Rule-Making Activity

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.

The Washington State Board of Nursing adopted rules amending WAC 246-840-750 through 246-840-780 and adding WAC 246-840-790 to establish new definitions, update existing terms, and add application requirements for a stipend for the substance use disorder monitoring program for nursing professionals in response to Substitute House Bill 1255 (chapter 141, Laws of 2023) codified in RCW 18.79.440.

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 Department of Health is considering adopting a new chapter to Title 246 that establishes general administrative procedures and fees for non-potable water systems.

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.

The Washington State Department of Health (DOH) is proposing a new rule in response to legislative requirements under Substitute House Bill (SHB) 1271 (chapter 290, Laws of 2023) to establish the minimum standards for organ transport vehicles and equipment in WAC 246-976-360.

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 and the Washington State Department of Health (DOH) are proposing amendments to WAC 246-853-045 and WAC 246-853-21, and to repeal WAC 243-853-060, as a result of the review to clarify and update language.

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).

Becky McElhiney
360-236-4766

The Board of Hearing and Speech adopted rules to reflect federal changes for over-the-counter (OTC) hearing aids. To align with changes in federal regulation, the board’s adopted amendment removes requirements in WAC 246-828-100 for medical clearance as a condition for sale of OTC hearing aids. The adopted changes to WAC 246-828-100 only remove requirements no longer permitted by federal rule and do not otherwise change licensure requirements.

The Board of Hearing and Speech is proposing amendments to WAC 246-828-100 (Hearing instruments fitting and dispensing – Minimum standards of practice) to reflect changes to relevant federal rules by the Food and Drug Administration (FDA) regarding the sale of over-the-counter (OTC) hearing aids (21 C.F.R. Parts 800, 801, 808, and 874 (2022)).

Nina Helping
360-236-3065

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-480 and creating new sections in chapter 246-945 WAC to improve notifications and prescription transfer directions provided to patients when the facility closes permanently.

The Pharmacy Quality Assurance Commission adopted health equity continuing education requirements to meet the requirements of the Department of Health’s equity model rules in WAC 246-12-800 through 246-12-830. The adopted rules add one hour of health equity education every two years, coinciding with the license renewal cycles for both pharmacists and pharmacy technicians.

In 2020, the Pharmacy Quality Assurance Commission consolidated multiple chapters of rules into chapter 246-945 WAC that covers the practice of pharmacy. This adopted rule amends WAC 246-945-040(1) to incorporate Title 21 of the CFR by reference for the purpose of capturing any changes made to Title 21 after WAC 246-945-040 went into effect on July 1, 2020. Language was also added to the rule for the purpose of providing individuals directions for acquiring copies of the reference material listed for public inspection.

Updating reference to United States Pharmacopeia (USP) General Chapters 795 and 797. The Pharmacy Quality Assurance Commission (commission) is proposing a revision to WAC 246-945-100, Compounding minimum standards, to update the rule to the most recent version of the USP – National Formulary <795> and <797>.

Purpose of the proposal and its anticipated effects, including any changes in existing rules: The proposed rule amends WAC 246-945-100 to update the rule to the most recent versions of the USP <795> and <797>. USP <795> and <797> were adopted into rule by reference effective on July 1, 2020. Since then, USP <795> and <797> have been updated.

Reasons supporting proposal: The existing reference in WAC 246-945-100 does not account for changes made to USP <795> and <797> that are official as of November 1, 2023 by USP. The proposed rule updates the references to the most recent versions. The proposed rule language qualifies for expedited rulemaking under RCW 34.05.353(1)(b) as the language incorporates by reference national standards without material change.

 IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Haleigh Mauldin, Pharmacy Quality Assurance Commission, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-890-0720, fax 360-236-2901, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY April 17, 2023.

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-155, WAC 246-945-156, and adding a new section to chapter 246-945 WAC. These changes would grant renewal extensions to pharmacy interns and would extend temporary pharmacy intern practice permits for spouses of military personnel in accordance with Second Substitute House Bill 1009 (chapter 165, Laws of 2023).

Notice of Adoption: This policy Issued by the Pharmacy Quality Assurance Commissions clarifies the Commission’ approach to United States Pharmacopeia General chapters 795, 797, 800, and 825 as it relates to WAC 246-945-100 and RCW 18.64.270(2). Policy PO-10. Effective Date: November 1, 2023.

Rescission of Policy Statement P004, Regulatory Standards Applicable to Remote Dispensing Sites. Filed February 8, 2024.

The pharmacy quality assurance commission (commission) is rescinding the policy statement Regulatory Standards Applicable to Remote Dispensing Sites, which was filed on July 2, 2020, and published as WSR 20-15-011.

The department of health is rescinding this policy statement because rulemaking was completed allowing a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications used for the treatment of opioid use disorder or its symptoms. The CR-103P was filed under WSR 24-01-098 and went into effect on January 18, 2024.

Individuals requiring information on this rule should contact Joshua Munroe, rules and legislative consultant, phone 360-502-5058, email PharmacyRules@doh.wa.gov. 

