DEPARTMENT OF HEALTH

[Filed June 12, 2026, 12:30 p.m., effective July 13, 2026]

Effective Date of Rule: Thirty-one days after filing.

Purpose: Washington health professional services (WHPS) program name change to compassion, accountability, recovery, empowerment, and safety (CARES). The Washington state board of nursing (board) is adopting amendments to WAC 246-840-750 through 246-840-790 to update the rule language by removing outdated references to WHPS following the board's September 12, 2025, decision to rename the program to CARES. The amendments replace references to WHPS with the neutral term "approved substance use disorder monitoring program" and update definitions accordingly. These changes are technical and nonsubstantive and do not alter the meaning, requirements, or effect of the rules.

Citation of Rules Affected by this Order: Amending WAC 246-840-750, 246-840-760, 246-840-770, 246-840-780, and 246-840-790.

Statutory Authority for Adoption: RCW 18.79.010 and 18.79.110.

Other Authority: RCW 18.130.175.

Adopted under notice filed as WSR 26-05-086 on February 18, 2026.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 5, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 5, Repealed 0.

Date Adopted: June 4, 2026.

Alison Bradywood DNP, MN/MPH, RN, NEA-BC

Washington State Board of Nursing

AMENDATORY SECTION(Amending WSR 24-12-066, filed 6/3/24, effective 7/1/24)

WAC 246-840-750Philosophy governing the voluntary approved substance use disorder monitoring program((s)).

The Washington state board of nursing (board) recognizes the need to establish a means of providing early recognition and treatment options for licensed practical nurses or registered nurses whose competency may be impaired due to the use of drugs or alcohol. The board intends that such nurses be treated, and their treatment monitored so that they can return to or continue to practice their profession in a manner, that safeguards the public. ((The Washington health professional services (WHPS) program is the board's approved substance use monitoring program under RCW 18.130.175.)) The board may refer licensed practical nurses or registered nurses to ((WHPS))the board's approved substance use disorder monitoring program under RCW 18.130.175 as either an alternative to or in connection with disciplinary actions ((under RCW 18.130.160)).

AMENDATORY SECTION(Amending WSR 24-12-066, filed 6/3/24, effective 7/1/24)

WAC 246-840-760Definitions of terms used in WAC 246-840-750 through 246-840-790.

The definitions in this section apply throughout WAC 246-840-750 through 246-840-790 unless the text clearly requires otherwise.

(1) "Approved substance use disorder monitoring program" means the compassion, accountability, recovery, empowerment, and safety (CARES) program that the board has determined meets the criteria in WAC 246-840-770 and RCW 18.130.175. The approved substance use disorder monitoring program does not provide evaluation or treatment services.

(2) "Continuing care" means the phase of treatment following acute treatment. Common elements of continuing care include relapse prevention and self-help group participation.

(((2)))(3) "Defray" means the board may pay up to 80 percent of out-of-pocket expenses related to ((WHPS))the approved substance use disorder monitoring program participation that includes substance use disorder (SUD) evaluations, SUD treatment and other ancillary services including drug testing, participation, professional peer support groups, and any other expenses deemed appropriate by the board.

(((3)))(4) "Financial assistance" means board approval to use funds to pay for a participant's out-of-pocket costs associated with participation in the ((WHPS))approved substance use disorder monitoring program.

(((4)))(5) "Financial need" means a demonstrated need by ((a WHPS))the approved substance use disorder monitoring program participant when they need help to pay for costs related to participation in the ((WHPS))approved substance use disorder monitoring program.

(((5)))(6) "Monitoring contract" is a comprehensive, structured agreement between the recovering nurse and ((WHPS))the approved substance use disorder monitoring program defining the requirements of the nurse's program participation.

(((6)))(7) "Peer support group" is a professionally facilitated support group designed to support recovery and re-entry into practice.

(((7)))(8) "Random drug screens" means laboratory tests to detect the presence of drugs in body fluids and other biologic specimens that are performed at irregular intervals not known in advance by the person to be tested.

