title: RCW 18.20.340

text:
(1) An assisted living facility licensee may permit a resident's family member to administer medications or treatments or to provide medication or treatment assistance to the resident. The licensee shall disclose to the department, residents, the residents' legal representative if any, and if not, the residents' representative if any, and to interested consumers upon request, information describing whether the licensee permits such family administration or assistance and, if so, the extent of limitations or conditions thereof.
(2) If an assisted living facility licensee permits a resident's family member to administer medications or treatments or to provide medication or treatment assistance, the licensee shall request that the family member submit to the licensee a written medication or treatment plan. At a minimum, the written medication or treatment plan shall identify:
(a) By name, the family member who will administer the medication or treatment or provide assistance therewith;
(b) The medication or treatment administration or assistance that the family member will provide consistent with subsection (1) of this section. This will be referred to as the primary plan;
(c) An alternate plan that will meet the resident's medication or treatment needs if the family member is unable to fulfill his or her duties as specified in the primary plan; and
(d) An emergency contact person and telephone number if the assisted living facility licensee observes changes in the resident's overall functioning or condition that may relate to the medication or treatment plan.
(3) The assisted living facility licensee may require that the primary or alternate medication or treatment plan include other information in addition to that specified in subsection (2) of this section.
(4) The medication or treatment plan shall be signed and dated by:
(a) The resident, if able;
(b) The resident's legal representative, if any, and, if not, the resident's representative, if any;
(c) The resident's family member; and
(d) The assisted living facility licensee.
(5) The assisted living facility may through policy or procedure require the resident's family member to immediately notify the assisted living facility licensee of any change in the primary or alternate medication or treatment plan.
(6) When an assisted living facility licensee permits residents' family members to assist with or administer medications or treatments, the licensee's duty of care, and any negligence that may be attributed thereto, shall be limited to: Observation of the resident for changes in overall functioning consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition, or when the assisted living facility is aware that both the primary and alternate plan are not implemented; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.
[ 2012 c 10 s 23; 2004 c 142 s 6.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Effective dates—2004 c 142: See note following RCW 18.20.020.

catchline: Resident's family member administers medications or treatment—Written primary or alternate plan—Licensee's duty of care/negligence.


doc_type: statute

jurisdiction: wa

title: RCW 18.20.350

text:
(1) The assisted living facility licensee shall conduct a preadmission assessment for each resident applicant. The preadmission assessment shall include the following information, unless unavailable despite the best efforts of the licensee:
(a) Medical history;
(b) Necessary and contraindicated medications;
(c) A licensed medical or health professional's diagnosis, unless the individual objects for religious reasons;
(d) Significant known behaviors or symptoms that may cause concern or require special care;
(e) Mental illness diagnosis, except where protected by confidentiality laws;
(f) Level of personal care needs;
(g) Activities and service preferences; and
(h) Preferences regarding other issues important to the resident applicant, such as food and daily routine.
(2) The assisted living facility licensee shall complete the preadmission assessment before admission unless there is an emergency. If there is an emergency admission, the preadmission assessment shall be completed within five days of the date of admission. For purposes of this section, "emergency" includes, but is not limited to: Evening, weekend, or Friday afternoon admissions if the resident applicant would otherwise need to remain in an unsafe setting or be without adequate and safe housing.
(3) The assisted living facility licensee shall complete an initial resident service plan upon move-in to identify the resident's immediate needs and to provide direction to staff and caregivers relating to the resident's immediate needs. The initial resident service plan shall include as much information as can be obtained, under subsection (1) of this section.
(4) When a facility provides respite care, before or at the time of admission, the facility must obtain sufficient information to meet the individual's anticipated needs. At a minimum, such information must include:
(a) The name, address, and telephone number of the individual's attending physician, and alternate physician if any;
(b) Medical and social history, which may be obtained from a respite care assessment and service plan performed by a case manager designated by an area agency on aging under contract with the department, and mental and physical assessment data;
(c) Physician's orders for diet, medication, and routine care consistent with the individual's status on admission;
(d) Ensure the individuals have assessments performed, where needed, and where the assessment of the individual reveals symptoms of tuberculosis, follow required tuberculosis testing requirements; and
(e) With the participation of the individual and, where appropriate, their representative, develop a plan of care to maintain or improve their health and functional status during their stay in the facility.
[ 2012 c 10 s 24; 2008 c 146 s 3; 2004 c 142 s 7.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Findings—Intent—Severability—2008 c 146: See notes following RCW 74.41.040.
Effective dates—2004 c 142: See note following RCW 18.20.020.

