AN ACT Relating to developing a process to allow pilot programs for health care professionals to learn new skills or roles, use existing skills in new circumstances, and accelerate training; adding new sections to chapter 43.131 RCW; adding a new chapter to Title 18 RCW; creating a new section; and providing an effective date.

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

(1) "Approved project" means an educational or training program approved by the department that does any of the following on a pilot program basis:

(a) Teaches new skills to existing categories of health care personnel;

(b) Uses existing skills in new circumstances or settings;

(c) Accelerates the training of existing categories of health care personnel; or

(d) Teaches new health care roles and skills to previously trained persons whose skills or license is not recognized within the state.

(2) "Department" means the department of health.

(3) "Disciplining authority" has the same meaning as defined in RCW 18.130.020.

(4) "Health care services" means, within the scope of an approved project and the supervisor's scope of practice, the skills of a supervisor which may be taught to a trainee.

(5) "Sponsoring organization" means an organization in existence on the effective date of this section, such as a hospital, clinic, nonprofit educational institution, or government agency, that is engaged in health or education activities and that chooses to sponsor a project.

(6) "Supervisor" means, within the scope of an approved project and the individual's scope of practice, the person designated by the sponsoring organization who possesses the skills to be taught to or used by trainees and who is certified or licensed in Washington to perform the health care services involving the skills.

(7) "Trainee" means a person who, within the scope of the approved project, will be learning to perform health care tasks involving skills taught by a supervisor for which the person does not hold a credential issued by the department.

(a) The aim of the project;

(b) The intended impact on patient care, access to services, and cost;

(c) The category of person to be trained, as described in section 2(1) (a) through (d);

(d) A description of the category of persons to be trained, including types of previous required training, relevant credentials, and work experience;

(e) The tasks to be taught;

(f) The numbers of trainees and supervisors who will participate in the project;

(g) Identification and a description of the health care facilities to be used for training students;

(h) A description of the types of patients likely to be seen or treated, including, where appropriate, average age, income, diagnoses, and ethnicity; and

(i) A description of how existing licensure laws prevent implementation of the project without approval under this chapter.

(2) The application for a project must contain a description of the following:

(a) The evaluation process to be used in assessing project outcomes;

(b) The baseline data and information to be collected;

(c) The nature of program data that will be collected and the methods for collecting and analyzing the data;

(d) Provision for protecting the safety of patients seen or treated in the project; and

(e) A statement of previous experience in providing related health care services.

(3) The application must also include a letter of support from the bargaining representative for any collective bargaining unit impacted by the proposed project if employees within the bargaining unit provide care directly to patients and are employed by the sponsoring organization.

(2) The department may designate an innovative health workforce project as an approved project only if the project is submitted by a sponsoring organization. Individual supervisors and trainees may not sponsor a project and must collaborate with a sponsoring organization. Nothing in this section precludes approved projects from utilizing hospitals or clinics and the offices of physicians, dentists, pharmacists, and other clinical settings as training sites.

(3) The department may set a reasonable application fee for project submissions at a sufficient level to defray the costs of the program, including providing the department resources necessary to: (a) Evaluate and approve or disapprove projects; and (b) monitor and evaluate approved projects.

(4) The department may consult appropriate professional societies, appropriate regulatory entities, institutions of higher education, and other relevant experts prior to designating approved projects. Except where it is necessary to contract with a technical expert, the department may not factor such consultations into the development of application fees.

(5) The department shall give priority for approval to projects operating in high need areas, such as health provider shortage areas, central city areas, and disproportionate share hospitals.

(6) The department may not approve a project for an initial period lasting more than twenty-four months, unless the department determines that the project is likely to contribute substantially to the availability of high quality health services in the state or a region or more time is needed to obtain valid and reliable study results.

(7) The department's decision to deny a project application, accept an application only with required modifications, or modify or revoke an approved project is not an appealable agency action and is not subject to the provisions of chapter 34.05 RCW.

