Rule-Making Activity

Submit Written Comments to: Vicki Brown, P.O. Box [47852], Olympia, WA [98504-]7852, email vicki.brown@doh.wa.gov, fax 360-236-2901, by July 14, 2023.

Assistance for Persons with Disabilities: Contact Vicki Brown, phone 360-236-4865, fax 360-236-2901, TTY 711, email vicki.brown@doh.wa.gov, by June 30, 2023.

The Dental Quality Assurance Commission is adopting amendments to requirements for the administration of anesthetic agents for dental procedures to reflect changes in patient care standards since the rule was adopted. The amendment includes changes and additions to pediatric protocols, emergency and on-call protocols, education, training, and medications including prescribing, administration and dosage.

Standards of care have changed since the current rule was adopted and a complete review was necessary. Creating a pediatric sedation endorsement is necessary to provide safeguards for the unique sedation needs of pediatric patients.

The adopted rule amendments require 24 hour on-call availability, update basic life support education requirements, add requirements for emergency protocols and training, clarify requirements for record keeping and emergency medications, establish requirements for self-inspections for all dentists when anesthetic is administered, update requirements for on-site inspections for dentists with moderate sedation with parenteral agents or general anesthesia permits, create a pediatric sedation endorsement, require vital sign monitoring for pediatric patients, clarify the requirement to obtain vital signs on American Society of Anesthesiologist classification ASA I age 13 and under will be at the dentist’s discretion, clarify requirements for prescribing for patient dosage prior to the appointment and specify that electrocardiogram (EKG) monitoring is not required when a pediatric patient is uncooperative or the emotional condition means monitoring is not possible or the patient does not tolerate the monitoring pads.

The commission made the following edits upon adoption:

• The date in WAC 246-817-765 (1) was changed from “January 1, 2024” to “January 1, 2025”.
• The word “and” was added to WAC 246-817-765(3)(c)(ii)(B)(V). 
• The word “or” was removed from WAC 246-817-740(1)(a) and (1)(b).

The Department of Health is considering changes to requirements for adult elective PCI programs in response to a rulemaking petition. The petition requests amendment of WAC 246-310-720(2), to eliminate the requirement that existing PCI programs in the planning area must meet the minimum volume standard before a new elective PCI program may be approved. The department will also consider amendments to other PCI rules, as part of this rule project.

Amending WAC 246-840-010, 246-840-340, 246-840-342, and other related sections in chapter 246-840 WAC. The Washington State Board of Nursing is considering amendments to education requirements for ARNP licensure in response to the Joint Administrative Rules Review Committee’s (JARRC) recommendation.

Second Substitute House Bill 1724 (chapter 425, Laws of 2023) made several immediate changes impacting behavioral health agencies, including amending the definition of “mental health professional” (MHP) and to establish two new credentials, the certified agency affiliated counselor (C-AAC) and the licensed agency affiliated counselor (L-AAC). This emergency rule continues without changes to the original emergency rule package while permanent rule making is in progress.

Eric Hernandez
360-236-2956

Submit Written Comments to: Becky McElhiney, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2850,

The Department of Health is proposing to update and clarify Applied Behavior Analysis, chapter 246-805 WAC to: clarify licensure requirements, supervision, examinations, educational programs, training, and continuing education. This proposal also establishes reciprocity, temporary licenses and updates fees.

The Veterinary Board of Governors is adopting an amendment to WAC 246-935-060 Eligibility for examination as a veterinary technician, to clarify that a registered apprenticeship program is an approved post-secondary educational pathway to qualify for licensure exams as a veterinary technician.

The Department of Health is adopting an amendment to WAC 246-916-060 to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021), codified as RCW 43.70.613. The department is adopting the health equity model rules, WAC 246-12-800 through 246-12-830, for the athletic trainer profession to comply with the statute.

The Department of Health, in consultation with the Athletic Training Advisory Committee, is proposing to create a new section of rule, WAC 246-916-070 Medications, to define terms used and establish education and training requirements for athletic trainers in response to Substitute House Bill 1275, (chapter 143, Laws of 2023).

