BILL REQ. #:  Z-0471.2 

Read first time 02/07/2003.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to nursing practices in community-based and in-home care; amending RCW 18.79.040, 18.79.260, 18.88A.140, 18.88A.200, 18.88A.210, 18.88A.230, 70.127.010, 70.127.040, 70.127.120, 70.127.170, 69.41.010, and 69.41.085; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.79.040 and 1995 1st sp.s. c 18 s 50 are each amended to read as follows:
     (1) "Registered nursing practice" means the performance of acts requiring substantial specialized knowledge, judgment, and skill based on the principles of the biological, physiological, behavioral, and sociological sciences in either:
     (a) The observation, assessment, diagnosis, care or counsel, and health teaching of ((the ill, injured, or infirm)) individuals with illnesses, injuries, or disabilities, or in the maintenance of health or prevention of illness of others;
     (b) The performance of such additional acts requiring education and training and that are recognized by the medical and nursing professions as proper and recognized by the commission to be performed by registered nurses licensed under this chapter and that are authorized by the commission through its rules;
     (c) The administration, supervision, delegation, and evaluation of nursing practice. However, nothing in this subsection affects the authority of a hospital, hospital district, in-home service agency, community-based care setting, medical clinic, or office, concerning its administration and supervision;
     (d) The teaching of nursing;
     (e) The executing of medical regimen as prescribed by a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner.
     (2) Nothing in this section prohibits a person from practicing a profession for which a license has been issued under the laws of this state or specifically authorized by any other law of the state of Washington.
     (3) This section does not prohibit (a) the nursing care of the sick, without compensation, by an unlicensed person who does not hold himself or herself out to be a registered nurse, (b) the practice of licensed practical nursing by a licensed practical nurse, or (c) the practice of a nursing assistant, providing delegated nursing tasks under chapter 18.88A RCW.

Sec. 2   RCW 18.79.260 and 2000 c 95 s 3 are each amended to read as follows:
     (1) A registered nurse under his or her license may perform for compensation nursing care, as that term is usually understood, ((of the ill, injured, or infirm)) to individuals with illnesses, injuries, or disabilities.
     (2) A registered nurse may, at or under the general direction of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, naturopathic physician, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner acting within the scope of his or her license, administer medications, treatments, tests, and inoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required. Such direction must be for acts which are within the scope of registered nursing practice.
     (3) A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient.
     (a) The delegating nurse shall:
     (i) Determine the competency of the individual to perform the tasks;
     (ii) Evaluate the appropriateness of the delegation;
     (iii) Supervise the actions of the person performing the delegated task; and
     (iv) Delegate only those tasks that are within the registered nurse's scope of practice.
     (b) A registered nurse, working for a home health or hospice agency regulated under chapter 70.127 RCW, may delegate the application, instillation, or insertion of medications to a registered or certified nursing assistant under a plan of care.
     (c) Except as authorized in (b) or (e) of this subsection, a registered nurse may not delegate the administration of medications. Except as authorized in (e) of this subsection, a registered nurse may not delegate acts requiring substantial skill, ((the administration of medications, or)) and may not delegate piercing or severing of tissues ((except to registered or certified nursing assistants who provide care to individuals in community-based care settings as authorized under (d) of this subsection)). Acts that require nursing judgment shall not be delegated.
     (((c))) (d) No person may coerce a nurse into compromising patient safety by requiring the nurse to delegate if the nurse determines that it is inappropriate to do so. Nurses shall not be subject to any employer reprisal or disciplinary action by the nursing care quality assurance commission for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety.
     (((d))) (e) For delegation in community-based care settings or in-home care settings, a registered nurse may delegate nursing care tasks only to registered or certified nursing assistants. Simple care tasks such as blood pressure monitoring, personal care service, or other tasks as defined by the nursing care quality assurance commission are exempted from this requirement.
     (i) "Community-based care settings" includes: Community residential programs for the developmentally disabled, certified by the department of social and health services under chapter 71A.12 RCW; adult family homes licensed under chapter 70.128 RCW; and boarding homes licensed under chapter 18.20 RCW. Community-based care settings do not include acute care or skilled nursing facilities.
     (((i))) (ii) "In-home care settings" include an individual's place of temporary or permanent residence, but does not include acute care or skilled nursing facilities, and does not include community-based care settings as defined in (e)(i) of this subsection.
     (iii) Delegation of nursing care tasks in community-based care settings and in-home care settings is only allowed for individuals who have a stable and predictable condition. "Stable and predictable condition" means a situation in which the individual's clinical and behavioral status is known and does not require the frequent presence and evaluation of a registered nurse.
     (((ii))) (iv) The determination of the appropriateness of delegation of a nursing task is at the discretion of the registered nurse. However, the administration of medications by injection, sterile procedures, and central line maintenance may never be delegated.
     (((iii))) (v) The registered nurse shall verify that the nursing assistant has completed the required core nurse delegation training required in chapter 18.88A RCW prior to authorizing delegation.
     (((iv))) (vi) The nurse is accountable for his or her own individual actions in the delegation process. Nurses acting within the protocols of their delegation authority are immune from liability for any action performed in the course of their delegation duties.
     (((v) On or before June 30, 2001, the nursing care quality assurance commission, in conjunction with the professional nursing organizations and the department of social and health services, shall make any needed revisions or additions to nurse delegation protocols by rule, including standards for nurses to obtain informed consent prior to the delegation of nursing care tasks.))
     (vii) Nursing task delegation protocols are not intended to regulate the settings in which delegation may occur, but are intended to ensure that nursing care services have a consistent standard of practice upon which the public and the profession may rely, and to safeguard the authority of the nurse to make independent professional decisions regarding the delegation of a task.
     (((e))) (f) The nursing care quality assurance commission may adopt rules to implement this section.
     (4) Only a person licensed as a registered nurse may instruct nurses in technical subjects pertaining to nursing.
     (5) Only a person licensed as a registered nurse may hold herself or himself out to the public or designate herself or himself as a registered nurse.

