Effective Date of Rule: July 1, 2013.

     Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: Under RCW 18.360.080, on July 1, 2013, the department of health must cease issuing health care assistant credentials, and must begin issuing medical assistant credentials as provided in these rules.

     Purpose: Chapter 246-827 WAC, Medical assistants (new) and amending WAC 246-826-990 Health care assistant fees and renewal cycle. Adopting new and amended rules to implement four new medical assistant credentials created by ESSB 6237 (2012), and to describe how individuals with an active health care assistant credential on July 1, 2013, will transition to three of the new medical assistants credentials.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-826-990.

     Statutory Authority for Adoption: Chapter 18.360 RCW, RCW 43.70.280, chapter 153, Laws of 2012.

      Adopted under notice filed as WSR 13-08-083 on April 3, 2013.

     Changes Other than Editing from Proposed to Adopted Version:

Rule as proposed in WSR 13-08-083	Rule as adopted	Reason
WAC 246-827-0110 (3)(f) Delegation and supervision.      (3) A medical assistant may only accept delegated tasks when:      ...(f) The task, if performed improperly likely would not present life-threatening consequences or the danger of immediate and serious harm to the patient.	WAC 246-827-0110 (3)(f) Delegation and supervision.      (3) A medical assistant may only accept delegated tasks when:      ...(f) The task, if performed improperly by:      (i) A medical assistant-certified, medical assistant-registered, or a medical assistant-phlebotomist would likely not present life-threatening consequences or the danger of immediate and serious harm to the patient.      (ii) A medical assistant-hemodialysis technician is not likely to present life-threatening consequences or the danger of immediate and serious harm to the patient.	The change makes the rule consistent with changes to RCW 18.360.060 made by EHB [ESHB] 1515 (2013). Commenters noted that the subsection as proposed was not consistent with the bill.
WAC 246-827-0200 (1)(b) Medical assistant-certified -- Training and examination.      ...(1) Successful completion of one of the following medical assistant training programs:      ...(b) Postsecondary school or college accredited by a regional or national accrediting organization approved through the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;	WAC 246-827-0200 (1)(b) Medical assistant-certified -- Training and examination.      ... (1) Successful completion of one of the following medical assistant training programs:      ... (b) Postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;	The change clarifies that the United States Department of Education recognizes accrediting agencies, but does not approve them.
WAC 246-827-0200(2) Medical assistant-certified -- Training and examination.      Certification requirements - Applicants for a medical assistant-certified credential must meet the following requirements:      ... (2) Pass one of the following examinations within three years prior to submission of an initial application for this credential:	WAC 246-827-0200(2) Medical assistant-certified -- Training and examination.      Certification requirements - Applicants for a medical assistant-certified credential must meet the following requirements:      ... (2) Pass one of the following examinations within five years prior to submission of an initial application for this credential:	Setting a limit for when applicants may take an examination prior to application helps assure that the applicant is tested on the most current training standards. Changing the period that a medical assistant-certified applicant may take one of the available examination options from three to five years is more consistent with the national MA certification cycle for most applicants. The change will mean fewer applicants who have national MA certification will need to pay for the cost of retaking an exam prior to application, addressing concerns raised by some commenters.
WAC 246-827-0220 (1)(d) Medical assistant-certified -- Application -- Interim certification.      (1) Application requirements - Applicants for a medical assistant-certified credential shall submit the following:      ...(d) Proof of successful completion of an approved examination under WAC 246-827-0200(2), completed within three years prior to submission of an initial application for this credential;	WAC 246-827-0220 (1)(d) Medical assistant-certified -- Application -- Interim certification.      (1) Application requirements - Applicants for a medical assistant-certified credential shall submit the following:      ...(d) Proof of successful completion of an approved examination under WAC 246-827-0200(2), completed within five years prior to submission of an initial application for this credential;	The change in subsection (1)(d) makes it consistent with the change in WAC 246-827-0200(2), which pertains to the time limit for taking an examination. (See the row above.)
