Rule-Making Activity

The Department of Health adopted national standards sources of radionuclide emissions by reference. This rulemaking updates the reference to national standards for sources of radionuclide emissions federal regulations to the most recent version, adopted in 2023.

Nina D. Helpling

Department of Health

PO Box 47820 Olympia, WA 98504-7820

radruleupdates@doh.wa.gov

The Department of Health is Proposing amendments for substance use disorder and their trainees, to reduce barriers to certification. This includes removing the requirement to verify educational coursework for applicants with a national certification, making pharmacists eligible for the alternative training pathway in, and removing the obsolete AIDS training from the list of probationary license requirements.

The Pharmacy Quality Assurance Commission has adopted 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>. This will capture the revisions to the USP <795> and <797>, which have been made official since WAC 246-945-100 became effective on July 1, 2020.

The Washington State Board of Nursing is proposing new sections of rule, WAC 246-840-835 and 246-840-935, and amendments to WAC 246-840-930 and 246-840-940 to implement Substitute House Bill (SHB) 1124 (chapter 14, Laws of 2022) to expand the delegation of glucose monitoring and testing to all settings where Nursing Assistant -Registered and Nursing Assistant-Certified individuals work. Additionally, the board is proposing changes to supervision and valuation timeframes to align with SHB 1124.

Substitute Senate Bill (SSB) 6086, passed in 2020, allows a pharmacy to extend its pharmacy license to a remote dispensing site where technology is used to dispense medications for the treatment of Opioid Use Disorder (OUD) or its symptoms. The Pharmacy Quality Assurance Commission adopted rules that establish the minimum standards for OUD medication remote dispensing sites. Adopted rules reflect standards, restrictions and requirements set in statute.

The minimum standards must address who may access medications at the remote dispensing site pursuant to a valid prescription or chart order. The minimum standards must also require that the pharmacy is responsible for stocking and maintaining a perpetual inventory of the OUD medications stored in or at the remote dispensing site (referred to as the “supplying pharmacy” in the rule language).

Current rules in chapter 246-945 WAC cover requirements for drugs stored outside of a pharmacy but restrict their location to a facility that is otherwise able to store and possess drugs (i.e., a licensed pharmaceutical firm). The adopted rule, WAC 246-945-457, is necessary to establish enforceable minimum standards as directed by SSB 6086 for OUD medication remote dispensing sites. As the statute specifically requires rulemaking, no other alternatives were considered.

Effective Date of Rule: May 7, 2023.

Purpose: WAC 246-840-365 Inactive and reactivating an ARNP license and 246-840-367 Expired license. The nursing care quality assurance commission (commission) is adopting amendments to WAC 246-840-365 and 246-840-367 to remove nonevidence-based licensure requirements for inactive and reactivating advanced registered nurse practitioner (ARNP) licenses.

Amendments to WAC 246-840-365 and 246-840-367 are currently enacted under emergency rule, and the commission is adopting the amendments into permanent rule. The requirements include completion of 250 hours of advanced clinical practice for each designation within the past two years. If the ARNP has not satisfied the advanced clinical practice requirements, the requirements include completion of at least 250 hours of supervised advanced clinical practice hours and the need to obtain an interim permit to complete the practice hours.

For ARNPs whose license has been expired for less than two years, the rule removes the requirement for ARNPs who do not meet required advanced clinical practice requirements to complete 250 hours of supervised advanced clinical practice for every two years the ARNP has been out of practice and the need to obtain an interim permit to complete the practice hours.

Housekeeping amendments remove "of chapter 246-12 WAC, Part 2" in subsection (1)(a) and replaces [it] with "for initial and renewal credentialing of practitioners as identified under WAC 246-12-020 through 246-12-051[.]"

The commission is adopting amendments to current rules identified as barriers to the provision of services both in emergency response and during regular operations.

Citation of Rules Affected by this Order: Amending WAC 246-840-365 and 246-840-367.

Statutory Authority for Adoption: RCW 18.79.010, 18.79.110, and 18.79.250.

Adopted under notice filed as WSR 23-01-134 on December 20, 2022.

A final cost-benefit analysis is available by contacting Jessilyn Dagum, P.O. Box 47865, Olympia, WA 98504-7864 [7865], phone 360-236-3538, fax 360-236-4738, TTY 711, email ncqac.rules@doh.wa.gov, website www.nursing.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: January 27, 2023.

The Board of Osteopathic Medicine and Surgery and the Department of Health are removing references to Osteopathic Physician Assistants by adopting changes to WAC 246-853-290, 246-853-300, 246-853-630, 246-853-640, 246-853-662, 246-853-750, and 246-853-990. The adopted amendments will remove obsolete language and align the rules with recent statute changes.

