WSR 25-14-117
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed July 1, 2025, 4:08 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 23-22-058.
Title of Rule and Other Identifying Information: Dental therapist; the department of health (department) is proposing new chapter 246-819 WAC for the dental therapist profession in order to implement ESHB 1678 (chapter 460, Laws of 2023), codified as chapter 18.265 RCW.
Hearing Location(s): On August 05, 2025, at 1:00 p.m., virtually via Zoom. Register in advance for this webinar at https://us02web.zoom.us/webinar/register/WN_OOrdgq4tTzS0BKv1LVrdww. After registering, you will receive a confirmation email containing information about joining the webinar.
Date of Intended Adoption: August 5, 2025.
Submit Written Comments to: Katherine Einert, P.O. Box 47852, Olympia, WA 98504-7852, fax 360-236-2901, https://fortress.wa.gov/doh/policyreview, beginning the date and time of this filing, by August 5, 2025, at 11:59 p.m.
Assistance for Persons with Disabilities: Contact Katherine Einert, phone 360-236-4843, fax 360-236-2901, TTY 711, email kitty.einert@doh.wa.gov, by July 29, 2025.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Chapter 18.265 RCW established the new profession of dental therapy. This statute authorized the department to adopt rules in order to implement the new statute. The proposed new chapter of rules establishes the new profession's education, continuing education, training, examination, and licensure requirements, which include several pathways to licensure as a dental therapist.
Dental therapists are considered mid-level dental providers who work in collaboration with a licensed dentist. In compliance with the statute, dental therapists may only practice in federally qualified health centers and federally qualified health center look-a-likes as recognized under 42 C.F.R. §§ 413.65 (m) - (n).
The legislature found that good oral health is an integral piece of overall health and well-being. Dental related issues are a leading reason that Washingtonians seek care in hospital emergency departments. The purpose of this rule making is to implement this important legislation to expand access to oral health care by addressing racial and ethnic disparities in health and rural health care access gaps by providing care in local communities through dental therapists.
Reasons Supporting Proposal: The proposed rule is necessary to implement the new statute, chapter 18.265 RCW, which directs the secretary, in consultation with the dental quality assurance commission, to establish by rule the procedures and requirements for licensure and to create other rules necessary to implement this new legislation. Rules are necessary to create clear and enforceable standards for the dental therapist profession.
Statutory Authority for Adoption: RCW 43.70.110, 43.70.250, and 43.70.280.
Statute Being Implemented: Chapter 18.265 RCW, Dental therapists.
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: Katherine Einert, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4843.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Katherine Einert, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4843, fax 360-236-2901, TTY 711, email kitty.einert@doh.wa.gov.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025(4).
Explanation of exemptions: The proposed rule is exempt under RCW 19.85.025 because it only affects the dental therapy license, which is not considered a small business under RCW 19.85.020.
Scope of exemption for rule proposal:
Is fully exempt.
July 1, 2025
Kristin Peterson, JD
Chief of Policy
for Jessica Todorovich, MS
Acting Secretary of Health
RDS-6237.3
Chapter 246-819 WAC
DENTAL THERAPISTS
NEW SECTION
WAC 246-819-010Applicability.
A licensed dental therapist may practice only in federally qualified health centers, tribal federally qualified health centers, and federally qualified health center look-a-likes. Individuals licensed as a dental therapist shall comply with the requirements in chapter 18.265 RCW and this chapter.
NEW SECTION
WAC 246-819-020Definitions.
The definitions in RCW 18.265.010 apply throughout this chapter unless the context clearly indicates otherwise.
(1) "Close supervision" means the same as RCW 18.260.010.
(2) "Commission" means the dental quality assurance commission as established in chapter 18.32 RCW.
(3) "Dental health aide therapist" means the same as RCW 70.350.010.
(4) "Dental therapist" means a person licensed to practice dental therapy under this chapter.
(5) "Dental therapy" means the services and procedures specified in RCW 18.265.050.
(6) "Dentist" means a person licensed to practice dentistry under chapter 18.32 RCW or exempt from such licensure pursuant to Title 25 U.S.C. Sec. 1621t of the Indian Health Care Improvement Act.