Sec. 3   RCW 18.88A.140 and 2000 c 171 s 25 are each amended to read as follows:
     Nothing in this chapter may be construed to prohibit or restrict:
     (1) The practice by an individual licensed, certified, or registered under the laws of this state and performing services within their authorized scope of practice;
     (2) The practice by an individual employed by the government of the United States while engaged in the performance of duties prescribed by the laws of the United States;
     (3) The practice by a person who is a regular student in an educational program approved by the secretary, and whose performance of services is pursuant to a regular course of instruction or assignments from an instructor and under the general supervision of the instructor;
     (4) A nursing assistant, while employed as a personal aide as defined in RCW 74.39.007, from accepting direction from an individual who is self-directing their care.

Sec. 4   RCW 18.88A.200 and 1995 1st sp.s. c 18 s 45 are each amended to read as follows:
     The legislature recognizes that nurses have been successfully delegating nursing care tasks to family members and auxiliary staff for many years. The opportunity for a nurse to delegate to nursing assistants qualifying under RCW 18.88A.210 may enhance the viability and quality of health care services in ((community health)) community-based care settings ((for long-term care services)) and in-home care settings to allow ((citizens)) individuals to live as independently as possible with maximum safeguards.

Sec. 5   RCW 18.88A.210 and 2000 c 95 s 1 are each amended to read as follows:
     (1) A nursing assistant meeting the requirements of this section who provides care to individuals in community-based care settings or in-home care settings, as defined in RCW 18.79.260(3), may accept delegation of nursing care tasks by a registered nurse as provided in RCW 18.79.260(3).
     (2) For the purposes of this section, "nursing assistant" means a nursing assistant-registered or a nursing assistant-certified. Nothing in this section may be construed to affect the authority of nurses to delegate nursing tasks to other persons, including licensed practical nurses, as authorized by law.
     (3) Before commencing any specific nursing care tasks authorized under this chapter, the nursing assistant must (a) provide to the delegating nurse a certificate of completion issued by the department of social and health services indicating the completion of basic core nurse delegation training, (b) be regulated by the department of health pursuant to this chapter, subject to the uniform disciplinary act under chapter 18.130 RCW, and (c) meet any additional training requirements identified by the nursing care quality assurance commission. Exceptions to these training requirements must adhere to RCW 18.79.260(3)(((d)(iii))) (e)(v).

Sec. 6   RCW 18.88A.230 and 2000 c 95 s 2 are each amended to read as follows:
     (1) The nursing assistant shall be accountable for their own individual actions in the delegation process. Nursing assistants following written delegation instructions from registered nurses performed in the course of their accurately written, delegated duties shall be immune from liability.
     (2) Nursing assistants shall not be subject to any employer reprisal or disciplinary action by the secretary for refusing to accept delegation of a nursing task based on patient safety issues. No community-based care setting as defined in RCW 18.79.260(3)(((d))) (e), or in-home services agency as defined in RCW 70.127.010, may discriminate or retaliate in any manner against a person because the person made a complaint or cooperated in the investigation of a complaint.