(((8)))(9) "Referral contract" is a formal agreement between the board and the nurse to comply with the requirements of the ((WHPS))approved substance use disorder monitoring program in lieu of discipline.

(((9)))(10) "Self-help groups" means groups or fellowships providing support for people with substance use disorder to support their sobriety and recovery.

(((10)))(11) "Stipend program" means the board program to defray the out-of-pocket expenses for participants who have applied for and been approved to receive financial assistance in connection with participation in ((WHPS))the approved substance use disorder monitoring program. The purpose is to assist nurses who would otherwise be unable to participate in the program because of personal financial limitations.

(((11)))(12) "Stipend program application" means a board form that the participant uses to request stipend assistance that provides information to determine eligibility for stipend funds.

(((12)))(13) "Substance use disorder" (SUD) means a chronic progressive illness that involves the use of alcohol or other drugs to a degree that it interferes with the functional life of the registrant/licensee, as manifested by health, family, job (professional services), legal, financial, or emotional problems.

(((13) "Washington health professional services (WHPS)" is the approved substance use monitoring program as described in RCW 18.130.175 that meets criteria established by the board. WHPS does not provide evaluation or treatment services.))

AMENDATORY SECTION(Amending WSR 24-12-066, filed 6/3/24, effective 7/1/24)

WAC 246-840-770((Approval))Requirements of the approved substance use disorder monitoring program((s)).

((The board uses WHPS as the approved monitoring program.))

(1) ((WHPS will))The approved substance use disorder monitoring program must:

(a) Employ staff with the qualifications and knowledge of both substance use and the practice of nursing as defined in this chapter to be able to evaluate:

(i) Clinical laboratories;

(ii) Laboratory results;

(iii) Providers of substance use treatment, both individuals and facilities;

(iv) Peer support groups;

(v) The nursing work environment; and

(vi) The ability of the nurse to practice with reasonable skill and safety.

(b) Enter into a monitoring contract with the nurse to oversee the nurse's required recovery activities. Exceptions may be made to individual components of the contract as needed.

(c) Determine, on an individual basis, whether a nurse will be prohibited from engaging in the practice of nursing for a period of time and restrictions, if any, on the nurse's access to controlled substances in the workplace.

(d) Maintain case records on participating nurses.

(e) Report to the board any nurse who fails to comply with the requirements of the approved substance use disorder monitoring program as defined by the board.

(f) Provide the board with an annual statistical report.

(2) The board approves ((WHPS's))the approved substance use disorder monitoring program's procedures on treatment, monitoring, and limitations on the practice of nursing for those participating in the program.

AMENDATORY SECTION(Amending WSR 24-12-066, filed 6/3/24, effective 7/1/24)

WAC 246-840-780Conditions for participants entering the approved substance use disorder monitoring program.

(1) Any nurse participating in the approved substance use disorder monitoring program must:

(a) Undergo a complete substance use disorder evaluation. This evaluation will be performed by health care professional(s) with expertise in chemical dependency.

(b) Enter into a monitoring contract with ((WHPS))the approved substance use disorder monitoring program which includes, but is not limited to, the following terms, which require the nurse to:

(i) Undergo any recommended level of treatment by a board-designated licensed treatment provider, including continuing care;

(ii) Abstain from all mind-altering substances including alcohol and cannabis except for medications prescribed by an authorized prescriber, as defined in RCW 69.41.030 and 69.50.101;

(iii) Cause the treatment counselor(s) to provide reports to the approved substance use disorder monitoring program at specified intervals;

(iv) Attend peer support group, or self-help group meetings, or both as specified by ((WHPS))the approved substance use disorder monitoring program;

(v) Complete random or for-cause drug screening as specified by ((WHPS))the approved substance use disorder monitoring program;

(vi) Comply with specified employment conditions and restrictions as defined by the monitoring contract;

(vii) Agree in writing to allow ((WHPS))the approved substance use disorder monitoring program to release information to the board if the nurse does not comply with any contract requirements or is unable to practice with reasonable skill and safety;

(viii) Pay the costs of any required evaluations, substance use treatment, peer support group, random drug screens, and other personal expenses incurred in relation to the approved substance use disorder monitoring program;

(ix) Sign any requested release of information authorizations.