The Department of Health, in consultation with the Board of Hearing and Speech, is proposing a new section of rule, WAC 246-828-991, to implement House Bill (HB) 1001, (chapter 53, Laws of 2023). HB 1001 entered Washington into the ASLP-IC interstate licensure compact for audiologists and speech-language pathologists and gives member states the discretion to charge a fee for granting compact privileges. The proposed rule specifies the fees and renewal cycle for compact practice privileges in Washington state.

The Board of Hearing and Speech (board) adopted a new rule, WAC 246-828-505, and amended WAC 246-828-510 to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The board adopted and exceeded the health equity model rule minimum standards. The board’s adopted rules require two hours of health equity education to be completed every three years as part of the current CE requirements for the professions. The adopted rules do not increase total CE hours but require two hours of health equity CE be absorbed into the existing CE hour requirements. This exceeds the minimum two hours of health equity education required every four years in the model rules.

The Department of Health is considering amendments to WAC 246-835-010 and WAC 246-835-025 to clarify the definition of “culturally congruent care” and to ensure education and training requirements related to “culturally congruent care” are clear.

The Department of Health is considering amendments to the birth doula certification requirements in WAC 246-835-040, Applicants currently certified in other states or territories, to comply with Second Substitute House Bill (2SHB) 1724 (chapter 425, Laws of 2023).

Rescission of Interpretive Statement BON 21-01, Continuing Education Pharmacology Documentation. Filed February 8, 2024.

The board is rescinding this interpretive statement because the board has adopted amendments to WAC 246-836-080 Continuing competency program, that clarify what forms of documentation are acceptable to verify meeting the pharmacology continuing education requirements. Thus, the interpretive statement is no longer necessary.

Individuals requiring information on this rule should contact Rachel Phipps, program manager, phone 564-233-1277, email naturopathy@doh.wa.gov.

Policy Number: OD 24-01. Allowances for in-person continuing education for licensed optometrists who have a continuing education reporting date in year 2024. Effective Date: March 1, 2024.

Becky McElhiney

PO Box 47852 Olympia, WA 98504-7852
360-236-4766

Agency:Department of Health - Board of Physical Therapy 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.
☐ Other (specify) (If less than 31 days after filing, a specific finding under RCW 34.05.380(3) is required and should 
be stated below)
Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☐ Yes ☒ No If Yes, explain: 
Purpose: Changing English test passing scores and removing a requirement related to an accredited program for licensure 
as a physical therapist. The Board of Physical Therapy (board) is adopting amendments to WAC 246-915-120 – Foreign 
educated applicants to change the Test of English as a Foreign Language (TOEFL) minimum passing scores. Washington 
state’s current passing score requirements were originally established based on the Federation of State Boards of Physical 
Therapy (FSBPT) passing score recommendation. The FSBPT’s minimum passing score recommendations have since been 
updated. To align with the FSBPT’s recommendation, the board is adopting this rule to lower the minimum passing score for 
the writing and speaking tests and raise the minimum passing score requirements for the reading and listening tests. The 
board is also adopting amendments to remove the requirement that an applicant’s first professional degree must only be from 
a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited program, in order to allow applicants who 
went on to pursue additional professional degrees in physical therapy through a CAPTE accredited program to pursue 
licensure outside of the foreign-educated pathway. 
Citation of rules affected by this order:
New: None 
Repealed: None 
Amended: WAC 246-915-120 
Suspended: None 
Statutory authority for adoption: RCW 18.74.023 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-08-031 on March 28 2023 (date).
Describe any changes other than editing from proposed to adopted version: None. 
If a preliminary cost-benefit analysis was prepared under RCW 34.05.328, a final cost-benefit analysis is available by 
contacting:
Name: Allyson McIver 
Address: PO Box 47877 Olympia, WA 98504-7877 
Phone: 360-236-2878 
Fax: 360-236-2901 
TTY: 711 
Email: physical.therapy@doh.wa.gov 
Web site: doh.wa.gov 
Other:

The Department of Health is considering amending WAC 246-10-501 to include applicants for interstate license compacts, milk banks, and 988-line crisis call centers to the list of applicant types who are eligible for brief adjudicated proceedings as a due process recourse if their application is denied.

Rule making notices will be delivered via GovDelivery. To receive notices, interested persons may sign up for any or all of the lists. Please go to: https://public.govdelivery.com/accounts/WADOH/subscriber/new. After signing in, please click open the box labeled "Health Systems Quality Assurance." Next click open the box labeled "Health Professions." From there, check the Medical Cannabis Program box. You may also check any other box of the professions listed that you may be interested in.

