State Regulatory Issues

State regulations have a big impact on hospitals, health systems and their patients. WSHA tracks rulemaking activity throughout the state and works closely with regulatory agencies, as well as other groups, to advocate for a reasonable regulatory environment. All statewide rulemaking activity is published in the Washington State Register.

Click here to see WSHA’s Top Priority State Rules Tracker

(Updated: April 18, 2024)

There are several regulatory issues at the top of WSHA’s current priority list, including:

Delegation of Glucose Monitoring and Testing by an RN: The Department of Health has issued a CR-102 rulemaking related to nurse delegation of blood glucose monitoring and testing in settings other than in-home or in the community, pursuant to SHB 1124 (Chapter 14, Laws of 2022). This proposed rulemaking expands the scope of tasks that a registered nurse (RN) is authorized to delegate and broadens the authorized health care settings in which care delivery occurs. WSHA participated in the collaborative rule making process and provided significant feedback to ensure the rulemaking language was consistent with the scope of SHB 1124. WSHA will continue to monitor this rulemaking. (Katerina LaMarche).

WA HEALTH tracking system and hospital readiness reporting: The Department of Health has issued a CR-101 rulemaking considering permanent adoption of current emergency rules regarding the Washington Health Care Emergency and Logistics Tracking Hub (WA HEALTH). Permanent rule adoption would amend Title 246 WAC to require acute care hospitals licensed pursuant to 70.41 RCW and add behavioral health facilities licensed under RCW 71.24.037 to report hospital system readiness to DOH through the WA HEALTH database. WSHA intends to participate in the collaborative rule making process upon issuance of the CR-102 rulemaking. (Caitlin Safford)

Electronic visit verification rulemaking: The Health Care Authority has issued a CR-101 rulemaking to describe system requirements for electronic visit verification (EVV) for home health care services. EVV elements are federally required per Section 12006(a) of the 21st Century Cures Act. WSHA will continue to closely monitor this rulemaking and participate in the stakeholder process. (Zosia Stanley, Caitlin Safford)

State-funded guardianship, conservatorship and alternative arrangements assistance program: The Department of Social and Health Services has issued a CR-101 rulemaking to amend chapter 388-106 WAC for the implementation of a state-funded guardianship, conservatorship and alternative arrangements program. This rulemaking will put forth requirements for the program including eligibility criteria and an application process for clients or potential clients of the department. WSHA will continue to monitor this rulemaking process. (Zosia Stanley).

Temporary Practice Permits for Nurses  The Washington state board of nursing (board) has released a CR 102 proposal to align the issuance of temporary practice permits with the board’s process, and to implement 2SHB 1009 (chapter 165, Laws of 2023).

Nurse applicants (LPNs, RNs, ARNPs) from outside of the state are required to complete a national fingerprint background check prior to licensure. Current practice is to issue a temporary practice permit (TPP) after an applicant meets all other licensure requirements aside from receipt of the national fingerprint background check. In the interest of public safety and to ensure that applications are completed, the board is proposing to reduce the length of time a TPP is active from 180 days to 60 days, and to reduce the TPP extension from 180 days to 30 days. Applicants will now have 90 days to complete their fingerprint background check. The board’s licensing data supports that the fingerprint process can be completed in 90 days or less.

Trauma Designation Proposed Rulemaking Withdrawn: The Washington State Department of Health previously issued a CR-102 rule with proposed amendments to the state trauma designation process for level I and II trauma services (amending WAC 246-976-580). Pursuant to two memos filed by the Department on October 31, 2023 (WSR 23-22-108, WSR 23-22-109) this proposed rulemaking has been withdrawn due to stakeholder feedback received in opposition. (Zosia Stanley)

Clean Buildings Emergency Rulemaking: The Department of Commerce issued an emergency rulemaking, with the intent to make it a permanent rule, related to applying for an exemption for Tier 1 Clean Buildings law compliance. Building owners will now have 3 years prior to their scheduled compliance date to apply for an exemption compared to the original 1 year application period. For full details, visit WSHA’s bulletin on the rulemaking.  (Remy Kerr)

