Rule-Making Activity

The Washington State Department of Health (DOH) adopted amendments to WAC 246-290-100, water system plans, to add a climate resilience element to the water system plans as a requirement for public water systems with one thousand or more connections. The adopted amendments also make editorial changes.

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

naturopathy@doh.wa.gov

360-236-4941

Heather Cantrell

WA-DOH is proposing a new chapter of rule, chapter 246-837 WAC, Music Therapists, to implement Substitute House Bill 1247 (chapter 175, Laws of 2023), which creates the music therapist profession. WA-DOH is proposing to establish the education and training, examination and licensure requirements, continuing education, and fees. The proposed rules also implement other recently enacted legislation.

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. 
Page 2 of 3
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

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 Dental Quality Assurance Commission is considering amending WAC 246-187-190 to include a minimum age requirement for dental assistant registration.

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.

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.

The Department of Health is proposing health equity model rules for dental hygienists 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.

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 include 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 manifests 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. 

The Washington State Department of Health (DOH) adopted a new section of rule to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The adopted rule adds two hours of health equity education, as required in the model rules, to be completed as part of the current CE requirements every four years. The adopted 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.

The Dental Quality Assurance Commission (commission) is considering amending WAC 246-817-135 to remove requirements pertaining to federal or state tax numbers when applying for licensure without an examination. The commission is also considering amending WAC 246-817-160 to clarify clinical and didactic education and training requirements for foreign-trained dentists and graduates of non-accredited schools or programs.

The Dental Quality Assurance Commission adopted health equity continuing education requirements to meet the requirements of the Department of Health’s equity model rules, WAC 246-12-800 through 246-12-830. The amended rules add two hours of health equity education, to be completed as part of the current continuing education requirements every three years.

The Dental Quality Assurance Commission is proposing amending WAC 246-817-150 to remove specific references about granting licenses to University of Washington faculty and replacing this with a reference to a faculty of any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA).

The Dental Quality Assurance Commission is adopting amendments to update rules regarding out-of-state licensure in line with Senate Bill 5113 (chapter 89, Laws of 2023) to include any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA) for faculty licensure.

The Department of Health is considering establishing a new chapter of rules, chapter 246-819 WAC, for the dental therapist profession to implement Engrossed Substitute House Bill (ESHB) 1678 (Chapter 460, Laws of 2023).

The Board of Denturists (board) is considering updates to jurisprudence exam and examination requirements to reduce barriers for Denturists. The board is considering adopting substantial equivalency standard rules within WAC 246-812-120, WAC 246-812-125, WAC 246-812-159, and other rules to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023). 

The Board of Denturist adopted requirements in WAC 246-812-462 for the use of placement of prefabricated implant abutments. The adopted rule establishes the requirements that are to be followed for a licensed denturist to place a prefabricated implant abutment on an implant for the purpose of fabricating, repairing, relining, or rebasing a denture. The board also amended WAC 246-812-501 to ensure that a licensed denturist develop and maintain written infection control policies, procedures, and requirements for infection prevention and control that are appropriate for the denturist services provided by the facility.

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.

Interpretive Statement – Health Equity Continuing Education for Dental Hygienists, HSQA OHP DH2301

Health equity continuing education (CE) requirements for Dental Hygienists under chapter 246-815 WAC. Training requirements in WAC 246-12-800 through WAC 246-12-
830 will apply to a Dental Hygiene licensee starting January 1, 2024. Filed December 22, 2023.

Interpretive Statement – Health Equity Continuing Education for Licenses Behavior Analysts and Licensed Behavior Analysts, ABA 23-01

Health equity continuing education (CE) requirements for LBA’s and LABA’s under chapter 246-805 WAC. Training requirements in WAC 246-12-800 through WAC 246-12-830 will apply to a LBA and LABA licensee starting January 1, 2024. Filed December 22, 2023.

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 Department of Health is proposing amending, repealing, and creating new rule sections in chapter 246-822 WAC, Dietitians and Nutritionists, to clarify, streamline, update, and modernize rules for licensing dietitians and nutritionists.

The Washington State Department of Health (DOH) amended chapter 246-822 WAC to clarify, streamline, and modernize rules for dietitians and nutritionists. The adopted amendments include updated rules that align with national professional standards for dietitians, clear standards for education, experience, and supervision requirements, rules that reflect current department processes, the removal of redundant mandatory reporting language, and updates and cross references for clarification.