The Pharmacy Quality Assurance Commission is proposing to add a new subsection to WAC 246-945-055 to utilize the commission’s authority, to delete substances designated as a Schedule IV controlled substance. The commission is also proposing to create a new section, WAC 246-945-05001, to establish a list of exempted substances from RCW 69.50.204, RCW 69.50.206, RCW 69.50.208, RCW 69.50.210, and RCW 69.50.212, including fenfluramine.

The Washington Medical Commission is extending its emergency rule that amends WAC 246-919-330 to eliminate the outdated requirement for consecutive years of training in no more than two programs. This change will remove a barrier for qualified applicants to obtain a physician license. This rule continues emergency rules filed on November 9, 2023, under WSR 23-23-071 while permanent rulemaking is in process.

THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. 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 Joshua Munroe, Pharmacy Quality Assurance Commission, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-2987, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY January 3, 2023.

The Emergency rule amending specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) has been rescinded with an effective date of November 4, 2023, because it has been replaced by permanent rules in chapter 246-841A WAC.

The board is rescinding this emergency rule which amended specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) effective November 4, 2023, because it is no longer necessary.

This policy statement provided guidance to donor milk banks and insurance carriers consistent with RCW 43.70.645 until the department adopted permanent rules. The policy statement served as the milk bank safety standards established by the department for inpatient use for the purpose of RCW 43.70.645 and 48.43.815, clarified and added a definition addressing donor human milk obtained from a milk bank for the purposes of ensuring inclusion of donor milk provided by renumerated donors and ensuring inclusive language use.

The department is rescinding this policy statement because it is superseded by permanent rules that were adopted August 22, 2023, filed as WSR 23-17-149 with an effective date of September 22, 2023, making the policy statement obsolete.

Individuals requiring information on this should contact Me'kyel Bailey, lead policy advisor, email mekyel.bailey@doh.wa.gov, or phone 360-754-9161. Filed February 5, 2024.

The Department of Health is considering amending requirements for respiratory care practitioner application, examination licensure, and out of state credentialing and temporary practice permits.

The Department of Health adopted amendments regarding Safe Medication Return to update rules about multiple program operators. Amendments also set a fee for proposal review and provide transparency for the department’s method of calculating program operator annual fees.

Jocelyn W. Jones
360-236-3020

Stuart Glasoe
360-236-4111

Peter Beaton
 

The Washington State Board of Health (Board) is considering adding Guanidinoacetate methyltransferase deficiency (GAMT) and Arginase 1 deficiency (ARG1-D) to the list of mandatory conditions for newborn screening conducted by the Department of Health (Department).

The Board has the authority under RCW 70.83.050 to define and adopt rules for screening Washington-born infants for hereditary conditions. WAC 246-650-010 defines the conditions, and WAC 246-650-020 lists the conditions for which all Washington-born newborns are to be screened. GAMT deficiency and ARG1-D are rare inherited metabolic conditions that can result in severe disability and in some cases death if not detected and treated early. Early diagnosis of GAMT deficiency and ARG1-D through newborn screening is essential to save lives and to improve the quality of life for impacted infants and their families.

To be added to the listserv for notifications regarding this rulemaking, email Molly.Dinardo@sboh.wa.gov with the subject line "Newborn Screening – GAMT & ARG1-D."

Stuart Glasoe
 

The Department of Health (department) is considering amending chapter 246-790 WAC to increase flexibility in allowed vendor types and update program requirements for vendors. The department is also considering amendments to the Participant Compliance rules to reflect virtual service options.

WSBOH@sboh.wa.gov

Samantha Pskowski
360-789-2358
 

The Washington State Board of Health is considering amending the auditory screening sections of chapter 246-760 WAC, Auditory and Visual Standards – School Districts, to align with current national evidence-based practices and assess potential options regarding whether to include otoacoustic emission (OAE) screening technology in the Board’s rules. The Board may also consider other technical or editorial changes as needed.

The State Board of Health is proposing amendments to address changes to existing requirements, including requirements governing local management plans, repairs, registration of proprietary treatment products, minimum lot sizes, treatment levels, and licensing of operations and maintenance providers. The proposed rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues. The proposed rule also makes several editorial updates to improve clarity and repeals obsolete rules.

The State Board of Health has adopted amendments to chapter 246-272A WAC to implement changes to existing requirements. The adopted rule establishes new requirements, including requirements for field verification of proprietary products, property transfer inspections, remediation, and product supply chain issues and makes clarification updates. 