(7) "Department" means the department of health.
(8) "General supervision" means the same as RCW 18.260.010.
(9) "Off-site supervision" means supervision that does not require the dentist to be personally on-site when services are provided or to previously examine or diagnose the patient.
(10) "Secretary" means the secretary of health.
NEW SECTION
WAC 246-819-030License requirements—License by exam.
An applicant seeking dental therapist licensure shall submit to the department the following:
(1) Official transcripts verifying successful completion of a dental therapy education program approved by the commission.
(2) Official verification of passing the dental therapy examinations approved by the commission under WAC 246-819-050. Official verification must be sent directly to the department from the testing agency.
(3) An initial application on forms provided by the department.
(4) Written certification of any health professional licenses held, submitted directly from another licensing entity, and including license number, issue date, expiration date, and whether applicant has been the subject of final or pending disciplinary action.
(5) Proof of completion of a written jurisprudence exam.
(6) Authorization for background inquiries to other sources. These may be conducted as determined by the commission including, but not limited to, the national practitioner data bank and drug enforcement agency.
(7) Any fees incurred in obtaining verification of requirements.
(8) Any other information for each license type as determined by the secretary.
(9) Fees as required in WAC 246-819-990.
NEW SECTION
WAC 246-819-040Approved educational program content requirements.
To be eligible for initial dental therapy licensure, the applicant must successfully complete a dental therapy education program approved by the commission. The commission accepts educational programs as listed in RCW 18.265.030 (1) and (2).
(1) Dental therapy education programs must include coursework encompassing the subject areas within the Washington state dental therapy scope of the practice as listed in RCW 18.265.050 including didactic and clinical competency in:
(a) Periodontal scaling and root planing; and
(b) Administration of nitrous oxide analgesia.
(2) Dental therapy education programs whose curriculum does not include the didactic and clinical competency as required in subsection (1) of this section, will be accepted if the applicant successfully completes supplemental education approved by the commission.
(a) The commission accepts supplemental education taken from CODA accredited dental, dental hygiene, and dental therapy schools.
(b) Non-CODA education requires commission approval.
NEW SECTION
WAC 246-819-050Approved examinations.
An applicant seeking licensure by examination in Washington must successfully complete dental therapy written and clinical examinations approved by the commission including:
(1) Central Regional Dental Testing Services (CRDTS);
(2) CDCA/WREB/CITA; or
(3) Any other examination that the commission determines as substantially equivalent.
NEW SECTION
WAC 246-819-060Licensure without exam—Licensed in another state.
An applicant may qualify for licensure by endorsement as a dental therapist if the applicant is currently licensed as a dental therapist or dental health aide therapist credentialed in a state or jurisdiction with substantially equivalent licensing standards, and has been licensed for at least two years immediately preceding an application and meets all other requirements in RCW 18.130.077. The applicant must submit to the department:
(1) A completed application on forms provided by the department;
(2) Proof of licensure history that demonstrates compliance with RCW 18.130.077 (1) and (3);
(3) The licensing fees required under WAC 246-819-990;
(4) Proof of successful completion of a Washington state approved dental therapy jurisprudence examination; and
(5) Authorization for background inquiries to other sources that may include, but are not limited to, the national practitioner data bank, liability malpractice insurance carrier(s), and the drug enforcement agency.
NEW SECTION
WAC 246-819-070Limited license.
(1) An applicant may qualify for limited licensure if they hold a valid dental therapist license, dental health aide therapist (DHAT) certification, or recertification in another state or Canadian province, or have been certified or licensed by a federal or tribal governing board in the previous two years, and that the commission has determined the credential is similar or substantially equivalent, but not the entire scope of practice as defined in RCW 18.265.060.