The Pharmacy Quality Assurance Commission adopted updates to references, made grammar corrections, and made other technical changes that do not affect implementation of the rule.

Citation of rules amended by this order: WACs 246-945-001, 246-945-011, 246-945-014, 246-945-018, 246-945-063, 246-945-156, 246-945-170, 246-945-173, 246-945-175, 246-945-200, 246-945-217, 246-945-230, 246-945-417, and 246-945-590.

This proposal will remove citations to repealed WAC chapters, update citations to the current governing WAC chapter or specific rule(s) and make general grammatical corrections without making any material changes.

Joshua Munroe

The Board of Physical Therapy is considering amendments to update initial licensure and endorsement requirements in consideration of Second Substitute House Bill (2SHB) 1724, (chapter 425, Laws of 2023). The board will also consider making general updates to the licensing and endorsement process, examine the jurisprudence examination requirement, and review for housekeeping changes.

The Board of Physical Therapy is considering amendments to update initial licensure and endorsement requirements in consideration of Second Substitute House Bill (2SHB) 1724, (chapter 425, Laws of 2023). The board will also consider making general updates to the licensing and endorsement process, examine the jurisprudence examination requirement, and review for housekeeping changes.

Section 8 of 2SHB 1724 requires boards and commissions to waive any examination requirements in an effort to expedite the licensing process for applicants who meet the requirements under 2SHB 1724. The board will review the initial licensure and endorsement requirements to bring them into alignment with 2SHB 1724, and review the current license requirements for consistency and relevancy. The board will consider additional housekeeping updates.

Agency: Department of Health and the Board of Physical Therapy
Subject of possible rule making: Physical Therapists intramuscular needling requirements. The Board of Physical 
Therapy (board) and Department of Health (department) are considering rulemaking in chapter 246-915 WAC, Physical 
Therapists and Physical Therapist Assistants, to clarify statutory requirements for education and training and define an 
intramuscular needling endorsement. The board and department may consider associated training and education 
requirements, updating definitions, establishing a fee for the intramuscular needling endorsement, and creating a process 
to apply for the endorsement.
Statutes authorizing the agency to adopt rules on this subject: Second Substitute House bill (2SHB) 1039 (chapter 
198, Laws of 2023), RCW 18.74.023, 43.70.110, 43.70.250, and 43.70.280
Reasons why rules on this subject may be needed and what they might accomplish: 2SHB 1039 expands the 
scope of practice of physical therapists to perform intramuscular needling, also known as dry needling. Rules may be 
needed to clarify statutory requirements for education and training to receive an initial endorsement to perform 
intramuscular needling. The board and the department will also consider establishing the steps to apply for the 
endorsement, including establishing a fee.
Identify other federal and state agencies that regulate this subject and the process coordinating the rule with 
these agencies: None
Process for developing new rule (check all that apply):
☐ Negotiated rule making
☐ Pilot rule making
☐ Agency study
☒ Other (describe) Collaborative rulemaking
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule 
before publication by contacting:
(If necessary)
Name: Allyson McIver Name:
Address: PO Box 47852, Olympia, WA 98504-7852 Address:
Phone: 360-236-2878 Phone:
Fax: 360-236-2901 Fax:
TTY: 711 TTY:
Email: physical.therapy@doh.wa.gov Email:
Web site: doh.wa.gov Web site:
Other: Other:
Additional comments: Interested parties can participate in the drafting of the proposed rules. The department and the
board will be conducting rules workshops with interested parties and subject matter experts. The department will use 
existing GovDelivery lists and other known contact information to inform interested parties of opportunities to provide input
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on proposed rule language. To find out more information about our rulemaking, visit www.doh.wa.gov. To subscribe to 
GovDelivery, please visit www.doh.wa.gov, and select the "Subscribe" button at the bottom of the page, select Health 
Professions, and then Physical Therapy Program. You may also check the box next to one or more of the other 
professions listed to receive information related to that specific profession.
Date: July 18, 2023
Name: Kathryn Dale, PT, DSc and Kristin Peterson, JD for 
Umair A. Shah, MD, MPH
Title: Chair, Physical Therapy Board and Chief of Policy 
for Secretary of Health

The Board of Physical Therapy and the Washington State Department of Health (DOH) adopted amendments to chapter 246-915 WAC, Physical Therapists and Physical Therapist Assistants, to clarify statutory requirements included in Second Substitute House Bill (2SHB) 1039 (chapter 198, Laws of 2023) for obtaining an intramuscular needling endorsement and to establish a fee to cover the cost of the endorsement. The adopted rules clarify and set standards to ensure that physical therapists who are seeking the endorsement are prepared with the skills and education needed to provide safe intramuscular needling services to the public.

The Board of Physical Therapy and Department of Health are proposing amendments to clarify statutory requirements for education and training and define the endorsement for intramuscular needling, and to amend fees and renewal cycle, to implement Second Substitute House Bill 1039, (chapter 198, Laws of 2023) which expands the scope of practice of physical therapists to perform intramuscular needling.