(2) When referred to ((WHPS))the approved substance use disorder monitoring program in lieu of discipline, the nurse must enter into a referral contract with the board. The board may take disciplinary action against the nurse's license under RCW 18.130.160 based on any violation by the nurse of the referral contract.

(3) A nurse may voluntarily participate in ((WHPS))the approved substance use disorder monitoring program in accordance with RCW 18.130.175(2) without first being referred to ((WHPS))the approved substance use disorder monitoring program by the board.

AMENDATORY SECTION(Amending WSR 24-12-066, filed 6/3/24, effective 7/1/24)

WAC 246-840-790Stipend program of the approved substance use disorder monitoring ((stipend)) program.

(1) Applicants ((must))shall meet the requirements in RCW 18.79.440 to be eligible for the stipend program of the approved substance use disorder monitoring ((stipend)) program (((stipend program))). All disbursements of stipend program funds are subject to availability of budgeted funds.

(2) To be eligible for the stipend program, a person ((must))shall:

(a) Hold an active, inactive, or suspended license issued pursuant to this chapter;

(b) Submit an application on forms provided by the board;

(c) Be actively participating in the ((board's)) approved substance use disorder monitoring program (((WHPS program))) or have completed the ((WHPS))approved substance use disorder monitoring program within six months of submission of an application for the stipend program; and

(d) Have a demonstrated need for financial assistance with the expenses incurred in connection with participation in the ((WHPS))approved substance use disorder monitoring program.

(3) A person is not eligible for the stipend program if they have previously applied for and participated in the stipend program and had benefits paid on their behalf from the stipend program.

(4) The board may defray up to 80 percent of each out-of-pocket expense deemed eligible for defrayment under this section. The board will not pay stipend program funds directly to any person participating in the stipend program. The board will pay out-of-pocket expenses directly to entities providing services to the person participating in the stipend program.

(5) Out-of-pocket expenses eligible for defrayment under this section include the costs of substance use evaluation, treatment, other ancillary services, including drug testing, participation in professional peer support groups, and any other expenses deemed appropriate by the board.

(6) A person participating in the stipend program established in this section shall document and submit their out-of-pocket expenses in a manner specified by the board.

(7) Eligibility:

(a) A person may participate in the stipend program by having the stipend program defray authorized out-of-pocket expenses for one monitoring contract period only, including extensions of the contract monitoring period directed by ((WHPS))the approved substance use disorder monitoring program.

(b) An applicant who was approved for the stipend program for a monitoring contract period without having benefits paid from the stipend program on their behalf, and later reenters the ((WHPS))approved substance use disorder monitoring program, may be approved to participate in the stipend program.

(c) Stipend program applications are approved for a 12-month period. Persons participating in the stipend program shall submit an application every 12 months to renew their participation in the stipend program.

(d) A person may participate in the stipend program for a maximum of five years from the approval date of the initial stipend program application. Eligibility for the stipend program terminates upon successful completion of or discharge from the ((WHPS))approved substance use disorder monitoring program.

(e) An applicant who previously applied for the stipend program but whose application was denied is eligible to reapply if the applicant's financial circumstances have changed.

(8) To establish financial need for the stipend program, a person shall provide documentary proof that total household income is less than 400 percent of the federal poverty level as determined under 42 U.S.C. 9902(2) and published annually by the U.S. Department of Health and Human Services.

(9) Application forms and documentary proof provided to the board under this section by applicants will be submitted under penalty of perjury and, if shown to be false, could subject the applicant to criminal penalties or other adverse action including, but not limited to, adverse action for moral turpitude, misrepresentation, or fraud.

(10) The stipend program may defray the cost of eligible out-of-pocket expenses incurred by a stipend program participant up to six months prior to application submission.

(11) The board may adopt, publish, and use procedures, forms, guidelines, and other documents necessary for implementation of this rule. Such procedures, forms, guidelines, and documents may be revised, amended, or discontinued as necessary in the sole discretion of the board.