The Occupational Therapy Practice Board is considering amendments to implement Second Substitute House Bill (2SHB) 1724 (Chapter 425, Laws of 2023) to remove barriers to licensure and endorsement. Additionally, the board will consider amendments to align with the national certifying board and standards of ethics and professional conduct.

Section 8 of 2SHB 1724 directs boards and commissions to waive certain requirements to licensure for specific types of applicants. The intent of the bill was to change licensure requirements to remove barriers to entering and remaining in the health care workforce, and to streamline and shorten the credentialing process. Rulemaking may be necessary to amend licensure requirements to align with the new legislation. Additionally, the board consistently receives inquiries on whether an OT can work off the evaluation of another profession such as a physical therapist. The board is considering adding rule language that makes it clear that an OT must complete their own evaluation of the client, and will consider adding language that aligns continued competency rules with the national certifying board.

The Board of Osteopathic Medicine and Surgery is proposing amendments to WAC 246-853-290, 246-853-300, 246-853-310, and 246-853-320 to update the rules regarding health profession monitoring programs. The proposed changes reflect updated language changes made by Substitute Senate Bill 5496 (chapter 43, Laws of 2022). In partnership with the Secretary of Health, technical amendments are also being proposed to WAC 246-853-990 to reflect changes to the updated rules and statute.

The Washington State Board of Nursing proposes amendments and an addition to rules relating to the board’s substance use disorder (SUD) monitoring program in response to Substitute House Bill (SHB) 1255 (chapter 141, Laws of 2023) including application requirements for a stipend.

The Department of Health adopted amendments to reduce barriers to certification for Substance Use Disorder Professionals and Substance Use Disorder Professional Trainees. Changes include removing the requirement to verify educational coursework for applicants with a national certification in WAC 246-811-070, making pharmacists eligible for the alternative training pathway in WAC 246-811-076, and removing osteopathic physician assistants pursuant to Substitute House Bill 2378 (chapter 80, Laws of 2020). The rule also removes the obsolete AIDS training from the list of probationary license requirements pursuant to Engrossed Substitute House Bill 1551 (chapter 76, Laws of 2020).

The Board of Optometry amended WAC 246-851-440 through 246-851-470 to align with technical changes made by Substitute Senate Bill (SSB) 5496 (Chapter 43, Laws of 2022). Changes align the rules with currently accepted language for substance use disorders and related monitoring programs, and include technical clarifications as needed without changing the rule’s effect.

The Washington State Board of Nursing (board) adopted amendments to WAC 246-840-095, 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).

This policy clarifies the Pharmacy Quality Assurance Commission’s issuance of temporary practice permits to pharmacy interns who are spouses of military personnel. Policy number: P011. Effective Date: February 1, 2024.

This emergency rule temporarily removes the requirement for home care aide applicants to become certified within two years of completing training. These rules continue emergency rules initially filed on October 17, 2022, under WSR 22-21-102 and continued on February 14, 2023, under WSR 23-05-083 and on June 13, 2023, under WSR 23-13-068. They are being continued while permanent rulemaking is in progress to consider training timelines for home care aides.

Submit Written Comments to: Nina Helpling, DOH, P.O. Box 47820, Olympia, WA 98504-7820, email tempworkerrule@doh.wa.gov, by July 7, 2023.

Assistance for Persons with Disabilities: Contact Nina Helpling, phone 360-236-3065, TTY 711, email nina.helpling@doh.wa.gov, by June 13, 2023.

The Department of Health is considering amending fees in WAC 246-358-990 to cover operating costs in the Temporary Worker Housing program. The department will consider updating or restructuring existing fees and creating new fees. Rulemaking is being considered because the department conducted an initial assessment of the program and determined the current fee is not generating sufficient revenue to cover the program’s costs.

RCW 70.114A.065 directs the Department of Health (DOH) and the Department of Labor and Industries (L&I) to adopt joint rules for the licensing, operation, and inspection of temporary worker housing. DOH and L&I have assessed the emergency rule requirements, along with input from interested parties and adopted key provisions to address prevention of future outbreaks and the spread of any airborne infectious disease.

The Veterinary Board of Governors adopted health equity continuing education requirements in WAC 246-933-437 and WAC 246-935-307 for licensed veterinarians and veterinary technicians to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021.)

The Veterinary Board of Governors has adopted amendments to physician health monitoring programs for substance use disorders of veterinarian professions to update language changes made by Substitute Senate Bill (SSB) 5496 (chapter 43, Laws of 2022). Amendments include terminology and definitions for currently accepted language and replacing "substance abuse" with "substance use disorder." The board also made amendments to correct citations and other general housekeeping changes.