Shannon Angell

PO Box 47860

Olympia, WA 98504-7860

Phone: 360-236-2820

Email: shannon.angell@doh.wa.gov

Date of intended adoption: 9/20/23 (Note: This is NOT the effective date)
Submit written comments to: Assistance for persons with disabilities:
Name: Ted Dale Contact Ted Dale
Address: Office of Health Professions 
PO Box 47850
Olympia, WA 98504 
Phone: 360-236-2991
Email: https://fortress.wa.gov/doh/policyreview Fax: N/A
Fax: N/A TTY: 711
Page 2 of 4
Other: www.doh.wa.gov Email: ted.dale@doh.wa.gov
By (date) 9/13/23 Other: www.doh.wa.gov
By (date) 8/30/23 
Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12Purpose of the proposal and its anticipated effects, including any changes in existing rules: 
RCW 43.70.613(3)(b) directs the rule-making authority for each health profession licensed under Title 18 RCW that is subject 
to continuing education to adopt rules requiring a licensee to complete health equity continuing education training at least 
once every four years. The statute also directs the department to create model rules establishing the minimum standards for 
health equity CE programs. The department filed model rules for health equity CE minimum standards on November 23, 
2022, under WSR 22-23-167. Any rules developed for the department must meet or exceed the minimum standards in the 
model rules in WAC 246-12-800 through 246-12-830.
The department is proposing to amend WAC 246-810-027 and create new section WAC 246-810-0299 to implement ESSB 
5229. The department is proposing adopting the health equity model rules, WAC 246-12-800 through 246-12-830, for 
certified counselors and certified advisers to comply with RCW 43.70.613. 
The proposed rule adds two hours of health equity education, as required in the model rules, to be completed as part of the 
current continuing education requirements every four years. The proposed rule does not change total CE hours but requires 
two hours in health equity CE every four years, which is absorbed into the existing number of CE hours required. The health 
equity CE requirement is counted under existing, unspecified CE requirements for the profession.
Additionally, the department is proposing amendments to clarify and streamline WACs 246-810-027 and 246-810-0298.
These proposed amendments will remove unnecessary or outdated details about the required suicide prevention trainings.
Reasons supporting proposal: 
The goal of health equity CE is to equip health care workers with the skills to recognize and reduce health inequities in their 
daily work. The content of health equity trainings includes implicit bias trainings to identify strategies to reduce bias during
assessment and diagnosis in an effort to address structural factors, such as bias, racism, and poverty, that manifest as health 
inequities. 
Two hours of training allows individuals to gain a foundation in health equity that can have an immediate positive impact on 
the professional’s interaction with those receiving care. Health equity training enables health care professionals to care 
effectively for patients from diverse cultures, groups, and communities, varying race, ethnicity, gender identity, sexuality, 
religion, age, ability, socioeconomic status, and other categories of identity. The two hours of health equity CE credits may be 
earned as part of the health professional’s existing CE requirements, therefore not requiring completion of additional CE 
hours.
 
Statutory authority for adoption: RCW 43.70.613 and 18.19.050 
Statute being implemented: RCW 43.70.613, ESSB 5229 (chapter 276, Laws of 2021)

John Hilger
360-236-2929

The Chiropractic Quality Assurance Commission is adopting the Department of Health equity model rules to implement Engrossed Substitute Senate Bill (ESSB) 5229 (chapter 276, Laws of 2021). The adopted rule establishes minimum standards for chiropractors of two hours of health equity continuing education (CE) every four years. The rule as adopted does not change the total number of CE hours but requires two hours in health equity CE every four years within the existing number of CE hours required.

Policy Statement CH-24-03-014 (PDF). The Washington State Chiropractic Quality Assurance Commission issued a policy statement stating that an Individual’s holding a chiropractic license in “inactive” status, and endorsement or expired credential reissuance applicants are not required to take and pass the jurisprudence examination if the applicant holds an active credential recognized as having substantially equivalent standards. Effective Date: March 14, 2023.