WAC 246-827-0240(3) Medical assistant-certified -- Administering medications and injections.      (3) A medical assistant-certified is prohibited from administering schedule II controlled substances, chemotherapy agents or experimental drugs.	WAC 246-827-0240(3) Medical assistant-certified -- Administering medications and injections.      (3) A medical assistant-certified is prohibited from administering:      (a) Schedule II controlled substances, chemotherapy agents or experimental drugs; or      (b) Medications through a central intravenous line.	The change in subsection (3) helps clarify what routes are prohibited as well as what medication administration routes are permitted in subsection (5) for a medical assistant-certified. This addresses a concern raised by some commenters.
WAC 246-827-0240(5) Medical assistant-certified -- Administering medications and injections.      (5) A medical assistant-certified may only administer medications by the following drug category, route and level of supervision:	WAC 246-827-0240(5) Medical assistant-certified -- Administering medications and injections.      (5) A medical assistant-certified may only administer medications by the following drug category, route and level of supervision: *A medication assistant-certified is prohibited from administering medications through a central intravenous line.	Commenters noted that in the table in subsection (5) the row for "Other legend drugs: Intravenous injections” was missing the word "peripheral” consistent with other rows in this table. The asterisked wording after the table also clarifies the intended effect of subsection (5) that a MA-C cannot administer medications via a central intravenous line. We also reordered the rows for "Other legend drugs” for consistency within the table. These changes address a concern raised by some commenters.
WAC 246-827-0310(1) Medical assistant-registered -- Endorsement.      (1) A medical assistant-registered shall have a current attestation, signed by a health care practitioner, of his or her endorsement to perform specific tasks.	WAC 246-827-0310(1) Medical assistant-registered -- Endorsement.      (1) A medical assistant-registered shall have a current attestation, that is filed with the department and signed by a health care practitioner endorsing him or her to perform specific tasks authorized in RCW 18.360.050(4).	The rule was revised to clarify that the tasks a medical assistant-registered may perform (scope of practice) are contained in statute, RCW 18.360.050(4).
WAC 246-827-0400(1) Medical assistant-phlebotomist -- Certification and training. Certification requirements.      Applicants for a medical assistant-phlebotomist credential must meet the following requirements:      (1) Successful completion of an approved phlebotomy program through an accredited postsecondary school or college;	WAC 246-827-0400(1) Medical assistant-phlebotomist -- Certification and training. Certification requirements.      Applicants for a medical assistant-phlebotomist credential must meet the following requirements:      (1) Successful completion of a phlebotomy program through a postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education;	The rule was revised to clarify that a phlebotomy program must be offered by an accredited school or college, consistent with WAC 246-827-0200. The department does not intend to approve programs offered in a postsecondary school or college.
WAC 246-827-0410(3) Medical assistant-phlebotomist -- Application. Application requirements.      Applicants for a medical assistant-phlebotomist credential shall submit the following:      ...(3) Proof of successful completion of an accredited phlebotomy program or successful completion of a phlebotomy training program as attested by the phlebotomy training program's supervising health care practitioner;	WAC 246-827-0410(3) Medical assistant-phlebotomist -- Application. Application requirements.      Applicants for a medical assistant-phlebotomist credential shall submit the following:      ...(3) Proof of successful completion of a phlebotomy program through a postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education or successful completion of a phlebotomy training program as attested by the phlebotomy training program's supervising health care practitioner;	The rule was revised to clarify who recognizes the accreditation of postsecondary schools and college[s] and make it consistent with WAC 246-827-0200 and 246-827-0400(1). The department does not intend to approve programs offered in a postsecondary school or college.