Health Care Worker Unemployment Eligibility During a Public Health Emergency- WSHA successfully advocated for the Washington State Employment Security Department to align its’ final regulations on health care workers’ unemployment eligibility during a declared public health emergency with the underlying law passed via SB 5190 (2021). SB 5190 established unemployment insurance benefits for health care workers who quarantine because of contraction of or exposure to the disease that is the subject of a declared public health emergency. However, ESD’s initial draft did not align with statute and could have created unintended consequences for hospitals and other health care employers. WSHA’s advocacy resulted in final rules that reflect the statutory language, which ensures SB 5190 is implemented as intended. Please see WSHA’s bulletin on SB 5190 for more information about the law and the text of the final rules for the specific conditions regarding health care workers’ eligibility for unemployment insurance during a declared public health emergency.  (Remy Kerr)

OIC issues final rule implementing HB 1688 Balance Billing – The Washington State Office of the Insurance Commissioner (OIC) has issued its final CR-103 rule to implement E2SHB 1688. The rule aligns portions of the state’s Balance Billing Protection Act as amended by E2SHB 1688 with the federal No Surprises Act. 

OIC made significant changes to the definition of “outpatient hospital department” to the rule in response to WSHA’s comments, though the final rule does not reflect the exact language we requested. WSHA was concerned that definition could be improperly applied to non-hospital locations or freestanding clinics affiliated with a hospital or health system.  However, we are assured that the OIC’s Concise Explanatory Statement indicates the definition in the final rule is limited to hospital ownership/licensure and other relationships in which the outpatient service is financially integrated into that of the hospital. (Andrew Busz)

Contracting – In May, the Washington State Health Care Authority (HCA) finalized its rulemaking for enforcement of the requirement under Senate Bill 5377 that hospitals contract with at least one public option plan if they receive an offer from a carrier. WSHA had submitted comments during the rulemaking process. While HCA adopted some of WSHA’s suggested changes, we are disappointed it did not adopt others, particularly WSHA’s requests that hospitals not be subjected to the investigation process if they can document that they are contracted with at least one public option plan and that carriers be required to used precise terminology to identify public option plans in their offers. As a result, we recommend hospitals exercise care regarding their communications and negotiations with carriers that may include a public option plan. Additional information and recommendations are in our recent bulletin. (Andrew Busz)

Audio-Only Telemedicine – The Health Care Authority (HCA) issued a CR 102 proposal as part of the rulemaking process related to audio-only telemedicine under ESSB 1196. ESSB 1196 builds upon Washington state’s telemedicine payment parity laws by requiring that reimbursement for audio-only telemedicine be paid at the same rate that would be paid to the provider if the health care services were provided in person. ESSB 1196 increases access to remote care for patients who are currently unable to connect to audio-visual telemedicine visits, while ensuring that audio-only telemedicine is used as a supplemental tool for care.  WSHA commented on HCA’s preproposal draft rule with suggested changes to ensure alignment with the authorizing law and with generally accepted health care practices and standards. We were successful in aligning the proposal with statute regarding an associated visit for behavioral health services conducted through store and forward technology. We are also successful in clarifying some of the recordkeeping requirements. However, we will continue to advocate for the rules to align with the statute.

Please see WSHA’s comment letter to read more about WSHA’s position on the proposed rules. 

Please see WSHA’s bulletin for more information about ESSB 1196. WSHA will continue to work with members and the HCA throughout the rulemaking process. (Remy Kerr)

Prescription Drug Locker Guidance- The Pharmacy Quality Assurance Commission (PQAC) issued a guidance document regarding prescription drug pick up lockers. According to the document, PQAC “interprets its laws and rules to permit pharmacies to use pharmacy-owned lockers to deliver filled prescriptions for noncontrolled drugs, without the lockers being included as part of the pharmacy’s license. Pharmacies should be aware of specific laws and rules that apply to the delivery of filled prescriptions for non-controlled drugs, including WAC 246-945-415(1) which requires pharmacies to take appropriate measures when delivering filled prescriptions to ensure product integrity and receipt by the patient or patient’s agent.” Click here to access the full guidance document. (Remy Kerr)