The Chiropractic Quality Assurance Commission adopted rules concerning chiropractic X-ray technicians including: updates to course requirements; who can be approved to instruct the course; and set new requirements for obtaining, maintaining and returning from expired status. The commission also adopted health equity continuing education requirements. Amends WAC 246-808-201, creates new sections WAC 246-808-203, WAC 246-808-205, WAC 246-808-207, WAC 246-808-209, and WAC 246-808-211, and repeals WAC 246-808-215.

The Chiropractic Quality Assurance Commission is proposing changes to rules concerning chiropractic X-Ray technicians' course requirements including who can instruct the course, and updating the requirements for obtaining, maintaining, and returning from expired status. The commission is also adopting health equity continuing education requirements to reflect requirements in Engrossed Substitute Senate Bill 5229 (ESSB) (chapter 276, Laws of 2021). WAC 246-808-201, 246-808-203, 246-808-205, 246-808-207, 246-808-209, WAC 246-808-211 and repealing 246-808-215. 

The Pharmacy Quality Assurance Commission is considering amending WAC 246-945-507 to add certain intramammary antibiotic formulation drugs to the list of approved legend drugs in response to a petition from a veterinarian at the Washington Department of Fish and Wildlife (WDFW).

The Pharmacy Quality Assurance Commission is proposing to amend WAC 246-945-507 to add four intramammary antibiotics to the list of approved legend drugs in chapter 246-945 WAC in response to request from Washington State Department of Fish and Wildlife.

The Department of Health is proposing amending WAC 246-290-100, Water system plans, to add the climate resilience element as a requirement for public water systems with one thousand or more connections. The proposal also makes editorial changes to align with the Code Reviser’s 2023 Bill Drafting Guide.

Susan Gragg

PO Box 47852 Olympia, WA 98504-7852

naturopathy@doh.wa.gov

360-236-4941

Heather Cantrell

Agency: Department of Health 
Effective date of rule:
Permanent Rules
☒ 31 days after filing.

Any other findings required by other provisions of law as precondition to adoption or effectiveness of rule?
☒ No
Purpose: The Department of Health (department) adopts revisions to the Death with Dignity Act requirements in chapter 
246-978 WAC that reflect (1) the amendments made during the 2023 legislative session and (2) the writing style described in 
the 2023 Bill Drafting Guide.
Engrossed Substitute Senate Bill (ESSB) 5179 did the following:
• In RCW 70.245.010, made changes to multiple definitions.
o “Attending physician” became “attending qualified medical provider”.
o “Consulting physician” became “consulting qualified medical provider”.
o Added independent clinical social worker, advanced social worker, mental health counselor, psychiatric 
advanced registered nurse practitioner to the “counseling” definition.
o Removed the definition of “physician”.
o Added a definition of “qualified medical provider” that includes physician, physician assistant, and advanced 
registered nurse practitioner.
• Changed the terms used throughout chapter 70.245 RCW to match the terms defined in RCW 70.245.010.
• In RCW 70.245.030, removed the long-term care facility witness requirement in subsection (4).
• In RCW 70.245.150, expanded how participating providers may send forms to the department. Now the department 
can accept forms electronically and by fax.
WAC 246-978-010 duplicates the definitions in statute, which means that the department must update definitions every time 
the legislature changes the definitions. The department adopts replacement of duplicate definitions with a cross-reference to 
statute and removal of definitions no longer in use.
WAC 246-978-020 describes how participating providers must report to the department as required by RCW 70.245.150(2). 
The department adopts three changes:
• Replacing “physician” with “qualified medical provider”.
• Replacing the mailing address with “electronically, by mail, or fax”.
• Removing the publication number after the form name.
WAC 246-978-030 duplicates language in RCW 70.245.150(2). The department repeals WAC 246-978-030 to remove the 
duplication and prevent potential conflicts between statute and rule.
WAC 246-978-040 describes who can be a witness for a patient living in a long-term care facility. ESSB 5179 repealed the 
witness requirement for a long-term care facility described in RCW 70.245.030(4). The department repeals WAC 246-978-
040 because statute no longer requires it.
The department also adopts style changes throughout chapter 246-978 WAC that do not change the meaning of the rule. 
Page 2 of 3
Citation of rules affected by this order:
New: 
Repealed: WAC 246-978-030; WAC 246-978-040 
Amended: WAC 246-978-010; WAC 246-978-020 
Suspended: 
Statutory authority for adoption: ESSB 5179 (Chapter 38, Laws of 2023); Chapter 70.245 RCW 
Other authority: 
PERMANENT RULE (Including Expedited Rule Making)
Adopted under notice filed as WSR 23-12-093 on June 06, 2023 (date).
Describe any changes other than editing from proposed to adopted version: None

The Dental Quality Assurance Commission is considering adding residential habilitation centers, nursing homes, and long-term hospitals to the list of opioid prescribing exclusions in WAC 246-817-905 Exclusions.

