Rule-Making Activity

WAC 246-980-100 (5)(c) requires that home care aide certification testing occur within two years of training. This emergency rule removes the two-year limit on the validity of training. These rules continue without change, emergency rules initially filed on October 17, 2022. Emergency rules are being continued while permanent rulemaking is in progress to consider training timelines for home care aides.

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, June 13, 2023 under WSR 23-13-068, October 12, 2023 under WSR 23-21-065, and February 7, 2024 under WSR 24-04-095. They are being continued while permanent rulemaking is in progress to consider training time lines for home care aides. The standards set in this emergency rule are the same as the current emergency rule.

Interpreting the requirements of RCW 70.41.420, which describes the establishment, composition, and responsibilities of hospital staffing committees. Interpretive Statement CHS-01-17-24. Effective Date: January 1, 2024

The Washington State Department of Health's interpretation of RCW 70.41.420, as it relates to the establishment, composition, and responsibilities of hospital staffing committees. Effective Date: June 21, 2024.

This memo serves as notice that the Department of Health is withdrawing CR-101, filed January 8, 2021, published under WSR 21-03-011, and CR-102 filed on May 24, 2023, published under WSR 23-11-166. The department is withdrawing this CR-101 and CR-102 because the comments received from interested parties during the public comment process indicated substantial opposition to the rule as proposed.

As a result, the department will continue to use its existing authority and rules to determine the need for new trauma centers and the optimal distribution of trauma services to ensure equitable access to trauma care. Individuals requiring information on this rule should contact Anthony Partridge, Program Manager, at anthony.partridge@doh.wa.gov.

Purpose: WAC 246-500-055. The State Board of Health (Board) adopted amendments to WAC 246-500-055 to clarify rule 
language in subsection (2)(f) and Table 500-A, and to correct a typographical error in subsection (2)(b) without changing the 
rule’s effect. Minimal housekeeping changes were also made to subsections (2)(c), (2)(d), and (4). WAC 246-500-055 
establishes the requirements that natural organic reduction facilities (NOR) must meet for this particular reduction method. 
These minor revisions were made to the rule based on feedback from interested parties and Board staff. The adopted rule is 
necessary to allow facilities to continue with their processes and ensure initial testing requirements described in the rule are 
clear. 
Citation of rules affected by this order:
New: None 
Repealed: None 
Amended: WAC 246-500-055 
Suspended: None 
Statutory authority for adoption: RCW 43.20.050(2)(f) 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-04-100 on January 31, 2023.
Describe any changes other than editing from proposed to adopted version: 
There have been no changes to the proposed rule language filed under WSR 23-04-100. 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by 
contacting: 
This rule was exempt from a cost-benefit analysis under 34.05.328(5)(b)(iv). The adopted amendment corrected 
typographical errors and clarified language in the rule without changing its effect. 

The Washington State Board of Nursing is proposing amendments to clarify specific licensing requirements for out-of-state Registered Nurse (RN) and Licensed Practical Nurse (LPN) applicants.

The Washington State Board of Nursing adopted amendments to WAC 246-840-030 and WAC 246-840-090 clarifying specific licensing requirements for out-of-state registered nurse and licensed practical nurse applicants.

The Washington State Department of Health (DOH) is proposing a rewrite and reorganization of chapter 246-562 WAC to clarify and update rules about J-1 physician visa waivers. 

Withdrawal of WSR 23-12-089, for chapter 246-562 WAC Physician Visa Waivers. The department is expanding the scope of the rule making project under a new CR-101.

The Department of Health is proposing a new section, WAC 246-310-825 kidney disease treatment centers — temporary emergency situation exemption, and amending existing kidney disease treatment center rules, WAC 246-310-800 through 246-310-833, to implement Substitute Senate Bill (SSB) 5569 (chapter 48, Laws of 2023).

The Washington State Department of Health (DOH) is considering amending chapter 246-272B WAC to add a penalty schedule for the issuance of civil penalties. RCW 70A.115.050 gives DOH the ability to assess a penalty of not more than ten thousand dollars per day for every violation of a law or rule regulating large onsite sewage systems. Rules that establish a penalty schedule will clarify DOH’s penalties based on the severity of the violation.

The Washington State Department of Health (DOH) adopted updated certification requirements to reduce barriers, clarify requirements, and update continuing health equity and AIDS continuing education and training requirements. Fees were added and updated to support the new rule changes.

Citation of rules affected by this order:

New: WACs 246-805-025, 246-805-110, 246-805-120, 246-805-130, 246-805-250, 246-805-325, 246-805-340, 246-805-401, 246-805-402, 246-805-510, and 246-805-520

Repealed: WAC 246-805-020

Amended: WACs 246-805-010, 246-805-100, 246-805-200, 246-805-220, 246-805-230, 246-805-240, 246-805-300, 246-805-310, 246-805-320, 246-805-330, 246-805-400, 246-805-410, and 246-805-990

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).

