Rule-Making Activity

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) 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.

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 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. 

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 Board of Optometry adopted an amendment to WAC 246-851-490 that removes the jurisprudence (JP) examination requirement from initial licensure. The board is also adopting amendments to WAC 246-851-090 that adds the JP exam as a requirement for a licensed optometrist’s first full CE reporting period, allowing it to count for a maximum of three hours within the existing CE hour requirements.

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) is proposing rule amendments to WAC 246-827-0010, 246-827-0200, and 246-827-0240 to align rules with updated statutes and best practices. DOH is also proposing 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

The Washington State Department of Health (DOH) adopted 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.

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.