     A final cost-benefit analysis is available by contacting Brett Cain, Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4766, fax (360) 236-2901, e-mail brett.cain@doh.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 23, Amended 1, Repealed 0.

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

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, 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 23, Amended 1, Repealed 0.

     Date Adopted: May 31, 2013.

John Wiesman, DrPH, MPH

Secretary

OTS-5230.2

AMENDATORY SECTION(Amending WSR 11-20-092, filed 10/4/11, effective 12/1/11)

WAC 246-826-990   Health care assistant fees and renewal cycle.   (1) Certificates must be renewed every two years as provided in WAC 246-826-050 and chapter 246-12 WAC, Part 2.

     (2) ((If a health care assistant who holds a current active credential leaves employment with a facility or practitioner and returns to employment with a facility or practitioner that previously employed the health care assistant, and more than two years has passed since that health care assistant's employment with the previous facility or practitioner ended, the health care assistant must complete a new credential application and pay the application fee. However, that health care assistant is not required to pay the late renewal penalty and the expired credential reissuance fee.)) On July 1, 2013, all active certified health care assistant credentials will expire and be renewed as medical assistant credentials pursuant to RCW 18.360.080 and 43.70.280. The department will issue a medical assistant credential to a person who had an active health care assistant credential as of June 30, 2013. No fee will be required of the credential holder for this transition.

     (3) The following nonrefundable fees will be charged:

Title of Fee	Fee
Initial certification	$113.00
Renewal	113.00
Expired credential reissuance	55.00
Recertification	108.00
Late renewal penalty	55.00
Duplicate certificate	30.00

[Statutory Authority: RCW 43.70.110, 43.70.250, and 2011 1st sp.s. c 50. 11-20-092, § 246-826-990, filed 10/4/11, effective 12/1/11. Statutory Authority: RCW 43.70.110, 43.70.250, 2008 c 329. 08-15-014, § 246-826-990, filed 7/7/08, effective 7/7/08. Statutory Authority: RCW 18.135.030. 07-20-100, § 246-826-990, filed 10/2/07, effective 11/2/07. Statutory Authority: RCW 43.70.250, [43.70.]280 and 43.70.110. 05-12-012, § 246-826-990, filed 5/20/05, effective 7/1/05. Statutory Authority: RCW 43.70.250 and 18.135.030. 03-24-071, § 246-826-990, filed 12/1/03, effective 3/1/04. Statutory Authority: RCW 43.70.280. 98-05-060, § 246-826-990, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 43.70.250. 91-13-002 (Order 173), § 246-826-990, filed 6/6/91, effective 7/7/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-826-990, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.250. 90-04-094 (Order 029), § 308-175-140, filed 2/7/90, effective 3/10/90. Statutory Authority: RCW 18.135.030. 87-23-022 (Order PM 689), § 308-175-140, filed 11/12/87.]

OTS-5292.5

NEW SECTION
WAC 246-827-0010   Definitions.   The following definitions apply throughout this chapter unless the context clearly indicates otherwise:

     (1) "Direct visual supervision" means the supervising health care practitioner is physically present and within visual range of the medical assistant.

     (2) "Health care practitioner" means a physician licensed under chapter 18.71 RCW; an osteopathic physician and surgeon licensed under chapter 18.57 RCW; or acting within the scope of their respective licensure, a podiatric physician and surgeon licensed under chapter 18.22 RCW, a registered nurse or advanced registered nurse practitioner licensed under chapter 18.79 RCW, a naturopath licensed under chapter 18.36A RCW, a physician assistant licensed under chapter 18.71A RCW, an osteopathic physician assistant licensed under chapter 18.57A RCW, or an optometrist licensed under chapter 18.53 RCW.

     (3) "Hemodialysis" is a procedure for removing metabolic waste products or toxic substances from the human body by dialysis.

     (4) "Immediate supervision" means the supervising health care practitioner is on the premises and available for immediate response as needed.

     (5) "Legend drug" means any drug which is required by any applicable federal or state law or regulation to be dispensed on prescription only or is restricted to use by practitioners only.

     (6) "Medical assistant" without further qualification means a person credentialed under chapter 18.360 RCW as a:

     (a) Medical assistant-certified;

     (b) Medical assistant-registered;

     (c) Medical assistant-hemodialysis technician; and

     (d) Medical assistant-phlebotomist.

     (7) "Medical assistant-hemodialysis technician" means a patient care dialysis technician trained in compliance with federal requirements for end stage renal dialysis facilities.

     (8) "Secretary" means the secretary of the department of health or the secretary's designee.

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     (1) Accounting;

     (2) Insurance reimbursement;

     (3) Maintaining medication and immunization records;

     (4) Obtaining and recording patient history;

     (5) Preparing and maintaining examination and treatment areas;

     (6) Reception;

     (7) Scheduling;

     (8) Telephone and in person screening limited to intake and gathering of information; or

     (9) Similar administrative tasks.

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     (2) "Delegation" means direct authorization granted by a health care practitioner to a medical assistant to perform the functions authorized in RCW 18.360.050 which fall within the scope of practice of the health care practitioner and the training and experience of the medical assistant.