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Preadmission assessment—Initial resident service plan—Respite care.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 18.20.360

text:
(1) The assisted living facility licensee shall within fourteen days of the resident's date of move-in, unless extended by the department for good cause, and thereafter at least annually, complete a full reassessment addressing the following:
(a) The individual's recent medical history, including, but not limited to: A health professional's diagnosis, unless the resident objects for religious reasons; chronic, current, and potential skin conditions; known allergies to foods or medications; or other considerations for providing care or services;
(b) Current necessary and contraindicated medications and treatments for the individual, including:
(i) Any prescribed medications and over-the-counter medications that are commonly taken by the individual, and that the individual is able to independently self-administer or safely and accurately direct others to administer to him or her;
(ii) Any prescribed medications and over-the-counter medications that are commonly taken by the individual and that the individual is able to self-administer when he or she has the assistance of a resident-care staff person; and
(iii) Any prescribed medications and over-the-counter medications that are commonly taken by the individual and that the individual is not able to self-administer;
(c) The individual's nursing needs when the individual requires the services of a nurse on the assisted living facility premises;
(d) The individual's sensory abilities, including vision and hearing;
(e) The individual's communication abilities, including modes of expression, ability to make himself or herself understood, and ability to understand others;
(f) Significant known behaviors or symptoms of the individual causing concern or requiring special care, including: History of substance abuse; history of harming self, others, or property, or other conditions that may require behavioral intervention strategies; the individual's ability to leave the assisted living facility unsupervised; and other safety considerations that may pose a danger to the individual or others, such as use of medical devices or the individual's ability to smoke unsupervised, if smoking is permitted in the assisted living facility;
(g) The individual's special needs, by evaluating available information, or selecting and using an appropriate tool to determine the presence of symptoms consistent with, and implications for care and services of: Mental illness, or needs for psychological or mental health services, except where protected by confidentiality laws; developmental disability; dementia; or other conditions affecting cognition, such as traumatic brain injury;
(h) The individual's level of personal care needs, including: Ability to perform activities of daily living; medication management ability, including the individual's ability to obtain and appropriately use over-the-counter medications; and how the individual will obtain prescribed medications for use in the assisted living facility;
(i) The individual's activities, typical daily routines, habits, and service preferences;
(j) The individual's personal identity and lifestyle, to the extent the individual is willing to share the information, and the manner in which they are expressed, including preferences regarding food, community contacts, hobbies, spiritual preferences, or other sources of pleasure and comfort; and
(k) Who has decision-making authority for the individual, including: The presence of any advance directive, or other legal document that will establish a substitute decision maker in the future; the presence of any legal document that establishes a current substitute decision maker; and the scope of decision-making authority of any substitute decision maker.
(2) The assisted living facility shall complete a limited assessment of a resident's change of condition when the resident's negotiated service agreement no longer addresses the resident's current needs.
[ 2012 c 10 s 25; 2004 c 142 s 8.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Effective dates—2004 c 142: See note following RCW 18.20.020.

catchline: Full reassessment of resident.


title: RCW 18.20.370

text:
(1) The assisted living facility licensee shall complete a negotiated service agreement using the preadmission assessment, initial resident service plan, and full reassessment information obtained under RCW 18.20.350 and 18.20.360. The licensee shall include the resident and the resident's legal representative if any, or the resident's representative if any, in the development of the negotiated service agreement. If the resident is a medicaid client, the department's case manager shall also be involved.
(2) The negotiated service agreement shall be completed or updated:
(a) Within thirty days of the date of move-in;
(b) As necessary following the annual full assessment of the resident; and
(c) Whenever the resident's negotiated service agreement no longer adequately addresses the resident's current needs and preferences.
[ 2012 c 10 s 26; 2004 c 142 s 9.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Effective dates—2004 c 142: See note following RCW 18.20.020.

