DEPARTMENT OF HEALTH

(Board of Nursing Home Administrators)

[Filed July 15, 2025, 3:59 p.m.]

Preproposal statement of inquiry was filed as WSR 24-21-101.

Title of Rule and Other Identifying Information: Nursing home administrators—Administrator-in-training (AIT) programs and endorsement requirements. The board of nursing home administrators (board) is proposing amendments to WAC 246-843-090, 246-843-095, and 246-843-230 to reduce barriers for licensure and align with RCW 18.130.077.

Hearing Location(s): On October 24, 2025, at 9:10 a.m., at the Department of Health, Town Center 1, Room 164, 111 Israel Road S.E., Tumwater, WA 98501; or virtual through Microsoft Teams at https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZTM0MTQzZDgtMTgzZC00YjUyLTgyNDQtNjkyN2E4ZDYzMDNh%40thread.v2/0?context=%7b%22Tid%22%3a%2211d0e217-264e-400a-8ba0-57dcc127d72d%22%2c%22Oid%22%3a%227bfba9ef-0251-4647-8346-3fa4ff1ed862%22%7d.

Date of Intended Adoption: October 24, 2025.

Submit Written Comments to: Shelbee Scrimo, P.O. Box 47852, Olympia, WA 98504-7852, email nha@doh.wa.gov, https://fortress.wa.gov/doh/policyreview/, beginning the date and time of this filing, by October 17, 2025, 11:59 p.m.

Assistance for Persons with Disabilities: Contact Shelbee Scrimo, phone 360-236-4723, TTY 711, email shelbee.scrimo@doh.wa.gov, by October 17, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The board is proposing to amend WAC 246-843-090 Administrator-in-training program, by updating the program to allow participants to visit other facilities during their program which will expand their training experience allowing them to see how a different facility with different services is managed. The board is also proposing to amend WAC 246-843-095 Preceptors for administrator-in-training programs, by adding in the requirement to complete the national association's leadership course. The board is also proposing to amend WAC 246-843-230 Endorsement, to remove barriers for applicants coming from out of state.

Reasons Supporting Proposal: The board is proposing this rule change to reduce barriers for licensure and also to align with the intent of RCW 18.130.077. The national association has an AIT program used by many states; this program includes an easy way to determine how many hours are needed for each portion of the required clinical training. The board is proposing to align the current AIT program to the national AIT program to make it easier for applicants and to align with other states. In addition, the endorsement rule currently requires that all initial requirements of licensure must be met, which does not align with RCW 18.130.077.

Statutory Authority for Adoption: RCW 18.52.061, 18.52.071, and 18.130.077.

Statute Being Implemented: RCW 18.52.061, 18.52.071, and 18.130.077.

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

Name of Proponent: Board of nursing home administrators, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Shelbee Scrimo, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4723.

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 Shelbee Scrimo, P.O. Box 47852, Olympia, WA 98504-7852, phone 360-236-4723, TTY 711, email shelbee.scrimo@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: These amendments regulate individual licensees, not businesses.

Scope of exemption for rule proposal:

Rosalie Romano, Ph.D., Chair

Board of Nursing Home Administrators

AMENDATORY SECTION(Amending WSR 24-03-147, filed 1/23/24, effective 2/23/24)

WAC 246-843-090Administrator-in-training program.

Unless exempt by WAC 246-843-093, an applicant for the original license must complete an administrator-in-training (AIT) program according to this section as part of the original licensure process. The board must approve the AIT program before the applicant may begin the training.

(1) To participate in an AIT program, the applicant must submit to the department of health:

(a) In addition to the original license fee, the AIT program fee required in WAC 246-843-990; and

(b)(i) Information on forms provided by the department showing how the AIT program meets the requirements of subsection (2) of this section.

(ii) If the AIT program is less than 1,500 hours, the applicant must also include a resume and explanation of how the applicant meets the relevant requirements in WAC 246-843-091; and

(c) A statement sent directly by the preceptor on a form provided by the department that describes how the preceptor meets the requirements of WAC 246-843-095.

(2) The AIT program must consist of the following:

(a) Be under the guidance and supervision of a qualified preceptor as described in WAC 246-843-095;

(b) Be designed to provide for individual learning experiences and instruction based upon the person's academic background, training, and experience;

(c) Provide for a broad range of experience with a close working relationship between preceptor and AIT. A sponsoring facility of less than 50 beds will be considered for an AIT program only if there is a board approved plan to broaden the AIT experience with an equal percentage of experience in a larger facility under the guidance and supervision of a qualified preceptor as described in WAC 246-843-095;

(d) Be described in a prospectus signed by the preceptor. The prospectus must include a description of the rotation through departments. The board must approve the prospectus before the AIT program start date.