     (3) A medical assistant may only accept delegated tasks when:

     (a) The health care practitioner follows the requirements of RCW 18.360.060;

     (b) The task can be performed without requiring the exercise of judgment based on clinical knowledge;

     (c) The results of the task are reasonably predictable;

     (d) The task can be performed without a need for complex observations or critical decisions;

     (e) The task can be performed without repeated clinical assessments; and

     (f) The task, if performed improperly by:

     (i) A medical assistant-certified, medical assistant-registered, or a medical assistant-phlebotomist would not present life-threatening consequences or the danger of immediate and serious harm to the patient.

     (ii) A medical assistant-hemodialysis technician is not likely to present life-threatening consequences or the danger of immediate and serious harm to the patient.

     (4) A medical assistant may not accept delegation of acts that are not within his or her scope of practice.

     (5) A medical assistant is responsible and accountable for his or her practice based upon and limited to:

     (a) Scope of his or her education or training;

     (b) Scope of practice set forth in law and applicable sections of this chapter;

     (c) Demonstration of competency to the delegating health care practitioner;

     (d) Written documentation of competency as required by this rule and the health care employer's policies and procedures. The documentation will be maintained by the health care employer.

     (6) A medical assistant who has transitioned from a health care assistant credential as of July 1, 2013, may not accept delegated tasks unless he or she has received the necessary education or training to safely and competently perform the task.

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     (2) The medical assistant shall have knowledge and understanding of the laws and rules regulating medical assistants, including chapter 18.130 RCW, Uniform Disciplinary Act.

     (3) The medical assistant shall function within his or her scope of practice.

     (4) The medical assistant shall obtain instruction from the delegating health care practitioner and demonstrate competency before performing new or unfamiliar duties which are in his or her scope of practice.

     (5) The medical assistant shall demonstrate a basic understanding of the patient's rights and responsibilities.

     (6) The medical assistant must respect the client's right to privacy by protecting confidential information and may not use confidential health care information for other than legitimate patient care purposes or as otherwise provided in chapter 70.02 RCW, the Uniform Health Care Information Act.

     (7) The medical assistant shall comply with all federal and state laws and regulations regarding patient rights and privacy.

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     (1) Successful completion of one of the following medical assistant training programs:

     (a) Postsecondary school or college program accredited by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission of Accreditation of Allied Health Education Programs (CAAHEP);

     (b) Postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education, which includes a minimum of seven hundred twenty clock hours of training in medical assisting skills, including a clinical externship of no less than one hundred sixty hours;

     (c) A registered apprenticeship program administered by a department of the state of Washington unless the secretary determines that the apprenticeship program training or experience is not substantially equivalent to the standards of this state. The apprenticeship program shall ensure a participant who successfully completes the program is eligible to take one or more examinations identified in subsection (2) of this section; or

     (d) The secretary may approve an applicant who submits documentation that he or she completed postsecondary education with a minimum of seven hundred twenty clock hours of training in medical assisting skills. The documentation must include proof of training in all of the duties identified in RCW 18.360.050(1) and a clinical externship of no less than one hundred sixty hours.

     (2) Pass one of the following examinations within five years prior to submission of an initial application for this credential:

     (a) Certified medical assistant examination through the American Association of Medical Assistants (AAMA);

     (b) Registered medical assistant certification examination through the American Medical Technologists (AMT);

     (c) Clinical medical assistant certification examination through the National Healthcareer Association (NHA); or

     (d) National certified medical assistant examination through the National Center for Competency Testing (NCCT).

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     (a) Completed application on forms provided by the department;

     (b) Proof of completion of high school education or its equivalent;

     (c) Proof of successful completion of the required education or approved training program;

     (d) Proof of successful completion of an approved examination under WAC 246-827-0200(2), completed within five years prior to submission of an initial application for this credential;

     (e) Proof of completing seven clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;

     (f) Any fee required in WAC 246-827-990; and

     (g) Fingerprint cards for national fingerprint based background check pursuant to RCW 18.130.064(2), if requested by the department.

     (2) An applicant who has met all the requirements in subsection (1) of this section, except passage of the examination, may be issued an interim certification.

     (a) A person who has an interim certification possesses the full scope of practice of a medical assistant-certified.

     (b) A person who has an interim certification must notify their employer any time they fail any of the examinations listed in WAC 246-827-0200(2).