The Department of Health is proposing to clarify, streamline, update, and modernize rules for licensing dietitians and nutritionists in chapter 246-822 WAC. This is a supplemental proposal and includes an additional definition in WAC 246-822-010, clarification of application and education requirements for both dietitians and nutritionists, updates requirements for dietitian qualified supervisors, and removes unnecessary terms in rules regarding providing services.

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.

The Washington State Board of Health adopted an emergency rule on June 12, 2024, to amend WAC 246-290-315 regarding SALs and MCLs in order to maintain vital public health protections for drinking water safety. Along with the emergency rulemaking, the board will consider permanent rulemaking to amend the rule language to align with the emergency provision and explore other protections. 

The Washington State Department of Health (DOH) is proposing rule amendments to incorporate the federal requirements of the Bipartisan Infrastructure Law (BIL) – Public Law 117-58 – Bipartisan Infrastructure Investment and Jobs Act in chapter 246-296 WAC. The proposed rules redefine the definition of a disadvantaged community and change the state revolving fund priority point system for project rating and ranking proportionate with need.

Emergency Rule

The Washington State Department of Health (DOH) adopted rule amendments to incorporate the federal requirements of the Bipartisan Infrastructure Law (BIL) – Public Law 117-58 – Bipartisan Infrastructure Investment and Jobs Act. The adopted rules redefine the definition of a disadvantaged community and change the state revolving fund priority point system for project rating and ranking proportionate with need.

The department adopted emergency rules on August 30, 2023 (WSR# 23-18-044) and a second emergency rule December 29, 2023 (WSR# 24-02-060) 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 BIL. This emergency rule is being adopted to extend the existing emergency rule without making changes to the previous emergency rules.

The Pharmacy Quality Assurance Commission is proposing to amend WAC 246-945-455 to allow unlicensed employees or contractors of a health care facility to access certain drugs that are stored outside of the pharmacy in a designated area when they are acting within their scope of employment.

The Washington State Department of Health issued a policy statement regarding health requirements for hospitals providing emergency services to provide immediate access to abortion services or secure transfer to another hospital. Effective Date: June 17, 2024.

The Washington State Department of Health (DOH) updated and revised existing rules and added new sections to ensure regulations and standards are clear, concise, and reflect current standards of care and best practice for the benefit and safety of the public. This update will satisfy the requirements of RCW 43.70.041, enacted, and codified in 2013, which directs DOH to establish a formal review process of existing rules every five years.

The Department of Health is proposing amendments to update and align requirements with current national standards, make rules more clear, concise, and organized, propose changes to address barriers to initial and renewal application processes, and respond to new legislative requirements. WAC 246-976-010 through 246-976-182, 246-976-260 through 246-976-310, 246-976-330 through 246-976-395, 246-976-920, 246-976-960, 246-976-970 and proposing new WAC 246-976-026, 246-976-139, and 246-976-261.

The Department of Health is proposing amendments to existing sections and the addition of two new sections to chapter 246-976 WAC relating to EMS Data Systems reporting to the Washington EMS Information System (WEMSIS) system to meet the requirements of Section 19 of Substitute Senate Bill 5380 (chapter 314, Laws of 2019).

The Washington State Department of Health (DOH) adopted amendments to WAC 246-976-001, 246-976-430, and 246-976-910 and two new sections, WAC 246-976-445 and 246-976-455, to comply with Substitute Senate Bill 5380 (chapter 314, Laws of 2019). The adopted rules establish requirements for submitting patient data using the Washington EMS Information System (WEMSIS) and make housekeeping changes to implement these amendments.

This policy clarifies the Pharmacy Quality Assurance Commission’s renewal extension process for pharmacy interns who have reached the renewal limitation set in WAC 246-945-155(3). Policy number: P012. Effective Date: February 1, 2024.

The Department of Health is considering updates to rules regarding acute care and private psychiatric hospital fees to address funding needs under WAC 246-322-990. An update may be necessary to adequately fund the hospital inspection, investigation, and licensing programs to protect patients.

The Pharmacy Quality Assurance Commission is proposing to add a new subsection to WAC 246-945-055 to delete fenfluramine from Schedule IV in accordance with RCW 69.50.201. 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, 69.50.206, 69.50.208, 69.50.210, and 69.50.212, including fenfluramine.

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 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.