(a) Define certain tasks or patient care functions that a supervisor may delegate to a trainee to perform under direct supervision and with the appropriate training; and

(b) Identify the amount and types of liability insurance to be provided by the participating parties.

(2) A trainee is held to the same standard of care as an individual otherwise legally qualified to perform the health care service or services performed by the trainee or supervisor. While the trainee and supervisor are responsible for their own individual actions, under the collaborative work agreement the sponsoring organization and the supervisor retain overall accountability for patient care. A trainee may refuse to perform any tasks that the trainee reasonably believes may endanger patient safety, and the sponsoring organization may not retaliate against the trainee for such refusal. Participation in an approved project by a trainee or supervisor does not, by itself, constitute unlicensed practice or unprofessional conduct under chapter 18.130 RCW. Except as specified in this subsection, nothing in this chapter modifies the standard of care that would otherwise apply to a trainee, supervisor, or sponsoring organization.

(3) Any patient being seen or treated by a trainee must be apprised of that fact and must be given the opportunity to refuse treatment. If a patient is not competent to grant informed consent, then a trainee may not provide treatment unless consent is obtained from a person authorized to provide consent on behalf of the patient pursuant to RCW 7.70.065. Consent to treatment does not constitute assumption of the risk.

(4) The sponsoring organization may not charge a trainee a fee to participate in an approved project.

(2) The sponsoring organization shall report to the department and any relevant disciplining authorities on a predetermined basis. Reports must include, at a minimum, the following:

(a) Confirmation that the sponsoring organization, supervisor, and trainee are abiding by the approved scope of the project;

(b) Information pertaining to quality and patient safety including:

(i) Confirmation that quality of care and patient safety have not been compromised; and

(ii) Outcomes for selected quality metrics; and

(c) Confirmation that the sponsoring organization, supervisor, and trainee are on target to complete the approved project by the identified completion date.

(3) The department may modify or revoke an approved project if the sponsoring organization does not file reports on a timely basis or if, in the judgment of the department, either patient safety or quality of care is compromised.

(a) The aim of the project;

(b) Whether the aim was achieved;

(c) The degree to which the approved project had an impact on patient care, access to services, and cost;

(d) Recommendations based on approved project outcomes;

(e) The quality of care and patient acceptance of the project;

(f) The new health skills taught or the extent that existing skills have been reallocated;

(g) The implication of the project for existing licensure laws, including suggestions for changes in the law where appropriate;

(h) The implications of the project for health services curricula and for the health care delivery systems;

(i) The teaching methods used in the project; and

(j) The extent that persons with the new skills could find employment in the sponsoring organization or similar health care systems or facilities, assuming laws were changed to incorporate their skill.

(2) Prior to the conclusion of the project, the sponsoring organization may request that the department, in consultation with any relevant disciplining authorities, approve an extension of the project for a one-year period.

(3) At the conclusion of the project, the trainee must cease performing any tasks or services requiring a health care credential unless the trainee receives the appropriate credential from the department or meets an existing exemption in law.

(4) At the conclusion of the project, the department shall submit to the appropriate committees of the legislature an approval and validation of the sponsoring organization's report, a response to the sponsoring organization's report with differing conclusions, or the department's own report.

NEW SECTION.  Sec. 9.  A new section is added to chapter 43.131 RCW to read as follows:

The program authorizing innovative health workforce projects as established under chapter 18.-- RCW (the new chapter created in section 8 of this act) is terminated July 1, 2025, as provided in section 10 of this act.

NEW SECTION.  Sec. 10.  A new section is added to chapter 43.131 RCW to read as follows:

The following acts or parts of acts, as now existing or hereafter amended, are each repealed, effective July 1, 2026:

(1) Section 1 of this act;

(2) Section 2 of this act;

(3) Section 3 of this act;

(4) Section 4 of this act;

(5) Section 5 of this act;

(6) Section 6 of this act; and

(7) Section 7 of this act.

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