     (c) A person's interim certification expires upon issuance of the medical assistant-certified credential or one year after issuance of the interim certification, whichever occurs first.

     (d) A person cannot renew an interim certification.

     (e) A person is only eligible for an interim certification upon initial application.

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     (1) Drug administration shall not be delegated when:

     (a) The drug may cause life-threatening consequences or the danger of immediate and serious harm to the patient;

     (b) Complex observations or critical decisions are required;

     (c) A patient is unable to physically ingest or safely apply a medication independently or with assistance; or

     (d) A patient is unable to indicate awareness that he or she is taking a medication.

     (2) To administer medications, the delegator shall ensure a medical assistant-certified receives training concerning: Dosage, technique, acceptable route(s) of administration, appropriate anatomic sites, expected reactions, possible adverse reactions, appropriate intervention for adverse reaction, and risk to the patient. The delegator must ensure a medical assistant-certified is competent to administer the medication.

     (3) A medical assistant-certified is prohibited from administering:

     (a) Schedule II controlled substances, chemotherapy agents, or experimental drugs; or

     (b) Medications through a central intravenous line.

     (4) Except as provided in subsection (1) of this section, a medical assistant-certified may administer controlled substances in schedules III, IV, and V or other legend drugs when authorized by the delegating health care practitioner. Drugs shall be administered only by unit or single dosage or by a dosage calculated and verified by a health care practitioner. A medical assistant-certified shall only administer drugs by the level of supervision based on the route as described in subsection (5) of this section.

     (5) A medical assistant-certified may only administer medications by the following drug category, route and level of supervision:

Drug Category	Routes Permitted*	Level of Supervision Required
Controlled substances, schedule III, IV, and V	Oral, topical, rectal, otic, ophthalmic, or inhaled routes	Immediate supervision
	Subcutaneous, intradermal, intramuscular, or peripheral intravenous injections	Direct visual supervision
Other legend drugs	All other routes	Immediate supervision
	Peripheral intravenous injections	Direct visual supervision

*	A medical assistant-certified is prohibited from administering medications through a central intravenous line.

     (6) A medical assistant-certified may not start an intravenous line. A medical assistant-certified may interrupt an intravenous line, administer an injection, and restart at the same rate.

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     (1) A completed application on forms provided by the department;

     (2) Proof of completion of high school education or its equivalent;

     (3) An endorsement signed by a health care practitioner;

     (4) Proof of completing seven clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;

     (5) Any fee required in WAC 246-827-990; and

     (6) Fingerprint cards for national fingerprint based background check pursuant to RCW 18.130.064(2), if requested by the department.

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     (2) The medical assistant-registered shall only perform the tasks listed in his or her current attestation of endorsement filed with the department.

     (3) An endorsement is valid as long as the medical assistant-registered is continuously employed by the same health care practitioner, clinic or group practice.

     (4) A medical assistant-registered shall submit a new attestation of endorsement to the department within thirty days if the tasks listed on the current attestation change.

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     (1) Successful completion of a phlebotomy program through a postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education; or

     (2) Successful completion of a phlebotomy training program. The phlebotomy training program must be approved by a health care practitioner who is responsible for determining the content of the training and for ascertaining the proficiency of the trainee. The phlebotomy training program must include the following:

     (a) Training to include evaluation and assessment of knowledge and skills to determine entry level competency in the following areas:

     (i) Responsibilities to be delegated which include ethical implications and patient confidentiality;

     (ii) Patient identification process;

     (iii) Procedure requesting process, including forms used, accessing process, and collection patterns;

     (iv) Materials to be used;

     (v) Anatomic considerations for performing such functions as venipuncture, capillary finger collection, and heel sticks;

     (vi) Procedural standards and techniques for blood collection;

     (vii) Common terminology and practices such as medical classifications, standard diagnoses, test synonyms, background information on procedures, and interferences;

     (viii) Physical layout of the work place, including patient care areas; and

     (ix) Safety requirements including infection prevention and control, dealing with a client who has an infectious disease, and the handling and disposal of biohazardous materials.