New DEA Guidance on Schedule II Prescriptions- The Pharmacy Quality Assurance Commission (PQAC) issued a bulletin that contains the latest guidance from the Drug Enforcement Administration (DEA) regarding modifications to a schedule II prescription. DEA’s new guidance states, “Schedule II controlled substance prescriptions must contain all the information required in 21 CFR § 1306.05(a), and licensed pharmacists may add or modify Schedule II prescription information if consistent with state regulations or policy after oral consultation with a prescriber.” PQAC “interprets its laws and rules, and DEA’s laws, rules, and guidance, to permit a pharmacist to adapt a prescription for a controlled substance in Schedule II in accordance with WAC 246-945-335 after oral consultation with the prescriber. WAC 246-945-335 permits a pharmacist to: change the quantity (WAC 246-945-335(1)), change the dosage form (WAC 246-945-335(2)), or complete missing information (WAC 246-945-335(3)) if certain criteria are met. DEA guidance requires that any adaptation of a prescription for a controlled substance in Schedule II be in compliance with the commission’s laws and rules and after the pharmacist has had an oral consultation with the prescriber. If a pharmacist wants to adapt a prescription for a controlled substance in Schedule II in a manner that does not meet the criteria in WAC 246-945-335, then the pharmacist is required to obtain a new prescription from the prescriber that complies with WAC 246-945-010, WAC 246-945-011 and 21 C.F.R. § 1306.05(a).” Click here to read PQAC’s full bulletin regarding DEA’s new guidance. (Remy Kerr)

Hospital Data Reporting and Transparency – The Department of Health (DOH) has issued a final rulemaking, CR-103, to implement aspects of E2SHB 1272, related to patient demographic data required to be reported to the Department of Health (DOH) via the Comprehensive Hospital Abstract Reporting System (CHARS). The new demographic data reporting requirements apply to acute care hospitals licensed under chapter 70.41 RCW and behavioral health hospitals licensed under chapter 71.12 RCW.

Beginning on January 1, 2023, hospitals must report patient demographic information to the department via CHARS. This rulemaking requires hospitals to ask patients how they identify their race, ethnicity, gender identity, sexual orientation, preferred language, and disability status and report their responses via CHARS While hospitals are required to ask for the information, patient responses are voluntary. Hospitals must notify patients that their responses are voluntary.

The department is also required to develop a waiver and grant process to assist hospitals that are certified by the Centers for Medicare and Medicaid Services (CMS) as a critical access hospital, certified by CMS as a sole community hospital, or qualify as a Medicare dependent hospital to comply with the requirements. The department recently sent communications to eligible hospitals indicating that the application form for grants and waivers will be available on October 1, 2022 and were due by October 15, 2022.

Please see WSHA’s bulletin on the rulemaking for more information. WSHA actively participated in the legislative debate over E2SHB 1272 as well as participated in and commented on the rulemaking process. (Ashlen Strong)

Certificate of Need– The Washington State Department of Health has started to engage in rulemaking for the Certificate of Need (CN) program. The department is taking two tracks in this current rulemaking. Track 1 involves targeted changes to the Hospice methodology and the Percutaneous Coronary Intervention Volume Standards (PCI) methodology. DOH is currently hosting workshops on these targeted changes, however the PCI rulemaking is “on hold pending review of feedback received.” WSHA is neutral on these proposed changes but is monitoring to ensure that the processes used by DOH allow for active hospital engagement. Track 2 involves broader changes to the CN program “to clarify, streamline, and modernize language including need methodologies.”

