WSR 17-07-081

PROPOSED RULES

DEPARTMENT OF HEALTH

[Filed March 20, 2017, 9:33 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 16-15-061.

Title of Rule and Other Identifying Information: WAC 246-803-030 East Asian medicine and 246-803-040 Education and training for point injection therapy, the department of health is proposing to amend WAC 246-803-030 to define point injection therapy and list substances that may be administered as part of point injection therapy consistent with the practice of East Asian medicine, and proposes new WAC 246-803-040 to specify the education and training necessary to provide point injection therapy.

Hearing Location(s): Department of Health, 111 Israel Road S.E., Town Center 2, Room 158, Tumwater, WA 98501, on April 28, 2017, at 11:30 a.m.

Date of Intended Adoption: May 5, 2017.

Submit Written Comments to: Vicki Brown, Program Manager, Office of Health Professions, East Asian Medicine Practitioner (EAMP) Program, P.O. Box 47852, Olympia, WA 98504-7853 [98504-7852], email https://fortress.wa.gov/doh/policyreview, fax (360) 236-2901, by April 28, 2017.

Assistance for Persons with Disabilities: Contact Vicki Brown by April 21, 2017, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: SSB [SHB] 2448 (chapter 97, Laws of 2016) adds the substances that can be injected using point injection therapy with the required education and training. Rule making is necessary to align the existing rules with the new legislation. The proposed rules define point injection therapy, lists out the approved substances that can be administered as part of point injection therapy consistent with the practice of East Asian medicine, and establishes the education and training required to provide point injection therapy.

Reasons Supporting Proposal: SHB 2448 (chapter 97, Laws of 2016) requires the department to adopt rules that define point injection therapy, list out the substances that can be administered as part of point injection therapy consistent with the practice of East Asian medicine, and specify the education and training necessary to provide point injection therapy. The proposed rules would inform practitioners about what substances may be used in point injection therapy, and the training needed to assure that EAMPs perform point injection therapy safely.

Statutory Authority for Adoption: SHB 2448 (chapter 97, Laws of 2016) and RCW 18.06.140.

Statute Being Implemented: Chapter 18.06 RCW.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Vicki Brown, Program Manager, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4865.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rules would not impose more than minor costs on businesses in an industry.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Vicki Brown, Program Manager, Office of Health Professions, EAMP Program, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4865, fax (360) 236-2901, email vicki.brown@doh.wa.gov.

March 20, 2017

John Wiesman, DrPH, MPH

Secretary

AMENDATORY SECTION (Amending WSR 11-17-105, filed 8/22/11, effective 9/22/11)

WAC 246-803-030 East Asian medicine.

East Asian medicine is a health care service using East Asian medicine diagnosis and treatment to promote health and treat organic or functional disorders. East Asian medicine includes the following:

(1) Acupuncture. Acupuncture includes the use of acupuncture needles or lancets to directly or indirectly stimulate acupuncture points and meridians;

(2) Use of electrical, mechanical, or magnetic devices to stimulate acupuncture points and meridians;

(3) Moxibustion;

(4) Acupressure;

(5) Cupping;

(6) Dermal friction technique;

(7) Infrared;

(8) Sonopuncture;

(9) Laserpuncture;

(10) Point injection therapy (aquapuncture)((;)):

(a) Is the subcutaneous, intramuscular and intradermal injection of substances consistent with the practice of East Asian medicine to stimulate acupuncture points, AHSHI points, trigger points and meridians. Substances are limited to:

(i) Saline;

(ii) Sterile water;

(iii) Herbs specifically manufactured for injection by means of hypodermic needles;

(iv) Minerals specifically manufactured for injection by means of hypodermic needles;

(v) Vitamins in liquid form specifically manufactured for injection by means of hypodermic needles; and

(vi) Homeopathic and nutritional substances specifically manufactured for injection by means of hypodermic needles.

(b) For the purposes of this section, trigger points are included as a subset of acupuncture points and AHSHI points as recognized in the current practice of East Asian medicine.

