Rule-Making Activity

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.

Postponing enforcement of data reporting requirements using the Washington Emergency Medical Services Information System (WEMSIS) for licensed ambulance and aid services (RCW 70.168.090, WAC 246-976-455).

Effective Date: September 30, 2024. Filed September 9, 2024, as WSR 24-19-030.

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 Washington State Department of Health (DOH) is proposing amendments to chapter 246-780 WAC to include requirements for the use of electronic benefit payments.

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.

The Washington State Department of Health (DOH) is proposing amendments to WAC 246-825-080 to remove barriers to entering and remaining in the health care workforce. The updates will streamline and shorten the credentialing process for genetic counselors. DOH is proposing to waive existing education and exam requirements

The Washington State Board of Nursing adopted amendments WAC 246-840-930 and WAC 246-840-940 and adopted new rules, WAC 246-840-835 and WAC 246-840-935, to change the amount of time required for RN supervision and evaluation of the delegated task of insulin injections as well as established new sections of rule regarding nurse delegation of blood glucose monitoring and testing, in response to Substitute House Bill (SHB) 1124 (chapter 14, Laws of 2022).

The State Board of Health adopted changes to WAC 245-500-050, WAC 246-500-053, and WAC 246-500-055 to align with changes in statute. These rules establish the requirements for remains reduced through cremation, alkaline hydrolysis, and natural organic reduction. The amendment also added counties to the list of entities that may lawfully dispose of human remains after the holding period.

The Board of Hearing and Speech is proposing new WAC 246-828-505 and amendments to WAC 246-828-510 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill 5229 (ESSB 5229 chapter 276, Laws 2021).

The Department of Health adopted amendments to WACs 246-810-027 and 246-810-0298 and creating a new section, WAC 246-810-0299, to establish two hours of health equity continuing education (CE) requirements every four years for certified counselors and certified advisers. The health equity CE requirement is counted under existing, unspecific CE requirements for the profession and does not change the total number of CE hours required. Additionally, clarify and streamline rule language without changing its effect.

The Washington State Board of Nursing (board) adopted health equity continuing education requirements in WAC 246-840-220 and WAC 246-840-222 to comply with RCW 43.70.613. The board’s adopted rule adds two hours of health equity education to be completed as part of the current continuing education requirements every year. This exceeds the two hours of health equity education to be completed every four years required in the Department of Health’s model rules. The proposed rule requires two hours in health equity CE every year which can be counted under existing CE requirements for the profession. 

The Board of Massage in coordination with the Department of Health adopted amendments to WAC 246-830-475. The adopted rule complies with the model rules and requires two hours of health equity education to be completed as part of the current continuing education requirements every two years.

The Department of Health adopted amendments to WAC 246-809-095, 246-809-110, 246-809-130, 246-809-210, 246-809-310, 246-809-320, 246-809-330, 246-809-610, 246-809-630, 246-809-632, 246-809-650, and 246-809-730 to establish two hours of health equity continuing education (CE) requirements every four years for substance use disorder professionals. The adopted rules do not change the total CE hours. The hours are counted under existing, unspecified CE requirements for the profession.

The Board of Optometry adopted WAC 246-851-225, a new section requiring two hours of health equity continuing education (CE) every four years for licensed optometrists. Health equity CE programs must meet the standards created in the Department of Health model rules in WAC 246-12-800 through 246-12-830. The adopted rule does not add to the total CE hours required to renew the license.

The Department of Health amended WAC 246-850-140 to adopt the health equity model rules, WAC 246-12-800 through 246-12-830, for orthotists and prosthetists to comply with RCW 43.70.613. WAC 246-850-140 was amended to include at minimum two hours of CE in health equity every four years for orthotists and prosthetists. The health equity CE requirement will be added to the existing number of CE hours required for orthotists and prosthetists without changing the existing total number of required CE hours. The health equity CE requirement is counted under existing, unspecified CE requirements for the profession.

The Board of Osteopathic Medicine and Surgery adopted a new rule, WAC 246-873-045, to establish health equity continuing education (CE) requirements. The adopted rules do not change the total CE hours. They require two hours in health equity CE every four years, which is absorbed into the existing number of required CE hours. The health equity CE requirement is counted under existing, unspecified CE requirements for the profession.

The Washington Medical Commission (commission) adopted health equity continuing education requirements in new sections, WAC 246-918-195 and WAC 246-919-445. The commission has adopted the Department of Health’s health equity model rules, WAC 246-12-800 through 246-12-830, to adopt rules requiring a licensee to complete health equity CE training at least once every four years. The adopted rule does not change the 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.

Department of Health adopted amendments to WAC 246-930-410 to establish health equity continuing education (CE) requirements. The adopted rule does not change the total CE hours required for SOTPs. It requires two hours in health equity CE every four years, which is absorbed into the existing number of CE hours required. Additionally, because an individual must hold an SOTP credential in addition to a credential for their primary health profession, the adopted rule does not require an SOTP to take an additional health equity CE training if they have already completed the training for their primary credential.

