Rule-Making Activity

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 board, formerly known as the Nursing Care Quality Assurance Commission, is proposing a new section of rule and revisions to existing rule in WAC 246-840-220 and 246-840-222 to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021).

The Washington State Board of Nursing is proposing amendments to WAC 246-840-095, Temporary Practice Permits, for LPN and RN effective dates, reducing the length of time a temporary practice permit is effective and updating criteria to issue a temporary practice permit in order to align the internal board process with rule language and implement Second Substitute House Bill (2SHB) 1009 (chapter 165, Laws of 2023), Military Spouses—Professional Licensing and Employment.

The Washington State Department of Health (DOH) is considering adding new sections to and updating sections of chapter 246-926 WAC, Radiologic imaging professionals, to implement Substitute House Bill (SHB) 2355 (chapter 94, Laws of 2024), which establishes certification of MRI technologists. DOH will also consider minor housekeeping edits and or updates related specifically to establishing and regulating MRI technologists.

Purpose:Medical Assistants updated credentialing and licensure requirements in WAC 246-827-0010, 246-827-0110, 246-827-0120, 246-827-0140, 246-827-0200, 246-827-0300, 246-827-0400, and 246-827-0610. The Department of Health(department) is adopting revisions to medical assistant (MA) rules to remove outdated language, remove English languagerequirements, and update credentialing requirements. Outdated language includes removing language concerning theobsolete Health Care Assistant credential. Removing English requirements will remove unnecessary barriers for otherwisewell-qualified medical assistant staff to enter the workforce. RCW 18.360.010 was updated by House Bill (HB) 1378 (chapter44, Laws of 2021) to allow medical assistant supervision using audio and video technology during a telemedicine visit. Thedepartment is adding a new section to detail regulation for telemedicine supervision in response to HB 1378. Amendmentsremove irrelevant or confusing rule language, which will make the rules more easily understood. Updating credentialingrequirements to remove licensure barriers will allow experienced medical assistants to enter the Washington workforce.

The Washington State Department of Health (DOH) is considering rule amendments and adding new sections to chapter 246-827 WAC, Medical Assistants, to implement Substitute Senate Bill (SSB) 5940 (chapter 217, Laws of 2024) establishing the MA-EMT credential for individuals holding a current EMT, advanced EMT, or paramedic credential. DOH will also consider fees for the new credentials.

The Washington State Department of Health (DOH) is considering rule amendments to WAC 246-827-0010, 246-827-0200, and 246-827-0240 to align with Engrossed Substitute House Bill (ESHB) 1073 (chapter 134, Laws of 2023) and Engrossed Substitute Senate Bill (ESSB) 5983 (chapter 248, Laws of 2024) to ensure that the rules are current and align with best practices. DOH will also consider adding a new section, WAC 246-827-0340, to address the medication administration requirements for the medical assistant-registered credential.

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.

The Washington State Department of Health (DOH) is proposing amendments to sections WAC 246-338-022, 246-338-040, 246-338-050, 246-338-060, 246-338-070, 246-338-080, and 246-338-090 to incorporate existing minimum standards that are missing, make technical corrections to rules, and adopt new federal requirements.

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 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 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 24-14-078 filed on June 28, 2024, without change.

The Pharmacy Quality Assurance Commission and Washington State Department of Health (DOH) are jointly proposing adding five new sections, WACs 246-945-710, 246-945-712, 246-945-714, 246-945-716, and 246-945-718, to establish standards for the practice of medication assistance. The proposed rules describe definitions, actions, and restrictions pertaining to the provision of medication assistance 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 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 continuing emergency rules, without changes, to implement parts of 2SHB 1724 (chapter 425, Laws of 2023) and E2SHB 2247 (chapter 371, Laws of 2024). DOH is adopting and continuing amendments to WACs 246-809-110, 246-809-130, 246-809-220, 246-809-221, 246-809-230, 246-809-330, and 246-809-990. These emergency rules continue emergency rules initially filed under WSR 24-14-080, on June 28, 2024. The emergency rules will be renewed while permanent rulemaking filed under WSR 24-10-012 on April 18, 2024, 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 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.