating to the board’s substance use disorder (SUD) monitoring program in response to Substitute House Bill (SHB) 1255 (chapter 141, Laws of 2023) including application requirements for a stipend.

The Department of Health is considering updates to chapter 246-811 WAC to lower barriers to entering and remaining in the SUDP workforce and to streamline and shorten the credentialing process.