Sec. 7   RCW 70.127.010 and 2000 c 175 s 1 are each amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Administrator" means an individual responsible for managing the operation of an agency.
     (2) "Department" means the department of health.
     (3) "Director of clinical services" means an individual responsible for nursing, therapy, nutritional, social, and related services that support the plan of care provided by in-home health and hospice agencies.
     (4) "Family" means individuals who are important to, and designated by, the patient or client and who need not be relatives.
     (5) "Home care agency" means a person administering or providing home care services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A home care agency that provides delegated tasks of nursing under RCW 18.79.260(3)(e) is not considered a home health agency for the purposes of this chapter.
     (6) "Home care services" means nonmedical services and assistance provided to ill, disabled, ((infirm,)) or vulnerable individuals that enable them to remain in their residences. Home care services include, but are not limited to: Personal care such as assistance with dressing, feeding, and personal hygiene to facilitate self-care; homemaker assistance with household tasks, such as housekeeping, shopping, meal planning and preparation, and transportation; respite care assistance and support provided to the family; or other nonmedical services or delegated tasks of nursing under RCW 18.79.260(3)(e).
     (7) "Home health agency" means a person administering or providing two or more home health services directly or through a contract arrangement to individuals in places of temporary or permanent residence. A person administering or providing nursing services only may elect to be designated a home health agency for purposes of licensure.
     (8) "Home health services" means services provided to ill, disabled, ((infirm,)) or vulnerable individuals. These services include but are not limited to nursing services, home health aide services, physical therapy services, occupational therapy services, speech therapy services, respiratory therapy services, nutritional services, medical social services, and home medical supplies or equipment services.
     (9) "Home health aide services" means services provided by a home health agency or a hospice agency under the supervision of a registered nurse, physical therapist, occupational therapist, or speech therapist who is employed by or under contract to a home health or hospice agency. Such care includes ambulation and exercise, assistance with self-administered medications, reporting changes in patients' conditions and needs, completing appropriate records, and personal care or homemaker services.
     (10) "Home medical supplies" or "equipment services" means diagnostic, treatment, and monitoring equipment and supplies provided for the direct care of individuals within a plan of care.
     (11) "Hospice agency" means a person administering or providing hospice services directly or through a contract arrangement to individuals in places of temporary or permanent residence under the direction of an interdisciplinary team composed of at least a nurse, social worker, physician, spiritual counselor, and a volunteer.
     (12) "Hospice care center" means a homelike, noninstitutional facility where hospice services are provided, and that meets the requirements for operation under RCW 70.127.280.
     (13) "Hospice services" means symptom and pain management provided to a terminally ill individual, and emotional, spiritual, and bereavement support for the individual and family in a place of temporary or permanent residence, and may include the provision of home health and home care services for the terminally ill individual.
     (14) "In-home services agency" means a person licensed to administer or provide home health, home care, hospice services, or hospice care center services directly or through a contract arrangement to individuals in a place of temporary or permanent residence.
     (15) "Person" means any individual, business, firm, partnership, corporation, company, association, joint stock association, public or private agency or organization, or the legal successor thereof that employs or contracts with two or more individuals.
     (16) "Plan of care" means a written document based on assessment of individual needs that identifies services to meet these needs.
     (17) "Quality improvement" means reviewing and evaluating appropriateness and effectiveness of services provided under this chapter.
     (18) "Service area" means the geographic area in which the department has given prior approval to a licensee to provide home health, hospice, or home care services.
     (19) "Survey" means an inspection conducted by the department to evaluate and monitor an agency's compliance with this chapter.

