WSR 25-05-085
PERMANENT RULES
DEPARTMENT OF HEALTH
[Filed February 18, 2025, 1:35 p.m., effective March 21, 2025]
Effective Date of Rule: Thirty-one days after filing.
Purpose: Medical assistant medication administration requirements and apprenticeship programs.
The department of health (department) is adopting amendments to WAC 246-827-0010, 246-827-0200, and 246-827-0240 and new WAC 246-827-0340 to implement ESHB 1073 (chapter 134, Laws of 2023) and ESSB 5983 (chapter 248, Laws of 2024), codified under chapter
18.360 RCW. The purpose of the adopted amendments is to ensure that the rules are current and align with best practices.
The adopted amendments include updating and clarifying definitions, updating credentialing requirements, and aligning medication administration and supervision requirements to the recently enacted statutes. Additionally, the department is also adopting new WAC 246-827-0340 to address the medication administration requirements for the medical assistant-registered credential that implements ESHB 1073.
Citation of Rules Affected by this Order: New WAC 246-827-0340; and amending WAC 246-827-0010, 246-827-0200, and 246-827-0240.
Other Authority: ESHB 1073 (chapter 134, Laws of 2023) and ESSB 5983 (chapter 248, Laws of 2024), both codified under
18.360 RCW.
Adopted under notice filed as WSR 24-22-100 on November 2, 2024.
Changes Other than Editing from Proposed to Adopted Version: WAC 246-827-0110(13) updated the definition for "telemedicine supervision" to include "interactive audio or visual" when referring to telemedicine technology as it relates to the purpose of treating a known or suspected syphilis infection. This change aligned the rule language with RCW
18.360.010 (12)(ii).
Additionally, several technical amendments including grammar and punctuation were made to WAC 246-827-0240(6) and 246-827-0340(3).
A final cost-benefit analysis is available by contacting Becky McElhiney, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4766, fax 360-236-2901, TTY 711, email medical.assistants@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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 2, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 3, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 3, 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 1, Amended 3, Repealed 0.
Date Adopted: February 14, 2025.
Kristin Peterson, JD
Chief of Policy
for Jessica Todorovich, MS
Acting Secretary of Health
OTS-4184.9
AMENDATORY SECTION(Amending WSR 23-16-004, filed 7/19/23, effective 8/19/23)
WAC 246-827-0010Definitions.
The following definitions apply throughout this chapter unless the context clearly indicates otherwise:
(1)
"Controlled substance" has the same meaning as RCW 69.50.101.(2)"Direct visual supervision" means the supervising health care practitioner is physically present and within visual range of the medical assistant.
((
(2)))
(3)"Forensic blood draw" means a blood sample drawn at the direction of a law enforcement officer for the purpose of determining its alcoholic or drug content by a person holding one of the credentials listed in RCW
46.61.506, including a medical assistant-certified, medical assistant-phlebotomist, or forensic phlebotomist.
((
(3)))
(4)"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, or an optometrist licensed under chapter
18.53 RCW.
(((4)))(5)"Hemodialysis" is a procedure for removing metabolic waste products or toxic substances from the human body by dialysis.
(((5)))(6)"Immediate supervision" means the supervising health care practitioner is on the premises and available for immediate response as needed.
(((6)))(7) "Immediately available" means the supervising health care practitioner is available to arrive on the premises in a reasonable amount of time or for an immediate audio or video telephone consultation.
(8)"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 health care practitioners only.
((
(7)))
(9)"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.
(((8)))(10)"Medical assistant-hemodialysis technician" means a patient care dialysis technician trained in compliance with federal requirements for end stage renal dialysis facilities.
(((9)))(11) "Medication" means a legend drug, over-the-counter drug, vaccine, or Schedule III through V controlled substance.
(12)"Secretary" means the secretary of the department of health or the secretary's designee.
(((10)))(13)"Telemedicine supervision" means the delivery of direct patient care under supervision by a health care practitioner provided through the use of interactive audio and video technology, permitting real-time communication between a medical assistant at the originating site and a health care practitioner off premises. "Telemedicine" does not include the use of audio-only telephone, facsimile, or electronic mail.
"Telemedicine supervision" also includes supervision of a medical assistant-certified or medical assistant registered through interactive audio or visual telemedicine technology when administering intramuscular injections for the purpose of treating a known or suspected syphilis infection in accordance with RCW 18.360.050. AMENDATORY SECTION(Amending WSR 23-16-004, filed 7/19/23, effective 8/19/23)
WAC 246-827-0200Medical assistant-certified—Training and examination.
An applicant for a medical assistant-certified credential must meet the following requirements:
(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 720 clock hours of training in medical assisting skills, including a clinical externship of no less than 160 hours;
(c) ((A registered))An apprenticeship program ((administered by a department of the state of Washington))registered and approved by the Washington state apprenticeship and training council 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;
(d) The secretary may approve an applicant who submits documentation that they completed postsecondary education with a minimum of 720 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 160 hours; or
(e) The secretary may approve an applicant who submits documentation that they completed a career and technical education program approved by the office of the superintendent of public instruction with a minimum of 720 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 160 hours.
