Rule-Making Activity

The Washington State Department of Health (DOH) withdrew a CR101 impacting chapter 246-827 WAC; CR-101 titled “Medical Assistants— Various Provisions” filed October 3, 2023, published as WSR 23-20-118. DOH filed a new CR101 to accommodate Engrossed Substitute Senate Bill (ESSB) 5983 (chapter 248, Laws of 2024) which impacts the same sections of rule. 

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The Department of Health rescinded the CR103E filed as WSR 24-07-062 amending behavioral health agency licensing and certification requirements because it was incomplete.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The Washington State Board of Nursing (WABON) rescinded emergency rules in WAC 246-840-030 and WAC 246-840-090 filed as WSR 24-10-096 which clarified licensing requirements for registered nurse (RN) and licensed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. 

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 Washington Medical Commission is amending WAC 246-918-076 (physician assistants) and WAC 246-919-397 (physicians) to align with the provisions of the Military Spouse Employment Act.

The Dental Quality Assurance Commission is proposing amendments to WAC 246-817-187, Temporary practice permit - Military spouse eligibility and issuance, to update language changes made by Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023).

The Washington State Department of Health (DOH) adopted amendments to WAC 246-12-051 to align with recent legislation to expedite the issuance of professional licenses for military spouses who hold a license in another state by removing the need to first leave employment. 

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.

The Washington State Department of Health (DOH) adopted rules necessary to create a licensure program for music therapists. Individuals working as a music therapist are required to be licensed by January 1, 2025. The adopted rules establish the new profession’s licensure requirements which include education, training, and examination requirements for initial licensure; continuing education requirements; fees for licensing, examination, and renewal; and other qualifications as determined by the secretary.

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 Pharmacy Quality Assurance Commission adopted emergency rules to amend WAC 246-945-030 and add a new section, WAC 246-945-034, classifying the 3mg and 4mg naloxone hydrochloride nasal spray as approved by the United States Food and Drug Administration (FDA) for over-the-counter (OTC) distribution as an OTC drug in Washington state to combat the opioid epidemic in Washington.

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.

The Washington Medical Commission is considering amending WAC 246-919-601 to exempt the use of nitrous oxide in office-based surgical settings under certain circumstances. Additionally, the commission is considering adding a new subsection to further address the use of nitrous oxide in such settings.

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

The Washington State Board of Nursing is proposing a new section of rule, WAC 246-840-5341, and amendments to WAC 246-840-534 to implement Engrossed Second Substitute Senate Bill (E2SSB) 5582 (chapter 126, Laws of 2023).

Shad Bell

360-236-4711

The Washington State Department of Health (DOH), in consultation with the Washington State Board of Nursing, is proposing amendments to WAC 246-840-990 to make a housekeeping change to correct fee total amounts.

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.