Sec. 8   RCW 70.127.040 and 2000 c 175 s 4 are each amended to read as follows:
     The following are not subject to regulation for the purposes of this chapter:
     (1) A family member providing home health, hospice, or home care services;
     (2) A person who provides only meal services in an individual's permanent or temporary residence;
     (3) An individual providing home care through a direct agreement with a recipient of care in an individual's permanent or temporary residence;
     (4) A person furnishing or delivering home medical supplies or equipment that does not involve the provision of services beyond those necessary to deliver, set up, and monitor the proper functioning of the equipment and educate the user on its proper use;
     (5) A person who provides services through a contract with a licensed agency;
     (6) An employee or volunteer of a licensed agency who provides services only as an employee or volunteer;
     (7) Facilities and institutions, including but not limited to nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41 RCW, adult family homes under chapter 70.128 RCW, boarding homes under chapter 18.20 RCW, developmental disability residential programs under chapter ((71.12)) 71A.12 RCW, other entities licensed under chapter 71.12 RCW, or other licensed facilities and institutions, only when providing services to persons residing within the facility or institution;
     (8) Local and combined city-county health departments providing services under chapters 70.05 and 70.08 RCW;
     (9) An individual providing care to ill, disabled, ((infirm,)) or vulnerable individuals through a contract with the department of social and health services;
     (10) Nursing homes, hospitals, or other institutions, agencies, organizations, or persons that contract with licensed home health, hospice, or home care agencies for the delivery of services;
     (11) In-home assessments of an ill, disabled, or vulnerable((, or infirm)) individual that does not result in regular ongoing care at home;
     (12) Services conducted by and for the adherents of a church or religious denomination that rely upon spiritual means alone through prayer for healing in accordance with the tenets and practices of such church or religious denomination and the bona fide religious beliefs genuinely held by such adherents;
     (13) A medicare-approved dialysis center operating a medicare-approved home dialysis program;
     (14) A person providing case management services. For the purposes of this subsection, "case management" means the assessment, coordination, authorization, planning, training, and monitoring of home health, hospice, and home care, and does not include the direct provision of care to an individual;
     (15) Pharmacies licensed under RCW 18.64.043 that deliver prescription drugs and durable medical equipment that does not involve the use of professional services beyond those authorized to be performed by licensed pharmacists pursuant to chapter 18.64 RCW and those necessary to set up and monitor the proper functioning of the equipment and educate the person on its proper use;
     (16) A volunteer hospice complying with the requirements of RCW 70.127.050; and
     (17) A person who provides home care services without compensation.

Sec. 9   RCW 70.127.120 and 2000 c 175 s 10 are each amended to read as follows:
     The department shall adopt rules consistent with RCW 70.127.005 necessary to implement this chapter under chapter 34.05 RCW. In order to ensure safe and adequate care, the rules shall address at a minimum the following:
     (1) Maintenance and preservation of all records relating directly to the care and treatment of individuals by licensees;
     (2) Establishment and implementation of a procedure for the receipt, investigation, and disposition of complaints regarding services provided;
     (3) Establishment and implementation of a plan for ongoing care of individuals and preservation of records if the licensee ceases operations;
     (4) Supervision of services;
     (5) Establishment and implementation of written policies regarding response to referrals and access to services;
     (6) Establishment and implementation of written personnel policies, procedures and personnel records for paid staff that provide for prehire screening, minimum qualifications, regular performance evaluations, including observation in the home, participation in orientation and in-service training, and involvement in quality improvement activities. The department may not establish experience or other qualifications for agency personnel or contractors beyond that required by state law;
     (7) Establishment and implementation of written policies and procedures for volunteers who have direct patient/client contact and that provide for background and health screening, orientation, and supervision;
     (8) Establishment and implementation of written policies for obtaining regular reports on patient satisfaction;
     (9) Establishment and implementation of a quality improvement process; ((and))
     (10) Establishment and implementation of policies related to the delivery of care including:
     (a) Plan of care for each individual served;
     (b) Periodic review of the plan of care;
     (c) Supervision of care and clinical consultation as necessary;
     (d) Care consistent with the plan;
     (e) Admission, transfer, and discharge from care; and
     (f) For hospice services:
     (i) Availability of twenty-four hour seven days a week hospice registered nurse consultation and in-home services as appropriate;
     (ii) Interdisciplinary team communication as appropriate and necessary; and
     (iii) The use and availability of volunteers to provide family support and respite care; and
     (11) Establishment and implementation of policies related to agency implementation and oversight of nurse delegation as defined in RCW 18.79.260(3)(e).