catchline: Negotiated service agreement.


title: RCW 18.20.380

text:
(1) The assisted living facility licensee shall permit the resident, or the resident's legal representative if any, to independently arrange for or contract with a practitioner licensed under Title 18 RCW regulating health care professions, or a home health, hospice, or home care agency licensed under chapter 70.127 RCW, to provide on-site care and services to the resident, consistent with RCW 18.20.160 and chapter 70.129 RCW. The licensee may permit the resident, or the resident's legal representative if any, to independently arrange for other persons to provide on-site care and services to the resident.
(2) The assisted living facility licensee may establish policies and procedures that describe limitations, conditions, or requirements that must be met prior to an outside service provider being allowed on-site.
(3) When the resident or the resident's legal representative independently arranges for outside services under subsection (1) of this section, the licensee's duty of care, and any negligence that may be attributed thereto, shall be limited to: The responsibilities described under subsection (4) of this section, excluding supervising the activities of the outside service provider; observation of the resident for changes in overall functioning, consistent with RCW 18.20.280; notification to the person or persons identified in RCW 70.129.030 when there are observed changes in the resident's overall functioning or condition; and appropriately responding to obtain needed assistance when there are observable or reported changes in the resident's physical or mental functioning.
(4) Consistent with RCW 18.20.280, the assisted living facility licensee shall not be responsible for supervising the activities of the outside service provider. When information sharing is authorized by the resident or the resident's legal representative, the licensee shall request such information and integrate relevant information from the outside service provider into the resident's negotiated service agreement, only to the extent that such information is actually shared with the licensee.
[ 2012 c 10 s 27; 2004 c 142 s 10.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Effective dates—2004 c 142: See note following RCW 18.20.020.

catchline: Provision of outside services—Licensee's duty of care/negligence.