(2) Pass a medical assistant certification examination, approved by the secretary, within the preceding five years of submitting an initial application or currently hold a national medical assistant certification with a national examining organization approved by the secretary. A medical assistant certification examination approved by the secretary means an examination that:
(a) Is offered by a medical assistant program that is accredited by the National Commission for Certifying Agencies (NCCA); and
(b) Covers the clinical and administrative duties under RCW
18.360.050(1).
AMENDATORY SECTION(Amending WSR 13-12-045, filed 5/31/13, effective 7/1/13)
WAC 246-827-0240Medical assistant-certified—Administering medications and injections.
A medical assistant-certified shall be deemed competent by the delegating health care practitioner prior to administering any ((drug))medication authorized in this section. ((Drugs))Medications must be administered under a valid order from the delegating health care practitioner and shall be within the delegating health care practitioner's scope of practice. The order must be in written form or contained in the patient's electronic health care record.
(1) ((Drug))Medication administration shall not be delegated when:
(a) The ((drug))medication 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))they are 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))medications when authorized by the delegating health care practitioner. ((Drugs))Medications shall be administered only by unit or single dosage or by a dosage calculated and verified by a health care practitioner. For the purposes of this section, a combination or multidose vaccine shall be considered a unit dose. A medical assistant-certified shall only administer ((drugs by))medications under 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))medication category, route and level of supervision:
((Drug))Medication Category | Routes Permitted((*)) | Level of Supervision Required |
Controlled substances, schedule III, IV, and V | Oral, topical, rectal, otic, ophthalmic, or inhaled routes | Immediate supervision |
Intramuscular injections | Immediate supervision |
| Subcutaneous, intradermal, ((intramuscular,)) or peripheral intravenous injections | Direct visual supervision |
((Other))Legend drugs (excluding those prohibited by subsection (3)(a) of this section) | ((All other routes))Peripheral intravenous injections | ((Immediate))Direct visual supervision |
| All other routes | Immediate supervision |
Over-the-counter medications | All routes per manufacturer's instructions | Immediate supervision |
| ((Peripheral intravenous injections | Direct visual supervision)) |
Vaccines | Oral, inhaled, subcutaneous, or intramuscular routes | Immediately available or telemedicine 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.))
(6) A medical assistant-certified may:
(a) Start an intravenous line for diagnostic or therapeutic purposes under the immediate supervision of a health care practitioner;
(b) Interrupt an intravenous line and restart at the same rate under the immediate supervision of a health care practitioner;
(c) Administer intravenous injections for diagnostic or therapeutic agents under the direct visual supervision of a health care practitioner; and
(d) Administer intramuscular injections for the purposes of treating a known or suspected syphilis infection without immediate supervision if a health care practitioner is providing supervision through interactive audio or video telemedicine technology in accordance with RCW 18.360.010 (12)(c)(ii). NEW SECTION
WAC 246-827-0340Medical assistant-registered—Administering medications and injections.
A medical assistant-registered shall be deemed competent by the delegating health care practitioner prior to administering any medication authorized in this section. Medications must be administered under a valid order from the delegating health care practitioner and shall be within the delegating health care practitioner's scope of practice. The order must be in written form or contained in the patient's electronic health care record.
(1) Medication administration shall not be delegated when:
(a) The medication 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 they are taking a medication.
(2) To administer medications, the delegator shall ensure a medical assistant-registered 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-registered is competent to administer the medication.
(3) A medical assistant-registered is prohibited from administering:
(a) Schedule II controlled substances, chemotherapy agents, or experimental drugs; or
(b) Medications through a central intravenous line;
(c) Medications through an intravenous line; or
(d) Medications through intravenous injection.
(4) Except as provided in subsection (1) of this section, a medical assistant-registered may administer controlled substances in schedules III, IV, and V or other medications when authorized by the delegating health care practitioner. Medications shall be administered only by unit or single dosage or by a dosage calculated and verified by a health care practitioner. For the purposes of this section, a combination or multidose vaccine shall be considered a unit dose. A medical assistant-registered shall only administer medications under the level of supervision based on the route as described in subsection (5) of this section.
(5) A medical assistant-registered may only administer medications by the following medications category, route, and level of supervision:
Medication Category | Routes Permitted | Level of Supervision Required |
Controlled substances, schedule III, IV, and V | Intramuscular injections | Immediate supervision |
Legend drugs (excluding those prohibited by subsection (3)(a) of this section) | Intramuscular injections | Immediate supervision |
Over-the-counter medications | All routes per manufacturer's instructions | Immediate supervision |
Vaccines | Oral, inhaled, subcutaneous, or intramuscular routes | Immediately available or telemedicine supervision |
(6) A medical assistant-registered is prohibited from starting an intravenous line. A medical assistant-registered may interrupt an intravenous line.
(7) A medical assistant-registered may administer intramuscular injections for the purposes of treating a known or suspected syphilis infection without immediate supervision if a health care practitioner is providing supervision through interactive audio or video telemedicine technology in accordance with RCW
18.360.010 (12)(c)(ii).