The rules writing process is open to the public. The public is welcome to take part in helping us write rules. Rules are also known as regulations, Washington Administrative Code, or WAC. The rule-making process includes public notices and workshops, and usually a public hearing before a rule becomes final.
Current Rules in Progress
Osteopathic Physician and Surgeon Licensure Fee Rules
The Department of Health (department) officially filed a CR-101 with the Office of the Code Reviser on January 30, 2026 as WSR# 26-04-087. The department, in consultation with the Board of Osteopathic Medicine and Surgery (board), is considering rule amendments that include removing the Washington Osteopathic Principals and Practices (OP&P) exam and re-exam fee, adding the Washington Physicians Health Program (WPHP) impaired practitioner surcharge to initial licensure for osteopathic physicians, and updating fees to appropriate levels for program’s operating costs and reserve levels.
OP&P Exam fee: On January 7, 2025, the board adopted amendments to the osteopathic physician examination requirements listed under WAC 246-853-020. The purpose of this rule project was to simplify the examination requirements for out-of-state applicants entering in the Washington workforce. As a result, the board removed the OP&P exam as a requirement for licensure. In response to this update, the department is considering an amendment that removes the OP&P exam and re-exam fee from rule.
Impaired practitioner WPHP surcharge: As required by RCW 18.57.015, the board contracts with the WPHP to implement and operate an impaired practitioner program. Contracts with WPHP are financed by a surcharge applied to the osteopathic physician license. Currently, WAC 246-853-990 only provides for collection of the WPHP surcharge on license renewal. To adequately fund the board’s contract with WPHP, the department is considering adding the surcharge to initial licensure as authorized by RCW 18.57.015.
Osteopathic Licensing Fees: RCW 43.70.250 requires that licensing fees cover regulatory program expenses which necessitates the program to be self-funding. Limited fee adjustments may be made to ensure revenue is adequate to support regulated activities and maintain sufficient reserve levels without generating a surplus.
Nitrous Oxide Rules
The Board of Osteopathic Medicine and Surgery (board) officially filed a CR-101 with the Office of the Code Reviser on July 29, 2026 as WSR# 26-16-035. The board is considering rule amendments that establish requirements for the use of nitrous oxide.
The Washington Medical Commission (commission) recently adopted rules establishing the use of nitrous oxide in office-based surgical settings. The commission adopted rules that address a gap in existing regulations and to ensure consistent safety standards for the use of nitrous oxide in office-based settings.
Given the recent rules updates for allopathic physicians related to this topic, the board is considering updating WAC 246-853-650, Safe and effective analgesia and anesthesia in office-based settings, and adding a new section to ensure alignment of rules between osteopathic and allopathic physicians when administering nitrous oxide. The board works to remain consistent with the commission as osteopathic physicians and allopathic physicians regularly provide care in the same settings.
Opioid Prescribing Rules
The Board of Osteopathic Medicine and Surgery (board) officially filed a CR-101 with the Office of the Code Reviser on February 1, 2024 as WSR# 24-04-066 (PDF). The board is considering amendments to update the opioid prescribing requirements for osteopathic physicians and align with recent rule amendments by the Washington Medical Commission (WMC).
The board is considering rulemaking to possibly revise the following WACs:
Rule amendments may be needed to allow patients with Sickle Cell Disease receive the care they need in an efficient manner, provide osteopathic physicians and surgeons more clarity on when and how to taper patients to whom they prescribe opioids for chronic pain, and will provide rules that address how to work with patients that have an aberrant biological specimen test.