     (b) Direct visual supervision by a health care practitioner or a delegated and certified medical assistant-phlebotomist to the trainee to ensure competency in the following:

     (i) Practice technique in a simulated situation;

     (ii) Observe and perform procedures on patients until the trainee demonstrates proficiency to be certified at the minimum entry level of competency. The trainee must have adequate physical ability, including sufficient manual dexterity to perform the requisite health care services. The number of specific procedures may vary with the skill of the trainee.

     (c) Documentation of all phlebotomy training, duties, and responsibilities of the trainee must be completed, signed by the supervising health care practitioner and the trainee, and placed in the trainee's personnel file.

     (d) A trainee must complete the training program and submit an application within ninety days of starting the phlebotomy training program to continue to perform procedures on patients.

     (e) Training programs that meet the requirements described in this subsection are approved by the secretary.

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     (1) A completed application on forms provided by the department;

     (2) Proof of completion of high school education or its equivalent;

     (3) Proof of successful completion of a phlebotomy program through a postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education or successful completion of a phlebotomy training program as attested by the phlebotomy training program's supervising health care practitioner;

     (4) Proof of completing seven clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;

     (5) Any fee required in WAC 246-827-990; and

     (6) Fingerprint cards for national fingerprint based background check pursuant to RCW 18.130.064(2), if requested by the department.

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     (2) A medical assistant-phlebotomist may only perform arterial invasive procedures or line draws after the following education and training is completed and documented. A medical assistant-phlebotomist's training and education must be documented on a checklist, signed by the delegating health care practitioner and the medical assistant-phlebotomist, and placed in the medical assistant-phlebotomist's personnel file. The medical assistant-phlebotomist shall complete:

     (a) Education to include anatomy, physiology, concepts of asepsis, and microbiology;

     (b) Training to perform arterial invasive procedures for blood withdrawal and line draws, including theory, potential risks, and complications;

     (c) Anatomic considerations for performing such functions as arterial puncture, line draws, and use of local anesthetic agents;

     (d) Observation of the arterial invasive procedure and line draws; and

     (e) Successful demonstration of the arterial invasive procedure and line draws under direct visual supervision of a health care practitioner.

     (3) Upon successful completion of the training described in subsection (2) of this section, a medical assistant-phlebotomist may only perform:

     (a) Arterial invasive procedures for blood withdrawal while under the immediate supervision of a supervising health care practitioner; and

     (b) Line draws if the intravenous fluid is stopped and restarted by a health care practitioner under the immediate supervision of a supervising health care practitioner.

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     (a) Proof of a high school diploma or equivalent;

     (b) Basic math skills including the use of fractions and decimal points;

     (c) Either:

     (i) Complete a hemodialysis training program as described in subsection (2) of this section; or

     (ii) Have a national credential as a hemodialysis technician which is substantially equivalent to the hemodialysis training program described in subsection (2) of this section.

     (2) The hemodialysis training program may be facility based or a state recognized training facility or institution of higher education specific to training hemodialysis technicians that meets the following requirements:

     (a) The training program must:

     (i) Be approved by the program or facility medical director and governing body;

     (ii) Be under the direction of a registered nurse;

     (iii) Be focused on the operation of kidney dialysis equipment and machines;

     (iv) Include interpersonal skills, including patient sensitivity training and care of difficult patients; and

     (v) Provide supervised clinical experience opportunities for the application of theory and for the achievement of stated objectives in a patient care setting. The training supervisor must be physically accessible to the hemodialysis technician when the hemodialysis technician is in the patient care area.

     (b) The training program must cover the following subjects:

     (i) Principles of dialysis and fluid management;

     (ii) Care of patients with kidney failure, including interpersonal skills;

     (iii) Dialysis procedures and documentation, including initiation, proper cannulation techniques, use of central catheters, monitoring, and termination of dialysis;

     (iv) Use and care of hemodialysis accesses;

     (v) Common laboratory testing procedures and critical alert values;

     (vi) Possible complications of dialysis and dialysis emergencies;

     (vii) Water treatment and dialysate preparation;

     (viii) Infection control;

     (ix) Use of hazardous chemicals;

     (x) Safety;

     (xi) Dialyzer reprocessing, if applicable; and

     (xii) Use of medications used in dialysis and their side effects.