(2) The applicant shall submit to the department:
(a) A completed application on forms provided by the department;
(b) Fees as required in WAC 246-819-990;
(c) A verification by a U.S. state or territory, Canadian province, or tribal or federal certification board or equivalent authority of an active credential to practice dental therapy, dental health aide therapy (DHAT), certification or recertification in another jurisdiction without restrictions, and whether the applicant has been the subject of final or pending disciplinary action;
(d) Proof of graduation from an approved dental therapy or equivalent dental health aide therapist program. The only acceptable proof is an official, posted transcript sent directly to the department from such school;
(e) Proof that the applicant has at least 560 hours of active practice within the preceding 24 months. Active practice can include teaching, or practice in a clinical setting of dental therapy, dental health aide therapy (DHAT), certification or recertification;
(f) Proof of successful completion of an approved Washington state dental therapy jurisprudence examination;
(g) Authorization for background inquiries to other sources that may include, but are not limited to, the national practitioner data bank, liability malpractice insurance carrier(s), and the drug enforcement agency;
(h) The limited license shall expire when one of the following occurs:
(i) The individual demonstrates full competency in all procedures under RCW 18.265.050 and a full, unrestricted dental therapy credential is granted; or
(ii) Five years after the dental therapy limited license is issued;
(i) A dental therapy limited license shall not be renewed, reissued, or extended;
(j) A person practicing with a dental therapy limited license granted under this section has the authority to perform only those dental therapy procedures in RCW 18.265.050 that they were licensed or certified to practice in their previous state, tribe, or Canadian province.
NEW SECTION
WAC 246-819-080Practice plan contract requirements.
(1) A dental therapist may only practice dental therapy under the supervision of a dentist and under a written practice plan contract. The contract, at a minimum, must contain:
(a) The elements listed in RCW 18.265.060; and
(b) Limited conditions and emergency procedures.
(i) Limited conditions include nonsurgical extractions when a patient is classified as an American Society Anesthesiologists (ASA) I or ASA II.
(ii) Prior approval and consultation from the supervising dentist is required for patients classified as ASA III.
(2) The practice plan must be:
(a) Signed by the supervising dentist and a dental therapist and must outline the mutually agreed upon functions that the dentist authorizes the dental therapist to perform and the level and type of supervision that is required;
(b) Submitted to the secretary upon license renewal; and
(c) Submitted to the department within 30 days of any substantive revision.
NEW SECTION
WAC 246-819-090Liability insurance requirements.
On or before a dental therapist begins treating patients, they shall obtain liability insurance.
(1) Liability insurance must be maintained at all times.
(2) The amount of coverage must be equivalent to that of the supervising dentist's liability insurance coverage.
(3) A dental therapist shall submit a signed liability insurance attestation at the same time as the practice plan contract is submitted to the secretary.
NEW SECTION
WAC 246-819-100Patient record content.
A dental therapist licensed under this chapter shall comply with the same requirements for patient records as a dentist as described in WAC 246-817-304 and 246-817-305.
NEW SECTION
WAC 246-819-110Patient record retention requirements.
A dental therapist licensed under this chapter shall comply with the same requirements for patient records retention and accessibility as a dentist as described in WAC 246-817-310.
NEW SECTION
WAC 246-819-120Infection control for dental therapy practice.
A dental therapist licensed under this chapter shall maintain the same infection control standards as a dentist as described in WAC 246-817-601 through 246-817-660.
NEW SECTION
WAC 246-819-130Continuing education and renewal requirements.
(1) To renew a dental therapy license, an individual shall:
(a) Complete 54 hours of continuing education every three years following the first license renewal;
(b) Maintain a current basic life support (BLS) for the health care provider certification. Certification must include both didactic and hands-on components;
(c) Submit to the department a signed practice plan contract;
(d) Sign a declaration attesting to the completion of the required number of continuing education hours as part of the annual renewal requirement.
(2) The department will not authorize or approve specific continuing education courses. Continuing education course work must contribute to the professional knowledge and development of the dental therapist or enhance services provided to patients.