(c) Point injection therapy does not include injection of controlled substances contained in Schedules I through V of the Uniform Controlled Substances Act, chapter 69.50 RCW or steroids as defined in RCW 69.41.300.

(11) Dietary advice and health education based on East Asian medical theory, including the recommendation and sale of herbs, vitamins, minerals, and dietary and nutritional supplements.

Health education. Health education is educational information directed to the patient that attempts to improve, maintain, promote and safeguard the health care of the patient. Health education consists of educating the patient on how the mind, body and spirit connect in context of imbalances, emotional patterns and tendencies as defined by and treated in East Asian medicine. Health education does not include mental health counseling;

(12) Breathing, relaxation, and East Asian exercise techniques;

(13) Qi gong;

(14) East Asian massage. East Asian massage means manual techniques having originated in East Asia involving the manipulation of the soft tissues of the body for therapeutic purposes.

(a) East Asian massage consists of:

(i) Applying fixed or movable pressure;

(ii) Passive, resistive, and assisted stretching of fascial and connective tissue;

(iii) Holding or causing movement of the body; or

(iv) Tapping, compressions or friction.

(b) East Asian massage may be performed with the use of tools common to the practice and aids of superficial heat, cold, water, lubricants, salts, minerals, liniments, poultices, and herbs.

(c) East Asian massage does not include attempts to adjust or manipulate any articulations of the body or spine or mobilization of these articulations by the use of a thrusting force;

(15) Tui na. Tui na is a method of East Asian bodywork, characterized by the kneading, pressing, rolling, shaking, and stretching of the body and does not include spinal manipulation; and

(16) Superficial heat and cold therapies.

NEW SECTION

WAC 246-803-040 Education and training for point injection therapy.

East Asian medicine practitioners employing point injection therapy shall use only those substances and techniques for which they have received training.

(1) The education and training for point injection therapy shall:

(a) Consist of a minimum total of twenty-four contact hours of training in the topics required in this section;

(b) Include at least eight hours of clinical practical experience; and

(2) Curriculum for a point injection therapy training program must include:

(a) Review of physical examination, contraindications and universal precautions, and differential diagnosis;

(b) Compounding and administration of the substances authorized for point injection therapy under WAC 246-803-030, including aseptic technique, recordkeeping and storage of substances authorized for use in point injection therapy;

(d) Point injection therapy techniques and contraindication within the East Asian medicine scope of practice relative to the authorized substances listed in WAC 246-803-030 (10)(a)(i) through (vi).

(3) Except for the training in the use of inhaled oxygen and intramuscular epinephrine, the training must be delivered in person and not through webinar or other online or distance learning method.

(4) Requirements for instructors in point injection therapy. The instructor must have:

(a) A health care credential in good standing with a scope of practice that includes point injection therapy; and

(b) At least five years of experience in a health care practice that includes point injection therapy.

(5) In addition to point injection therapy meeting the requirements of subsectionS (1) and (2) of this section, East Asian medicine practitioners using point injection therapy must complete training in the use of inhaled oxygen (O2) and intramuscular epinephrine.

(a) Training in the use of inhaled oxygen and intramuscular epinephrine must be according to RCW 70.54.440(4).

(b) This training may be taken separately from the training in point injection therapy.

(c) Up to two hours of training in the use of inhaled oxygen and intramuscular epinephrine count in meeting the requirement for twenty-four hours of training.

(d) Subsection (a) of this section does not apply to East Asian medicine practitioners who hold an active credential with a scope of practice that includes the authority to prescribe, dispense or administer epinephrine.

(6) To qualify under this section, the training program shall provide each successful student with a:

(a) Certificate of successful completion of the program; and

(b) Course syllabus outlining the schedule and curriculum of the program.

(7) The requirements of subsections (1) through (6) of this section do not apply to an East Asian medicine practitioner who has provided point injection therapy prior to July 1, 2017. East Asian medicine practitioners using point injection therapy prior to July 1, 2017, must have completed training and education in point injection therapy.

(8) Any East Asian medicine practitioner performing point injection therapy must be able to demonstrate, upon request of the department of health, successful completion of education and training in point injection therapy.

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.