title: RCW 18.20.390

text:
(1) To ensure the proper delivery of services and the maintenance and improvement in quality of care through self-review, any assisted living facility licensed under this chapter may maintain a quality assurance committee that, at a minimum, includes:
(a) A licensed registered nurse under chapter 18.79 RCW;
(b) The administrator; and
(c) Three other members from the staff of the assisted living facility.
(2) When established, the quality assurance committee shall meet at least quarterly to identify issues that may adversely affect quality of care and services to residents and to develop and implement plans of action to correct identified quality concerns or deficiencies in the quality of care provided to residents.
(3) To promote quality of care through self-review without the fear of reprisal, and to enhance the objectivity of the review process, the department shall not require, and the long-term care ombuds program shall not request, disclosure of any quality assurance committee records or reports, unless the disclosure is related to the committee's compliance with this section, if:
(a) The records or reports are not maintained pursuant to statutory or regulatory mandate; and
(b) The records or reports are created for and collected and maintained by the committee.
(4) If the assisted living facility refuses to release records or reports that would otherwise be protected under this section, the department may then request only that information that is necessary to determine whether the assisted living facility has a quality assurance committee and to determine that it is operating in compliance with this section. However, if the assisted living facility offers the department documents generated by, or for, the quality assurance committee as evidence of compliance with assisted living facility requirements, the documents are protected as quality assurance committee documents under subsections (6) and (8) of this section when in the possession of the department. The department is not liable for an inadvertent disclosure, a disclosure related to a required federal or state audit, or disclosure of documents incorrectly marked as quality assurance committee documents by the facility.
(5) Good faith attempts by the committee to identify and correct quality deficiencies shall not be used as a basis for sanctions.
(6) Information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, a quality assurance committee are not subject to discovery or introduction into evidence in any civil action, and no person who was in attendance at a meeting of such committee or who participated in the creation, collection, or maintenance of information or documents specifically for the committee shall be permitted or required to testify as to the content of such proceedings or the documents and information prepared specifically for the committee. This subsection does not preclude:
(a) In any civil action, the discovery of the identity of persons involved in the care that is the basis of the civil action whose involvement was independent of any quality improvement committee activity;
(b) In any civil action, the testimony of any person concerning the facts which form the basis for the institution of such proceedings of which the person had personal knowledge acquired independently of their participation in the quality assurance committee activities.
(7) A quality assurance committee under subsection (1) of this section, RCW 70.41.200, 74.42.640, 4.24.250, or 43.70.510 may share information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, the committee, with one or more other quality assurance committees created under subsection (1) of this section, RCW 70.41.200, 74.42.640, 4.24.250, or 43.70.510 for the improvement of the quality of care and services rendered to assisted living facility residents. Information and documents disclosed by one quality assurance committee to another quality assurance committee and any information and documents created or maintained as a result of the sharing of information and documents shall not be subject to the discovery process and confidentiality shall be respected as required by subsections (6) and (8) of this section, RCW 43.70.510(4), 70.41.200(3), 4.24.250(1), and 74.42.640 (7) and (9). The privacy protections of chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and its implementing regulations apply to the sharing of individually identifiable patient information held by a coordinated quality improvement program. Any rules necessary to implement this section shall meet the requirements of applicable federal and state privacy laws.
(8) Information and documents, including the analysis of complaints and incident reports, created specifically for, and collected and maintained by, a quality assurance committee are exempt from disclosure under chapter 42.56 RCW.
(9) Notwithstanding any records created for the quality assurance committee, the facility shall fully set forth in the resident's records, available to the resident, the department, and others as permitted by law, the facts concerning any incident of injury or loss to the resident, the steps taken by the facility to address the resident's needs, and the resident outcome.
[ 2013 c 23 s 11; 2012 c 10 s 28; 2006 c 209 s 3; 2005 c 33 s 2; 2004 c 144 s 2.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Findings—2005 c 33: "The legislature finds that facilitation of the quality assurance process in licensed boarding homes and nursing homes will promote safe patient care. The legislature also finds that communication and quality assurance efforts by boarding homes and nursing homes will achieve the goal of providing high quality of care to citizens residing in licensed boarding homes and nursing homes, and may reduce property and liability insurance premium costs for such facilities. The legislature further finds that sharing of quality assurance information between boarding homes, nursing homes, coordinated quality improvement plans, peer review organizations, and hospitals will promote safe patient care and ensure consistency of care across organizations and practices." [ 2005 c 33 s 1.]
Finding—2004 c 144: "The legislature finds that quality assurance efforts will promote compliance with regulations by providers and achieve the goal of providing high quality of care to citizens residing in licensed boarding homes, and may reduce property and liability insurance premium costs for such facilities." [ 2004 c 144 s 1.]
Effective date—2004 c 144: "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 [March 26, 2004]." [ 2004 c 144 s 5.]

catchline: Quality assurance committee.


title: RCW 18.20.400

text:
If during an inspection, reinspection, or complaint investigation by the department, an assisted living facility corrects a violation or deficiency that the department discovers, the department shall record and consider such violation or deficiency for purposes of the facility's compliance history, however the licensor or complaint investigator shall not include in the facility report the violation or deficiency if the violation or deficiency:
(1) Is corrected to the satisfaction of the department prior to the exit conference;
(2) Is not recurring; and
(3) Did not pose a significant risk of harm or actual harm to a resident.
For the purposes of this section, "recurring" means that the violation or deficiency was found under the same regulation or statute in one of the two most recent preceding inspections, reinspections, or complaint investigations.
[ 2012 c 10 s 29; 2004 c 144 s 4.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Finding—Effective date—2004 c 144: See notes following RCW 18.20.390.

catchline: Correction of violation/deficiency—Not included in facility report.