The prospectus shall include the following components:

(i) A minimum of 90 percent of the required AIT program hours are spent in a rotation through each department of a resident occupied nursing home licensed under chapter 18.51 RCW or a Washington state veterans home established under chapter 72.36 RCW. Up to 10 percent of the hours may be at an alternative facility with a licensed nursing home administrator who meets the requirements in WAC 246-843-095; and

(ii) The remaining 10 percent of the AIT program will include:

(A) A written project assignment including at least one problem-solving assignment to improve the nursing home or nursing home procedures. A description of the project must be submitted in writing to the board and approved before the AIT program start date. The description of the project should indicate the definition of the project and method of approach such as data gathering. A project report that includes possible alternatives, conclusions, and final recommendations to improve the facility or procedure is to be submitted to the board for approval at least 10 days before the scheduled end date of the AIT program;

(B) Planned reading and writing assignments as designated by the preceptor; and

(C) Other planned learning experiences including learning about other health and social services agencies in the community.

(3) Preceptors of approved AIT programs shall submit ((quarterly))monthly reports to the department as follows:

(a) If the approved AIT program has more than one preceptor, each preceptor shall submit a ((quarterly))monthly report.

(b) The preceptor shall submit the final report to the department at least 10 days before the scheduled end date of the AIT program.

(i) Be on forms provided by the department;

(ii) Describe a detailed outline of AIT activities during the reporting period which includes:

(A) A document completed by the AIT and signed by the preceptor; and

(B) A document completed and signed by the preceptor.

(4) Changes in the AIT program, including a change of preceptor, facility or topic, must be immediately reported in writing to the board. A request for change must be in writing and explain why the change is needed.

(5) A site visit by a board member will take place before the program plan is considered complete.

(6) The AIT program must be completed to the board's satisfaction as a condition of licensure. The board may withdraw approval or alter conditions under which approval was given if the board finds that the approved program has not been or is not being followed.

AMENDATORY SECTION(Amending WSR 19-19-050, filed 9/13/19, effective 10/14/19)

WAC 246-843-095Preceptors for administrator-in-training programs.

The preceptor shall submit a statement to the board describing his or her qualifications and an agreement to perform the duties of a preceptor.

(1) Qualifications of preceptor:

(a) The preceptor must be actively practicing as a nursing home administrator for a duration of no less than three years prior to the submission of the AIT applicant's initial application for an AIT credential.

(b) The preceptor must be employed full time as the nursing home administrator in the facility where the AIT is trained.

(d) The preceptor shall submit proof that they have completed the National Association of Long Term Care Administrators Board (NAB) preceptor leadership course.

(2) Duties of the preceptor:

(a) The preceptor shall take the time necessary and have at least a weekly face-to-face conference with the AIT about the activities of the AIT relative to the training program and the nursing home.

(b) The preceptor shall evaluate the AIT and submit ((quarterly))monthly reports to the board on the progress of the AIT program.

(c) The preceptor shall provide learning opportunities that support the AIT's preparation to succeed on the licensure examination and competently assume the responsibilities of a nursing home administrator.

(3) A preceptor is limited to the supervision of only one AIT unless the preceptor has prior approval from the board.

(4) The board may periodically review and evaluate the quality of AIT programs and preceptor performance.

AMENDATORY SECTION(Amending WSR 19-19-050, filed 9/13/19, effective 10/14/19)

WAC 246-843-230Endorsement.

(1) The board may issue a license on the basis of licensure in good standing from another state to a nursing home administrator if that state requires qualifications substantially equivalent to qualifications required by RCW 18.52.071 and WAC 246-843-090. To obtain a license by endorsement the applicant shall:

(a) ((Satisfy requirements listed in WAC 246-831-071 [246-843-071}))Submit to the department a completed application for licensure on forms provided by the department that includes all information requested and payment of fees as required in WAC 246-12-020 through 246-12-051 and 246-843-990.

(b) Submit verification forms from all states in which currently or previously licensed that verifies the applicant was or is currently licensed and confirms licensure status.

(2) Applicants who are currently certified by the American College of Health Care Administrators (ACHCA) are exempt from taking the current NAB national examination.