Describe any changes other than editing from proposed to adopted version: On its own initiative, the department has made minor edits to update formatting and increase clarity, including: (1) discontinuing the use of “and/or”; (2) removing bold formatting from rule text; (3) dividing subsection (4) into paragraphs for clarity; and (4) relocating a paragraph for greater visibility.
 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by contacting:

Lana Crawford 
P.O. Box 47852
Olympia, WA 98504-7852 

Phone: 564-669-1455 
TTY: 711

Email: Lana.Crawford@doh.wa.gov

The Department of Health adopted amendments to WAC 246-811-220, 246-811-240, and 246-811-280 and adopts a new rule section, WAC 246-811-290, to establish two hours of health equity continuing education (CE) requirements every four years for substance use disorder professionals. The adopted rules do not change the total CE hours. The hours are counted under existing, unspecified CE requirements for the profession. Additionally, the department adopts minor amendments to update and clarify rule language.

The Board of Hearing and Speech is considering amendments to WAC 246-828-020, WAC 246-828-510, and WAC 246-828-617 to update requirements for speech-language pathology assistant certification. The board may also consider making related updates or new sections to clarify and streamline licensure in chapter 246-828 WAC.

The Department of Health continues rules to establish alternate certification time frames for individuals working toward certification as a home care aide or nursing assistant. This emergency rule continues the previous emergency rule (WSR 24-02-051) without change. Due to lasting impacts caused by the coronavirus disease 2019 (COVID-19) pandemic, many long-term care workers are still unable to obtain training and certification as home care aides or NA-Cs within statutory time frames.

The Washington State Department of Health (DOH) has adopted a sixth emergency rule to continue without change rules established alternate certification time frames for two different groups of long-term care workers: individuals working toward certification as a home care aide and individuals working toward certification as an NA-C. This includes amending WAC 246-980-025, 246-980-030, 246-980-040, 246-980-065 and adopting a new rule section, WAC 246-980-011. Rules impacting home care aides were developed in collaboration with the Department of Social and Health Services (DSHS), while rules impacting NA-Cs were developed in collaboration with DSHS and the Washington State Board of Nursing (WABON).

The Washington State Department of Health (DOH) adopted rules to implement legislation to increase the home care aide workforce in Chapter 246-980 WAC to align with statutory changes and implement Engrossed Second Substitute House Bill (E2SHB) 1694(chapter 424, Laws of 2023) and Engrossed Second Substitute Senate Bill (E2SSB) 5278 (chapter 323, Laws of 2023). These rules address the date of hire, the home care aide workforce, certification examinations, certification process, and other aspects of the profession. 

The Department of Health is considering amending chapter 246-980 WAC to implement Engrossed Second Substitute House Bill 1694, (chapter 424, Laws of 2023) and Engrossed Second Substitute Senate Bill 5278, (chapter 323, Laws of 2023). These laws reduce barriers to hire home care aides.

Emergency Rule

The Pharmacy Quality Assurance Commission is proposing to amend WAC 246-945-090, 246-945-091, 246-945-092, and 246-945-093 to include manufacturers and wholesalers of dialysis devices and approved legend drugs, including dialysate, in home dialysis program rules under the commission’s jurisdiction. The amendments are proposed in response to statutory changes made by Substitute House Bill (SHB) 1675 (chapter 23, Laws of 2022). 

The Washington State Department of Health (DOH) is considering establishing standards for hospital at-home services to implement Substitute House Bill (SHB) 2295 (chapter 259, Laws of 2024). DOH is considering amending chapter 246-320 WAC to add hospital at-home services as a type of service that can be offered by hospitals, establish standards, and consider creating a fee to cover costs.

The Washington State Department of Health (DOH) is considering amendments to the accounting and reporting manual requirements for the uniform, hospital financial reporting system in Chapter 246-454 WAC to implement requirements in Engrossed Second Substitute House Bill (E2SHB)1272 (chapter 162, Laws of 2021) and additional sections to update language that contains references to Chapter 246-454 WAC.

The Washington State Department of Health (DOH) is proposing amendments to chapter 246-454 WAC to simplify existing rules regarding the uniform system for hospitals for accounting, financial reporting, budgeting, and cost allocation. Also proposed are amendments to update outdated language within chapter 246-454 WAC, and two sections of Hospitals-Assessments and Related Reports, WAC 246-451-010 and 246-451-050.

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 Pharmacy Quality Assurance Commission adopted revisions to WAC 246-945-010, 246-945-013, 246-945-030, 246-945-550, and 246-945-565 to update various references incorporated throughout the rules. The new section adopted as WAC 246-945-034 incorporates updates to FDA drug classifications. When effective, the amendments to WAC 246-945-030 and adoption of WAC 246-945-034 will supersede emergency rules filed as WSR 24-16-085 on August 1, 2024.

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.