Sec. 10   RCW 70.127.170 and 2000 c 175 s 14 are each amended to read as follows:
     Pursuant to chapter 34.05 RCW and RCW 70.127.180(3), the department may deny, restrict, condition, modify, suspend, or revoke a license under this chapter or, in lieu thereof or in addition thereto, assess monetary penalties of a civil nature not to exceed one thousand dollars per violation, or require a refund of any amounts billed to, and collected from, the consumer or third-party payor in any case in which it finds that the licensee, or any applicant, officer, director, partner, managing employee, or owner of ten percent or more of the applicant's or licensee's assets:
     (1) Failed or refused to comply with the requirements of this chapter or the standards or rules adopted under this chapter;
     (2) Was the holder of a license issued pursuant to this chapter that was revoked for cause and never reissued by the department, or that was suspended for cause and the terms of the suspension have not been fulfilled and the licensee has continued to operate;
     (3) Has knowingly or with reason to know made a misrepresentation of, false statement of, or failed to disclose, a material fact to the department in an application for the license or any data attached thereto or in any record required by this chapter or matter under investigation by the department, or during a survey, or concerning information requested by the department;
     (4) Refused to allow representatives of the department to inspect any book, record, or file required by this chapter to be maintained or any portion of the licensee's premises;
     (5) Willfully prevented, interfered with, or attempted to impede in any way the work of any representative of the department and the lawful enforcement of any provision of this chapter. This includes but is not limited to: Willful misrepresentation of facts during a survey, investigation, or administrative proceeding or any other legal action; or use of threats or harassment against any patient, client, or witness, or use of financial inducements to any patient, client, or witness to prevent or attempt to prevent him or her from providing evidence during a survey or investigation, in an administrative proceeding, or any other legal action involving the department;
     (6) Willfully prevented or interfered with any representative of the department in the preservation of evidence of any violation of this chapter or the rules adopted under this chapter;
     (7) Failed to pay any civil monetary penalty assessed by the department pursuant to this chapter within ten days after the assessment becomes final;
     (8) Used advertising that is false, fraudulent, or misleading;
     (9) Has repeated incidents of personnel performing services beyond their authorized scope of practice;
     (10) Misrepresented or was fraudulent in any aspect of the conduct of the licensee's business;
     (11) Within the last five years, has been found in a civil or criminal proceeding to have committed any act that reasonably relates to the person's fitness to establish, maintain, or administer an agency or to provide care in the home of another;
     (12) Was the holder of a license to provide care or treatment to ill, disabled, ((infirm,)) or vulnerable individuals that was denied, restricted, not renewed, surrendered, suspended, or revoked by a competent authority in any state, federal, or foreign jurisdiction. A certified copy of the order, stipulation, or agreement is conclusive evidence of the denial, restriction, nonrenewal, surrender, suspension, or revocation;
     (13) Violated any state or federal statute, or administrative rule regulating the operation of the agency;
     (14) Failed to comply with an order issued by the secretary or designee;
     (15) Aided or abetted the unlicensed operation of an in-home services agency;
     (16) Operated beyond the scope of the in-home services agency license;
     (17) Failed to adequately supervise staff to the extent that the health or safety of a patient or client was at risk;
     (18) Compromised the health or safety of a patient or client, including, but not limited to, the individual performing services beyond their authorized scope of practice;
     (19) Continued to operate after license revocation, suspension, or expiration, or operating outside the parameters of a modified, conditioned, or restricted license;
     (20) Failed or refused to comply with chapter 70.02 RCW;
     (21) Abused, neglected, abandoned, or financially exploited a patient or client as these terms are defined in RCW 74.34.020;
     (22) Misappropriated the property of an individual;
     (23) Is unqualified or unable to operate or direct the operation of the agency according to this chapter and the rules adopted under this chapter;
     (24) Obtained or attempted to obtain a license by fraudulent means or misrepresentation; or
     (25) Failed to report abuse or neglect of a patient or client in violation of chapter 74.34 RCW.