The Dental Quality Assurance Commission is proposing amending WAC 246-246-817-440, Dental continuing education requirements, and WAC 246-817-445, Dental Anesthesia Assistant continuing education requirements, to establish health equity continuing education (CE) requirements to implement Engrossed Substitute Senate Bill (ESSB) 5229.

Purpose: The Dental Quality Assurance Commission (commission) is adopting amendments to update rules regarding health profession monitoring programs in line with the passage of Substitute Senate Bill (SSB) 5496. SSB 5496 updated terminology, definitions, and references for dentists in RCW 18.32.534 and clarified confidentiality protections in RCW 18.131.070 for health professional monitoring programs. The adopted rules in WAC 246-817-801, 236-817-810, 246-817- 820, and 246-817-830 make technical amendments to align with changes required from SSB 5496 without changing the effect.

The Department of Health is proposing health equity model rules for dental hygienists to comply with RCW 43.70.613. The proposed rule adds two hours of health equity education, as required in the model rules, to be completed as part of the current continuing education requirements every four years. The proposed rule does not change total CE hours but requires two hours in health equity CE every four years which is absorbed into the existing number of CE hours required. The health equity CE requirement is counted under existing, unspecified CE requirements for the profession.

The goal of health equity CE is to equip health care workers with the skills to recognize and reduce health inequities in their daily work. The content of health equity trainings include implicit bias trainings to identify strategies to reduce bias during assessment and diagnosis in an effort to address structural factors, such as bias, racism, and poverty, that manifests as health inequities.

Two hours of training allows individuals to gain a foundation in health equity that can have an immediate positive impact on the professional’s interaction with those receiving care. Health equity training enables health care professionals to care effectively for patients from diverse cultures, groups, and communities, varying race, ethnicity, gender identity, sexuality, religion, age, ability, socioeconomic status, and other categories of identity. The two hours of health equity CE credits may be earned as part of the health professional’s existing CE requirements, therefore not requiring completion of additional CE hours. 

The Dental Quality Assurance Commission adopted health equity continuing education requirements to meet the requirements of the Department of Health’s equity model rules, WAC 246-12-800 through 246-12-830. The amended rules add two hours of health equity education, to be completed as part of the current continuing education requirements every three years.

The Dental Quality Assurance Commission is proposing amending WAC 246-817-150 to remove specific references about granting licenses to University of Washington faculty and replacing this with a reference to a faculty of any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA).

The Dental Quality Assurance Commission is adopting amendments to update rules regarding out-of-state licensure in line with Senate Bill 5113 (chapter 89, Laws of 2023) to include any institution of higher education in Washington state accredited by the Commission on Dental Accreditation (CODA) for faculty licensure.

The Department of Health is considering establishing a new chapter of rules, chapter 246-819 WAC, for the dental therapist profession to implement Engrossed Substitute House Bill (ESHB) 1678 (Chapter 460, Laws of 2023).

The Board of Denturist adopted requirements in WAC 246-812-462 for the use of placement of prefabricated implant abutments. The adopted rule establishes the requirements that are to be followed for a licensed denturist to place a prefabricated implant abutment on an implant for the purpose of fabricating, repairing, relining, or rebasing a denture. The board also amended WAC 246-812-501 to ensure that a licensed denturist develop and maintain written infection control policies, procedures, and requirements for infection prevention and control that are appropriate for the denturist services provided by the facility.

The Board of Denturists (board) is proposing a new section of rule, WAC 246-812-462 - Prefabricated implant abutments, to set out the requirements for the placement of prefabricated implant abutments. The board is also proposing amending the infection control standards purpose statement in WAC 246-812-50 to ensure written policies and procedures are maintained.