     (c) The medical assistant-hemodialysis technician applicant, upon completion of the hemodialysis training program, must demonstrate competency of the following:

     (i) Dialysis procedures and documentation, including initiation, proper cannulation techniques, central catheter techniques, monitoring, and termination of dialysis;

     (ii) Operation of hemodialysis equipment;

     (iii) Calculation of patient fluid removal and replacement needs;

     (iv) Preparation and mixture of additives to hemodialysis concentrates as required by facility procedure based on patient prescription;

     (v) Preparation and administration of heparin and sodium chloride solutions and intradermal, subcutaneous, or topical administration of local anesthetics during treatment in standard hemodialysis doses;

     (vi) Provide initial response to patient complications and emergencies prior to, during, and after treatment per facility procedures including, but not limited to, the administration of normal saline per facility protocol;

     (vii) Use and care of hemodialysis vascular accesses;

     (viii) Administration of oxygen; and

     (ix) Initiation of cardiopulmonary resuscitation.

     (d) Technicians who perform monitoring and testing of the water treatment system must complete a training program that has been approved by the facility medical director and governing body.

     (e) The training program may accept documentation of a medical assistant-hemodialysis technician's successful completion of training objectives in another dialysis facility or accredited academic institution if it is substantially equivalent to the core competencies described in this subsection. The dialysis facility that accepts the documentation assumes responsibility for confirming the core competency of the medical assistant-hemodialysis technician.

     (f) Upon successful completion of the hemodialysis training program, an authorized representative of the hemodialysis training program will sign an attestation of completion of the training described in this subsection. The attestation shall include documentation of the satisfactory completion of a skills competency checklist equivalent to, or exceeding the competencies required by these rules.

     (g) Training programs that meet the requirements described in this subsection are approved by the secretary.

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     (1) A completed application on forms provided by the department;

     (2) Proof of high school education or equivalent;

     (3) Proof of successful completion of an approved training program or proof of national credential as a hemodialysis technician;

     (4) Proof of completing seven clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;

     (5) Current cardiopulmonary resuscitation certification;     (6) Any fee required in WAC 246-827-990; and

     (7) Fingerprint cards for national fingerprint based background check pursuant to RCW 18.130.064(2), if requested by the department.

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     (a) Venipuncture for blood withdrawal;

     (b) Administration of oxygen as necessary by cannula or mask;

     (c) Venipuncture for placement of fistula needles;

     (d) Connection to vascular catheter for hemodialysis;

     (e) Intravenous administration of heparin and sodium chloride solutions as an integral part of dialysis treatment;

     (f) Intradermal, subcutaneous or topical administration of local anesthetics in conjunction with placement of fistula needles; and

     (g) Intraperitoneal administration of sterile electrolyte solutions and heparin for peritoneal dialysis.

     (2) A medical assistant-hemodialysis technician may perform the dialysis tasks described in subsection (1) of this section, under the following supervision:

     (a) In a renal dialysis center under immediate supervision of a registered nurse; or

     (b) In the patient's home if a physician and a registered nurse are available for consultation during the dialysis.

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     (2) If the medical assistant credential has expired for less than three years, he or she shall meet the requirements of chapter 246-12 WAC, Part 2.

     (3) If the medical assistant credential has been expired for three years or more, and he or she is currently practicing as a medical assistant in another state or U.S. jurisdiction, he or she shall (a) meet the requirements of chapter 246-12 WAC, Part 2, and (b) provide verification of a current unrestricted active medical assistant credential in another state or U.S. jurisdiction which is substantially equivalent to the qualifications for his or her credential in the state of Washington.

     (4) If a medical assistant-certified, a medical assistant-hemodialysis technician, or a medical assistant-phlebotomist credential has been expired for three years or more and the person does not meet the requirements of subsection (3) of this section, he or she shall comply with chapter 246-12 WAC, Part 2, and demonstrate competence in one of the following ways:

     (a) A medical assistant-certified must successfully pass an examination as identified in WAC 246-827-0200 within six months prior to reapplying for the credential.

     (b) A medical assistant-phlebotomist must complete the training requirements of WAC 246-827-0400 within six months prior to reapplying for the credential.

     (c) A medical assistant-hemodialysis technician must complete the training requirements of WAC 246-827-0500 within six months prior to reapplying for the credential.

     (5) If the medical assistant-registered credential has expired, he or she must also submit a new application as provided for in WAC 246-827-0300.

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