Sec. 11   RCW 69.41.010 and 2000 c 8 s 2 are each amended to read as follows:
     As used in this chapter, the following terms have the meanings indicated unless the context clearly requires otherwise:
     (1) "Administer" means the direct application of a legend drug whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject by:
     (a) A practitioner; or
     (b) The patient or research subject at the direction of the practitioner.
     (2) "Community-based care settings" include: Community residential programs for the developmentally disabled, certified by the department of social and health services under chapter 71A.12 RCW; adult family homes licensed under chapter 70.128 RCW; and boarding homes licensed under chapter 18.20 RCW. Community-based care settings do not include acute care or skilled nursing facilities.
     (3) "Deliver" or "delivery" means the actual, constructive, or attempted transfer from one person to another of a legend drug, whether or not there is an agency relationship.
     (((3))) (4) "Department" means the department of health.
     (((4))) (5) "Dispense" means the interpretation of a prescription or order for a legend drug and, pursuant to that prescription or order, the proper selection, measuring, compounding, labeling, or packaging necessary to prepare that prescription or order for delivery.
     (((5))) (6) "Dispenser" means a practitioner who dispenses.
     (((6))) (7) "Distribute" means to deliver other than by administering or dispensing a legend drug.
     (((7))) (8) "Distributor" means a person who distributes.
     (((8))) (9) "Drug" means:
     (a) Substances recognized as drugs in the official United States pharmacopoeia, official homeopathic pharmacopoeia of the United States, or official national formulary, or any supplement to any of them;
     (b) Substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animals;
     (c) Substances (other than food, minerals or vitamins) intended to affect the structure or any function of the body of man or animals; and
     (d) Substances intended for use as a component of any article specified in ((clause)) (a), (b), or (c) of this subsection. It does not include devices or their components, parts, or accessories.
     (((9))) (10) "Electronic communication of prescription information" means the communication of prescription information by computer, or the transmission of an exact visual image of a prescription by facsimile, or other electronic means for original prescription information or prescription refill information for a legend drug between an authorized practitioner and a pharmacy or the transfer of prescription information for a legend drug from one pharmacy to another pharmacy.
     (((10))) (11) "In-home care settings" include an individual's place of temporary and permanent residence, but does not include acute care or skilled nursing facilities, and does not include community-based care settings.
     (12) "Legend drugs" means any drugs which are required by state law or regulation of the state board of pharmacy to be dispensed on prescription only or are restricted to use by practitioners only.
     (((11))) (13) "Legible prescription" means a prescription or medication order issued by a practitioner that is capable of being read and understood by the pharmacist filling the prescription or the nurse or other practitioner implementing the medication order.
     (((12))) (14) "Medication assistance" means assistance rendered by a nonpractitioner to an individual residing in a community-based care setting ((specified in RCW 69.41.085)) or in-home care setting to facilitate the individual's self-administration of a legend drug or controlled substance. It includes reminding or coaching the individual, handing the medication container to the individual, opening the individual's medication container, using an enabler, or placing the medication in the individual's hand, and such other means of medication assistance as defined by rule adopted by the department. ((The)) A nonpractitioner may help in the preparation of legend drugs or controlled substances for self-administration where a practitioner has determined((, in consultation with the individual or the individual's representative,)) and communicated orally or by written direction that such medication preparation assistance is necessary and appropriate. Medication assistance shall not include assistance with intravenous medications or injectable medications.
     (((13))) (15) "Person" means individual, corporation, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity.
     (((14))) (16) "Practitioner" means:
     (a) A physician under chapter 18.71 RCW, an osteopathic physician or an osteopathic physician and surgeon under chapter 18.57 RCW, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a registered nurse, advanced registered nurse practitioner, or licensed practical nurse under chapter 18.79 RCW, an optometrist under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010, an osteopathic physician assistant under chapter 18.57A RCW, a physician assistant under chapter 18.71A RCW, a naturopath licensed under chapter 18.36A RCW, or a pharmacist under chapter 18.64 RCW;
     (b) A pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a legend drug in the course of professional practice or research in this state; and
     (c) A physician licensed to practice medicine and surgery or a physician licensed to practice osteopathic medicine and surgery in any state, or province of Canada, which shares a common border with the state of Washington.
     (((15))) (17) "Secretary" means the secretary of health or the secretary's designee.

Sec. 12   RCW 69.41.085 and 1998 c 70 s 1 are each amended to read as follows:
     Individuals residing in community-based care settings, such as adult family homes, boarding homes, and residential care settings for the developmentally disabled, including an individual's home, ((might need medication assistance due to physical or mental limitations that prevent them from self-administering their legend drugs or controlled substances. The practitioner in consultation with the individual or his or her representative and the community-based setting, if involved, determines that medication assistance is appropriate for this individual. Medication assistance can take different forms such as opening containers, handing the container or medication to the individual, preparing the medication with prior authorization, using enablers for facilitating the self-administration of medication, and other means of assisting in the administration of legend drugs or controlled substances commonly employed in community-based settings)) may receive medication assistance. Nothing in this chapter affects the right of an individual to refuse medication or requirements relating to informed consent.

NEW SECTION.  Sec. 13   This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.