Track 2 is the continuation of the CR 101 that was issued in December 2019, but sidelined due to the COVID-19 pandemic. All of the latest information about the CN rulemaking can be found on DOH’s CN website. (Remy Kerr)

Charity Care The Washington State Department of Health (DOH) intends to begin rulemaking this summer to amend the state’s charity care regulations (WAC 246-453) following updates to state charity care law made by the legislature in 2022 by HB 1616 and in 2018 in SB 6273. While rulemaking was previously started for the 2018 law change, no rulemaking was ever completed. For more information on HB 1616 please see our recent bulletin. You can find WSHA’s 2018 bulletin on SB 6273  here. The DOH plans to hold workgroups with stakeholders in order to develop the draft language, and WSHA will actively participate in order to represent the interests of hospitals. If you are a member and are interested in joining our workgroup to participate in or be kept up to date on this rulemaking, please contact Cara Helmer. (Cara Helmer)

Prescription Label Translation– The Pharmacy Quality Assurance Commission (PQAC) issued a CR 101 in April to commence rulemaking for prescription label standards that will cover both language and disability accessibility standards. PQAC is currently in the first stages of stakeholder engagement in this rulemaking and has not specified a completion deadline. Current engagement steps are:

  • WSHA has asked the PQAC to consider hosting a hospital-specific stakeholder meeting to address our unique concerns and considerations.
  • Specific questions or feedback about this rulemaking can be sent to

This rulemaking will occur in place of HB 1852, which died at the end of the 2022 legislative session. HB 1852 would have created a statutory requirement for prescription label translations and contained specific requirements for pharmacies and PQAC. The bill was laudable in that it sought to offer prescription labels in additional languages, but unfortunately it created operational challenges for hospitals and health systems as written. WSHA will work to ensure that rules adopted by PQAC reflect the amendments and address other concerns raised by hospitals during the legislative session. In preparation for the rulemaking, WSHA will convene a Hospital Pharmacy Workgroup to participate in the regulatory process. Hospitals that would like to participate in the workgroup should email Remy Kerr for additional information. (Remy Kerr)

Acute Care Hospital Fines- The Department of Health has issued a CR 102 proposal as part of the rulemaking process to implement HB1148. HB1148 increased DOH’s oversight and enforcement abilities over acute care hospitals licensed under 70.41 RCW. The rulemaking, once complete, will create a fine matrix to establish fines that DOH will have the option to assess against hospitals based on the severity and scope of violation. 

Please see WSHA’s bulletin for more information about HB1148.

DOH has previously released CR101 draft language which can be previewed here. WSHA worked closely with DOH on editing the CR101 draft language, though a series of workshops with stakeholders. The CR 102 language reflects the work that went into that process. WSHA will continue to work with members and the DOH to support hospital interests through this rulemaking process. (Cara Helmer) 

Whistleblower Complaints in Healthcare Settings – DOH has issued a CR 102 proposal that contains updates to protections provided to “whistleblowers” that report to DOH or who initiate, participate, or cooperate in investigations which raise quality of care concerns. The rules establish rights of whistleblowers and procedures for filing, investigation, and resolution of whistleblower complaints. WSHA has been actively engaged in the rulemaking process. This rulemaking is in response to the passage of SHB1049 in 2019.  Please see WSHA’s bulletin on SHB1049 for more information on the law and WSHA’s participation in the legislative process. (Cara Helmer)

L&I Employment Law Webinars- Washington State’s Department of Labor & Industries announced a series of educational webinars about key state employment laws. According to L&I, “The sessions cover worker’s rights, white-collar overtime rules, isolated worker protections and the Equal Pay and Opportunities Act.” Each session will last approximately 45 minutes and includes time for Q&A. L&I’s announcement is available here and interested participants can register for the webinars through L&I’s webpage. (Remy Kerr)

Semi-Annual Rulemaking Agendas– Several state agencies relevant to hospitals issued their semi-annual rulemaking agendas. The agendas show what rules are currently in progress and what rules are forthcoming this year. Click the agency below to view its’ agenda:

Note: the DOH agenda includes rules for the Washington Medical Commission, State Board of Health, Pharmacy Quality Assurance Commission, and Nursing Care Quality Assurance Commission. (Remy Kerr)

Click here to see WSHA’s Top Priority State Rules Tracker – **2024 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2023 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2022 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2021 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2020 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2019 Completed Rules**

Click here to see WSHA’s Top Priority State Rules Tracker – **2018 Completed Rules**


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