Rule-Making Activity

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

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 Department of Health are filing jointly to reinstate medication assistance rules which establish criteria for medication assistance in community-based and in-home care settings in WACs 246-945-710, 246-945-712, 246-945-714, 246-945-716, 246-945-718, 246-945-720, 246-945-722, 246- 945-724, 246-945-726, and 246-945-728. This adopted emergency rule will extend WSR 23-23-032 filed on November 3, 2023, without change. 

The Department of Health rescinded the CR103E filed as WSR 24-07-062 amending behavioral health agency licensing and certification requirements because it was incomplete.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The Department of Health is rescinded the CR-103E for the Sixth Emergency rule for proprietary treatment products and the use of substitution products under WAC 246-272A-0110, published as WSR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. 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 amending, repealing, or creating new sections in chapter 246-809 WAC, to establish: a directory to help mental health counselor, marriage and family therapist, and social worker associates find supervisors; minimum standards for supervision of associates; and a stipend program to offset some costs of supervision for associates.

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 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 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.

Kaitlyn Dohahoe
360-236-4205

Shad Bell

360-236-4711

Shad Bell
360-236-4711

Amending specific training requirements for Nursing Assistant Registered (NAR) and Home Care Aides (HCA) in WAC 246-840-930 and 246-841-405.  This is the sixth emergency rule and continues the initial emergency rules filed.

The Board of Nursing is adopting a new chapter and amendments which represent a collaboration between the Board of Nursing and the Department of Health to address necessary changes in the nursing assistant rules and to consolidate, renumber, eliminate redundancy, and consolidate to address necessary changes in the nursing assistant rules. 246-841 WAC, 246-842 WAC, 246-841A WAC.

Amending specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) in WAC 246-841-420, 246-841-470, 246-841-490, 246-841-500, 246-841-510 and 246-841-555. This is the 11th emergency rule. The amendments remain the same as the previous filing. Emergency rules allow additional pathways to complete necessary training to enter the workforce.

Shad Bell
360-236-4711

Shad Bell

Jessilyn Dagum

Shad Bell

360-236-4711

The Department of Health adopted a retired active fee for the nursing home administrator license. Concurrently, the Board of Nursing Home Administrators adopted a retired active status to allow an individual to practice in emergent or intermittent circumstances and pay a reduced renewal fee. This will allow individuals to fill in at nursing homes that need a temporary administrator while recruiting a new administrator to assist in emergency circumstances such as a pandemic.

The Board of Nursing Home Administrators adopted rule amendments and a new rule to expand and clarify licensure requirement for licensure and temporary practice permits by correcting and updating continuing education requirements, language and citations, and correcting a typographical error. The rule no longer requires HIV/AIDS education. The rules add health equity continuing education.

The Department of Health (department) is proposing to establish a retired active fee for the nursing home administrator license in WAC 246-843-990.

Rescission of interpretive statement NCIS2.00 for WAC 246-840-4659 because a permanent rule has been adopted in its place. The rule clarifies the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. Filed on January 31, 2024.

The board engaged in rulemaking to clarify the application of the advanced practice pain management rules in nursing homes and long-term acute care hospitals and incorporated the interpretive statement into permanent rule. The proposed rule was adopted by the board in a rule hearing on May 12, 2023. The permanent rule was filed on June 29, 2023 as WSR 23-14-082.

Shad Bell
360-236-4711

Shad Bell
360-236-4711

Purpose: WAC 246-847-991 Occupational therapy licensure compact (compact) privilege fees and renewal cycle. The Department of Health (department) is adopting a new section of rule, WAC 246-847-991, to implement Senate Bill (SB) 5518 (Chapter 152, Laws of 2022), which creates a new interstate licensure compact for occupational therapy and gives member states the discretion to charge a fee for granting compact privileges. The department is adopting a new rule to specify the compact fees and renewal cycle.

The Occupational Therapy Practice Board and the Department of Health are considering amending rules and establishing fees for temporary practice permits in response to the Washington Military Spouse Employment Act.

The Washington Medical Commission is proposing amendments to the commission’s opioid prescribing rules for allopathic physicians and physician assistants to exclude patients with sickle cell disease, to clarify tapering considerations, and to clarify the use of biological specimen testing. Amending WAC 246-918-801, WAC 246-918-870, WAC 246-918-900, WAC 246-919-851, WAC 246-919-920, and WAC 246-919-950.

The Board of Optometry adopted changes to WAC 246-851-090 and WAC 246-851-125 through 246-851-230 related to CE requirements for licensed optometrists. Adopted amendments include online continuing education, new definitions, limits on types and categories of CE hours, reference to other required trainings, CE documentation requirements, clarifying self-study requirements, and certain allowances during a declared state of emergency.

The Board of Optometry is considering amendments to optometrist continuing education and examination requirements in WAC 246-851-090 through 246-851-230 and WAC 246-851-490 to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) and to consider increasing the number of allowable online credits.

Purpose: Provides prescribing requirement exemptions in specific circumstances. WAC 246-853-661, Exclusions. The Board of Osteopathic Medicine and Surgery (board) is adopting amendments to expand the types of patients who are exempt from opioid prescribing rules. The adopted language aligns with the Washington Medical Commission's recently adopted rules to ensure consistency and alignment with best practices.

The Board of Osteopathic Medicine and Surgery is considering amending WAC 246-853-080 to update the continuing education (CE) requirements for licensure renewal of osteopathic physicians to clarify Washington-specific mandated CE requirements.

The Board of Osteopathic Medicine and Surgery is considering amendments to update the examination requirements for licensure of osteopathic physicians in response to Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023) and to reduce potentially unnecessary licensure barriers.

2SHB 1724 requires regulatory authorities to review licensure standards for health professionals in other states to determine substantial equivalency to Washington licensure standards in order to streamline and expedite credentialing processes. In response to this requirement, and to reduce potentially unnecessary licensure barriers, the board is considering amendments to the osteopathic physician examination requirements.

The Board of Osteopathic Medicine and Surgery is considering amending WAC 246-853-661 Exclusions, WAC 246-853-730 Periodic review, and WAC 246-853-755 Tapering requirements, to modernize the language, add clarity, and align rules with the Washington Medical Commission (WMC).