(3) Continuing education is defined as any of the following activities:
(a) Continuing education courses offered or authorized by industry recognized local, state, private, national and international organizations, agencies or institutions of higher learning;
(b) BLS for health care providers, advanced cardiac life support (ACLS), Occupational Safety and Health Administration (OSHA)/Washington Industrial Safety and Health Act (WISHA), or emergency related training such as courses offered or authorized by the American Heart Association or the American Cancer Society, or any other organizations or agencies;
(c) Self-study through study clubs, books, research materials, or other publications. The required documentation for this activity is a summary of what was learned, not to exceed five hours per year;
(d) Distance learning includes, but is not limited to: Correspondence course, webinar, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/online-learning, or computer broadcasting/webcasting that includes an assessment tool upon completion;
(e) Provision of clinical dental therapy services in a documented volunteer capacity when preceded by educational/instructional training prior to provision of services, not to exceed five hours per year. Volunteering must be without compensation and under appropriate supervision;
(f) College courses;
(g) Attendance at a continuing education program with a featured speaker;
(h) Courses relating to practice organization and management, medical/dental insurance courses, or retirement, not to exceed five hours per year;
(i) Dental therapy examination standardization/calibration workshops and dental therapy examination item writer workshops, not to exceed five hours per year;
(j) A licensee who serves as a public health official or employee, contractor for a state or local health agency, community prevention education expert, or works in a field that relates to prevention activities in public health dentistry, may accumulate hours for the content preparation of providing services, education, or training to the underserved, rural, and at risk populations, not to exceed five hours per year.
(4) The department may randomly audit up to 25 percent of practitioners for compliance after the credential is renewed under WAC 246-12-190.
NEW SECTION
WAC 246-819-140Suicide prevention training.
A dental therapist licensed under this chapter shall complete a department-approved one-time training that is at least three hours in length in suicide assessment, treatment, and management training as described in RCW 43.70.442.
(1) This training must be completed by the end of the first full continuing education reporting period after initial licensure.
(2) Training approved by the department for this requirement must be on the department's model list as described in WAC 246-12-601 through 246-12-650.
(3) The hours spent completing the training in suicide assessment under this section count toward meeting applicable continuing education requirements for dental therapy license renewal.
NEW SECTION
WAC 246-819-150Health equity training requirements.
(1) A dental therapist licensed under this chapter shall complete two hours of health equity continuing education training every three years as described in WAC 246-12-820 and 246-12-830.
(2) The hours spent completing the training in health equity under this section counts toward meeting applicable continuing education requirements for dental therapy license renewal.
NEW SECTION
WAC 246-819-160Nondiscrimination.
A dental therapist licensed under this chapter shall comply with the same requirements for nondiscrimination as a dentist as described in WAC 246-817-370.
NEW SECTION
WAC 246-819-170Representation of care, fees, and records.
A dental therapist licensed under this chapter shall comply with the same requirements for representation of care, fees, and records as a dentist as described in WAC 246-817-390.
NEW SECTION
WAC 246-819-180Patient abandonment.
A dental therapist licensed under this chapter shall comply with the same patient abandonment requirements as a dentist as described in WAC 246-817-380.
NEW SECTION
WAC 246-819-190Sexual misconduct.
A dental therapist licensed under this chapter shall comply with the sexual misconduct rule as described in WAC 246-16-100.
NEW SECTION
WAC 246-819-200Report of patient injury or mortality.
(1) A dental therapist shall submit a complete report of any patient mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of said patient during, or as a direct result of dental procedures or anesthesia.
(2) A dental therapist shall notify the commission in writing within 72 hours of discovery and must submit a complete written report to the commission within 30 days of the incident.
NEW SECTION
WAC 246-819-210Display of licenses.
The license of a dental therapist must be displayed in a place visible to individuals receiving services on the premises, and readily available for inspection.
NEW SECTION
WAC 246-819-220Expired license.
The license of a dental therapist must be renewed every year on the practitioner's birthday. If the license expires, the dental therapist shall meet the requirements in WAC 246-12-020 through 246-12-051.
NEW SECTION
WAC 246-819-990Dental therapist fees and renewal cycle.
(1) A license must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC.
(2) The following nonrefundable fees will be charged:
Title of Fee
Fee
Initial application
$950.00
License renewal
$950.00
Late renewal penalty
$300.00
Expired license reissuance
$300.00
Limited license application
$950.00
Duplicate license
$15.00
Verification of license
$25.00