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.

The Washington State Department of Health (DOH) is considering adding new sections to and updating sections of chapter 246-926 WAC, Radiologic imaging professionals, to implement Substitute House Bill (SHB) 2355 (chapter 94, Laws of 2024), which establishes certification of MRI technologists. DOH will also consider minor housekeeping edits and or updates related specifically to establishing and regulating MRI technologists.

Purpose:Medical Assistants updated credentialing and licensure requirements in WAC 246-827-0010, 246-827-0110, 246-827-0120, 246-827-0140, 246-827-0200, 246-827-0300, 246-827-0400, and 246-827-0610. The Department of Health(department) is adopting revisions to medical assistant (MA) rules to remove outdated language, remove English languagerequirements, and update credentialing requirements. Outdated language includes removing language concerning theobsolete Health Care Assistant credential. Removing English requirements will remove unnecessary barriers for otherwisewell-qualified medical assistant staff to enter the workforce. RCW 18.360.010 was updated by House Bill (HB) 1378 (chapter44, Laws of 2021) to allow medical assistant supervision using audio and video technology during a telemedicine visit. Thedepartment is adding a new section to detail regulation for telemedicine supervision in response to HB 1378. Amendmentsremove irrelevant or confusing rule language, which will make the rules more easily understood. Updating credentialingrequirements to remove licensure barriers will allow experienced medical assistants to enter the Washington workforce.

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.

Shannon Angell

PO Box 47850 Olympia WA 98504-7850

360-236-2820

To align with federal rules, the Washington State Department of Health (DOH) removed the professions of naturopath licensed under chapter 18.36A RCW and midwife licensed under chapter 18.50 RCW from the list of licensed professionals that may perform a provider performed microscopic procedure (PPMP) in WAC 246-338-020. DOH clarified that both the laboratory director and testing personnel of PPMP must be licensed professionals. A technical citation amendment was also made to a definition in WAC 246-338-010.

Emergency Rule

To align with federal rules, the Department of Health (department) is proposing removing the professions of naturopath licensed under chapter 18.36A RCW and midwife licensed under chapter 18.50 RCW from the list of licensed professionals that may perform a provider performed microscopic procedure (PPMP) in WAC 246-338-020. The department is proposing to clarify that both the laboratory director and testing personnel of PPMP must be licensed professionals. The department is also proposing a technical citation adjustment to a definition in WAC 246-338-010. 

The Pharmacy Quality Assurance Commission and the Washington State Department of Health (DOH) are filing jointly to reinstate medication assistance rules as permitted under chapter 69.41 RCW by adopting new rules which extends emergency rules WSR 24-06-047 filed on March 1, 2024, without change. This rule establishes criteria for medication assistance in community-based and in-home care settings in accordance with chapter 69.41 RCW.

The Department of Health rescinded the CR103E filed as WSR 24-07-062 amending behavioral health agency licensing and certification requirements because it was incomplete. The emergency rule was refiled correctly under WSR 24-07-100. Filed March 20, 2024.

The Washington State Board of Nursing (WABON) rescinded emergency rules in WAC 246-840-030 and WAC 246-840-090 filed as WSR 24-10-096 which clarified licensing requirements for registered nurse (RN) and licensed practical nurse (LPN) out of state applicants because the amendments have been adopted in permanent rule, making the emergency rule unnecessary.

The Department of Health is rescinded the CR-103E for the Sixth Emergency rule for proprietary treatment products and the use of substitution products under WAC 246-272A-0110, published as WSR 24-04-071 because a permanent rule WSR 24-06-046 filed on March 1, 2024 makes the emergency rule redundant.

The Department of Health is continuing emergency rules that established licensure for mental health counselors, marriage and family therapists, and social workers. These emergency rules implement Section 7 of Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023), which was codified as RCW 18.225.180.

These rules continue without change the initial emergency rules filed on September 28, 2023 under WSR 23-20-055 and continued on January 26, 2024, under WSR 24-04-011. The department will continue these emergency rules until directory and supervision standards are adopted through the permanent rule making process. The department filed the Preproposal Statement of Inquiry (CR-101) to begin the permanent rule making on December 27, 2023 under WSR 24-02-038.

The Department of Health is considering rule amendments to reduce barriers to licensure and streamlining the credentialing process in chapter 246-809 WAC.

