Rule-Making Activity

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 Washington State Department of Health (DOH) is implementing legislation reducing licensure barriers for hearing and speech professions and clarifying requirements for speech-language pathology assistant certification in chapter 246-828 WAC.

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) established alternate certification time frames for individuals working toward certification as a home care aide or nursing assistant-certified. This includes amending WAC 246-980-025, 246-980-030, 246-980-040, 246-980-065 and adopting a new rule, WAC 246-980-011. The rules allow workers impacted by the coronavirus disease 2019 pandemic more time to complete requirements while training, testing, and credentialing capacity issues are being resolved. This is the seventh and anticipated final emergency rule.

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 proposing rules to establish operating standards and fees for hospital at-home services. Proposing amendments to WAC 246-320-199 and creating a new rule, WAC 246-320-278, to add hospital at-home services as a type of service offered by hospitals. The rules establish operating standards and create a fee to cover the costs of reviewing applications for the hospital at-home program.

In accordance with Governor Directive 25-01, the Washington State Department of Health (DOH) amended WAC 246-320-010 and WAC 246-320-281to ensure access to treatment, including abortion care, for emergency medical conditions in hospital emergency departments and protection of a pregnant person’s right to exercise informed consent in prioritizing their health and safety when receiving treatment for emergency medical conditions in hospital emergency departments. These requirements are subject to applicable protections of conscience and the free exercise of religion under state and federal law.

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.

The Washington State Department of Health (DOH) is refiling to correct a clerical error when filing original proposal. Amendments to chapter 246-454 WAC. 

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 Additionally, the adopted amendments update outdated language within chapter 246-454 WAC, and two sections of Hospitals-Assessments and Related Reports in WAC 246-451-010 and 246-451-050.

The Washington State Department of Health (DOH) is proposing amendments to WACs 246-320-500, 246-320-505, and 246-320-600 to align hospital licensing construction standards with the 2022 editions of the Guidelines for Design and Construction of Hospitals and the Guidelines for Design and Construction of Outpatient Facilities. Additionally, DOH is proposing to increase the construction cost threshold for projects that require a pre-submission conference from $250,000 to $500,000. For clarity and readability, DOH is proposing to reformat WAC 246-320-600 by adopting the 2022 Guidelines by reference and publishing a separate document outlining Washington’s amendments to the 2022 Guidelines. 

The Washington State Department of Health (DOH) aligned existing rules with Nationally Recognized Industry Standards in chapter 246-320 WAC. The updates also increase the cost threshold for projects that require a pre-submission conference with DOH and, for readability purposes, adopted the 2022 Guidelines by reference.

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.

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) amended chapter 246-562-WAC to rewrite the rule for better organization, clarity, and modernization. The adopted amendments better reflect the purpose and intent of the J-1 Visa Waiver Program and clarify the changes in physician practice and the need for physicians across Washington state. The adopted amendments address the applicant criteria, the application review process, and the need for more available specialist waivers slots earlier in the fiscal year. The rule adoption implements a scoring methodology to allow DOH to prioritize waiver placements based on physician practices, employers, and communities that are in highest need across the state. DOH created two new sections in the rule adoption to include requirements for requesting letters attestation and letters of completion.

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) adopted a new section, WAC 246-310-825 and adopted amendments to existing kidney disease treatment center rules, WAC 246-310-800 through 246-310-806, and 246-310-812 through 246-310-833, to implement Substitute Senate Bill (SSB) 5569 (chapter 48, Laws of 2023), codified in RCW 70.38.280. DOH also adopted amendments to address impacts to the need methodology based upon new temporary emergency situation exemption, as well as clean-up language to ensure consistency in kidney disease treatment center rules.

The Washington State Department of Health (DOH) is proposing to establish a civil penalty schedule for violations of a law or rule regulating large on-site sewage systems. This proposed rule is necessary to clarify DOH penalties based on significance of the violation, previous compliance record, and the presence of aggravating or exacerbating circumstances. 

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 Washington State Department of Health (DOH) is proposing permanent rules to implement new requirements in chapter 246-809 WAC. The proposed rules establish standards for the licensed counselor supervisor directory program, supervision, practice on a pending license, and the supervision stipend program.