The Veterinary Board of Governors is considering updates and revisions to WAC 246-935-050 animal health care tasks, WAC 246-935-040 responsibilities of a Veterinarian supervising a licensed Veterinary Technician or unregistered assistant, WAC 246-935-010 definitions (Veterinary Technicians), and WAC 246-937-010 definitions (registered Veterinary Medication Clerks).

WAC 246-282-006, Washington state Vibrio parahaemolyticus control plan. Vibrio parahaemolyticus (Vp) is a naturally occurring bacteria found in marine waters. Molluscan bivalve shellfish acquire Vp through filter feeding. Humans who consume raw or undercooked shellfish containing Vp can develop an intestinal disease called vibriosis. Chapter 246-282 WAC establishes the minimum performance standards for growing, harvesting, processing, packing, storage, transporting, and selling of shellfish for human consumption.

These rules do not apply to persons who conduct activities limited to retail food service, personal use, and transporting as a common carrier of freight. WAC 246-282-006 establishes the control plan for the months of May 1st through September 30th and are an extension of the NSSP Model Ordinance (U.S. Food and Drug Administration National Shellfish Sanitation Program, Guide for the Control of Molluscan Shellfish). Due to current early season high temperatures, this emergency rule making is necessary to protect public health by modifying the existing strictest harvest control requirements which currently start July 1st by setting even more protective measures immediately.

The State Board of Health (board) filed a Preproposal Statement of Inquiry (CR-101) on February 23, 2022, WSR 22-06-034 regarding permanent amendments to the existing rules to address harvest control measures and may also include updating definitions, seed size and other technical and editorial changes as needed. Until permanent rule making can be completed, the board has delegated emergency rule making authority to the Department of Health if heat-wave conditions occur prior to July 1To reduce the threat to public health, amending the “time of harvest to cooling requirements” to a more protective control season immediately is necessary.

The current Vp Control Plan, last revised in 2015, establishes a control season between May 1st and September 30th and authorizes enforcement of the rule’s strictest time-to cooling requirements for harvested oysters starting July 1 of the Vp control season. However, recent events demonstrate the need for more flexible rules.

From June 26 to July 2, 2021, the National Weather Service in Seattle reported a long-duration, unprecedented heat wave throughout the Pacific Northwest. Shellfish-related Vp illnesses increased sharply. Therefore, due to current early season temperatures and mid-day low tides, this emergency rule is necessary to protect public health.

The Department of Health is extending an emergency rule to continue to require acute care hospitals in Washington state to support statewide health system readiness by reporting hospital maintenance and operation data to the department through Washington’s Healthcare and Emergency and Logistics Tracking Hub (WA HEALTH). This fourth emergency rule continues the emergency rule originally filed on August 31, 2022 as WSR 22-18-060.

The Department of Health is considering requiring acute care hospitals to report hospital maintenance and operation data to the department through the Washington Healthcare Emergency and Logistics Tracking Hub (WA HEALTH), a statewide data management system. The department will also consider requiring behavioral health agencies and facilities to report hospital maintenance and operation data to the department through WA HEALTH.

Amelia Boyd

Notice of Adoption: This statement Issued by The Washington Medical Commission establishes the use of Nitrous Oxide in Office-Based Settings Under WAC 246-919-601, and regulates the use of analgesia, anesthesia, and sedation in office-based settings to exempt the use of nitrous oxide from the requirements of WAC 246-919-601. Interpretive Statement INS2023-02. Effective Date: October 20, 2023.

The Department of Health withdrew the CR-101 published as WSR 23-04-061 and the CR-102 published as WSR 23-23-186 for WAC 246-282-990, Shellfish fees, because the 2024 Legislature passed a budget proviso that gives the department funding to contract with an independent third-party consultant to study the commercial shellfish regulatory program and make recommendations on fees. The budget proviso prohibits the department from increasing commercial shellfish fees during fiscal year 2025. Filed as WSR 24-08-079 and WSR 24-08-079A.

The Department of Health is considering amending existing rules WAC 246-225-020 and 246-225-030 and creating new rules in chapter 246-225 WAC, X-Rays in the Healing Arts, to address technological advances in radiation therapy and fluoroscopic X-ray, establish machine performance and quality control standards, and to address plan review shielding requirements. Amendments to radiation therapy rules considered by the department will apply only to machine generated ionizing radiation, and not radiopharmaceuticals or radioactive materials.