The Washington State Department of Health (DOH) is adopted emergency rules to meet the requirements of Second Substitute House Bill 1724 (chapter 425, Laws of 2023) and Engrossed Second Substitute House Bill 2247 (chapter 371, Laws of 2024). DOH will also consider adopting these changes through the permanent rulemaking process, under WSR 24-10-012, filed April 18, 2024. These emergency rules will be renewed while permanent rulemaking is in progress. 

Amending the definition of mental health professional and creating certified agency affiliated counselor and licensed agency affiliated counselor credentials. Amending WACs 246-341-0200 and 246-341-0515 in chapter 246-341 WAC, Behavioral Health Agency Licensing and Certification Requirements, and WACs 246-810-010, 246-810-015, and 246-810-990 in chapter 246-810 WAC, Counselors. 

Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) made several immediate changes impacting behavioral health agencies, including amending the definition of “mental health professional” (MHP) and creating two new agency affiliated counselor (AAC) credentials. Because 2SHB 1724’s amendments to the MHP definition and AAC credentials went into effect immediately and were designated as necessary for the immediate preservation of the public health, safety, or general welfare, the Department of Health (department) implemented these changes by emergency rule under WSR 23-16-031, filed on July 21, 2023.

This emergency rules continues without change the original emergency rule. The emergency rule:

• Amends chapter 246-341 WAC to address language that conflicts with 2SHB 1724, deleting an outdated definition of MHP requirements and updating an incorrect cross-reference.
• Amends chapter 246-810 WAC to expand existing language to establish two new credentials, the certified agency affiliated counselor (C-AAC) and the licensed agency affiliated counselor (L-AAC). The amendments align rule language with statute and revise the registered AAC fees to apply to all AAC types.

The emergency rules will be continued while permanent rule making is in progress under WSR 23-16-044, filed on July 25, 2023.

Reasons for this finding: The legislature established in 2SHB 1724, Section 33 that many sections of the bill are “necessary for the immediate preservation of the public peace, health, or support of the state government and its existing public institutions and take effect immediately.” Sections 13 through 20, which create the new AAC credentials and amends the definition of MHP, are among the sections that became effective immediately.

Under 2SHB 1724, RCW 71.05.020 was amended to define an MHP as an individual practicing within their credential’s scope of practice. Qualifying credentials include the certified and licensed AAC credential, but not the current AAC registration. Prior to the passage of 2SHB 1724, many MHPs performed assessments and made diagnoses with only a registration. After 2SHB 1724 became effective, however, they were required to obtain an AAC certification, AAC license, or other qualifying credential in order to continue providing these services. Establishing the new AAC credentials immediately by emergency rule and continuing these emergency rules allows MHPs to transition into the new credentials and continue providing essential behavioral health services while permanent rules are in progress.

If the department had waited to make these amendments through standard rule making, MHPs with an AAC registration would be both unable to continue assessing and diagnosing due to the changed MHP definition and unable to obtain a higher AAC credential that would allow them to continue that work. Continuing these emergency rules will allow MHPs who are AACs to continue serving Washington residents with behavioral health needs.

The Washington State Department of Health (DOH) issued interpretive statement EHS-01-2024 advising local health officers on the application of chapter 64.44 RCW when personal use of methamphetamine is suspected in transient accommodations. Effective June 1, 2024. Filed as WSR 24-12-032 on May 29, 2024.

The Department of Health (department) adopted amendments to chapter 246-834 WAC implementing Substitute Senate Bill (SSB) 5765 (chapter 289, Laws of 2022), which created two levels of limited prescriptive license extensions for midwives to prescribe, obtain, and administer medications and certain therapies. The department also adopted amendments to chapter 246-834 WAC to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021) regarding health equity CE requirements. The adopted amendments additionally replace gendered language with gender-neutral terms to make the chapter more inclusive.

The Department of Health (department) is proposing amendments to chapter 246-834 WAC to implement Substitute Senate Bill 5765 (chapter 289, Laws of 2022), which created two levels of limited prescriptive license extension for midwives to prescribe, obtain, and administer medications and therapies for the prevention and treatment of common prenatal and postpartum conditions, family planning methods, medical devices and implants. This bill also gave the Secretary of Health the authority to establish education requirements in the chapter. The department is also proposing amendments to implement Engrossed Substitute Senate Bill 5229 (chapter 276, Laws of 2021) regarding health equity continuing education requirements.

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 Department of Health is proposing amendments to WAC 246-12-051 to update language changes made by Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023). The proposed changes will align the rules with statutory changes regarding licensure of military spouses who hold a license in another state.

The Department of Health in consultation with the Washington State Board of Nursing (board), adopted amendments to WAC 246-840-990 to establish the multistate nursing license fee and increase the nursing center surcharge fee as directed by Substitute Senate Bill (SSB) 5499 (chapter 123, Laws of 2023).

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.

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 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.