title: RCW 18.20.410

text:
The department of health, the department, and the building code council shall develop standards for small assisted living facilities between seven and sixteen beds that address at least the following issues:
(1) Domestic food refrigeration and freezer storage;
(2) Sinks and sink placement;
(3) Dishwashers;
(4) Use of heat supplements for water temperature in clothes washers;
(5) Yard shrubbery;
(6) Number of janitorial rooms in a facility;
(7) Number and cross-purpose of dirty rooms;
(8) Instant hot water faucets;
(9) Medication refrigeration; and
(10) Walled and gated facilities.
Based on the standards developed under this section, the department of health and the building code council shall study the risks and benefits of modifying and simplifying construction and equipment standards for assisted living facilities with a capacity of seven to sixteen persons. The study shall include coordination with the department. The department of health shall report its findings and recommendations to appropriate committees of the legislature no later than December 1, 2005.
[ 2012 c 10 s 30; 2005 c 505 s 1.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.

catchline: Standards for small assisted living facilities—Study.


title: RCW 18.20.415

text:
The department of health and the department of social and health services may adopt rules to implement RCW 18.20.410.
[ 2005 c 505 s 2.]

catchline: Rule-making authority.


title: RCW 18.20.420

text:
(1) If the department determines that the health, safety, or welfare of residents is immediately jeopardized by an assisted living facility's failure or refusal to comply with the requirements of this chapter or the rules adopted under this chapter, and the department summarily suspends the assisted living facility license, the department may appoint a temporary manager of the assisted living facility, or the licensee may, subject to the department's approval, voluntarily participate in the temporary management program.
The purposes of the temporary management program are as follows:
(a) To mitigate dislocation and transfer trauma of residents while the department and licensee may pursue dispute resolution or appeal of a summary suspension of license;
(b) To facilitate the continuity of safe and appropriate resident care and services;
(c) To protect the health, safety, and welfare of residents, by providing time for an orderly closure of the assisted living facility, or for the deficiencies that necessitated temporary management to be corrected; and
(d) To preserve a residential option that meets a specialized service need or is in a geographical area that has a lack of available providers.
(2) The department may recruit, approve, and appoint qualified individuals, partnerships, corporations, and other entities interested in serving as a temporary manager of an assisted living facility. These individuals and entities shall satisfy the criteria established under this chapter or by the department for approving licensees. The department shall not approve or appoint any person, including partnerships and other entities, if that person is affiliated with the assisted living facility subject to the temporary management, or has owned or operated an assisted living facility ordered into temporary management or receivership in any state. When approving or appointing a temporary manager, the department shall consider the temporary manager's past experience in long-term care, the quality of care provided, the temporary manager's availability, and the person's familiarity with applicable state and federal laws. Subject to the provisions of this section and RCW 18.20.430, the department's authority to approve or appoint a temporary manager is discretionary and not subject to the administrative procedure act, chapter 34.05 RCW.
(3) When the department appoints a temporary manager, the department shall enter into a contract with the temporary manager and shall order the licensee to cease operating the assisted living facility and immediately turn over to the temporary manager possession and control of the assisted living facility, including but not limited to all resident care records, financial records, and other records necessary for operation of the facility while temporary management is in effect. If the department has not appointed a temporary manager and the licensee elects to participate in the temporary management program, the licensee shall select the temporary manager, subject to the department's approval, and enter into a contract with the temporary manager, consistent with this section. The department has the discretion to approve or revoke any temporary management arrangements made by the licensee.
(4) When the department appoints a temporary manager, the costs associated with the temporary management may be paid for through the assisted living facility temporary management account established by RCW 18.20.430, or from other departmental funds, or a combination thereof. All funds must be administered according to department procedures. The department may enter into an agreement with the licensee allowing the licensee to pay for some of the costs associated with a temporary manager appointed by the department. If the department has not appointed a temporary manager and the licensee elects to participate in the temporary management program, the licensee is responsible for all costs related to administering the temporary management program at the assisted living facility and contracting with the temporary manager.
(5) The temporary manager shall assume full responsibility for the daily operations of the assisted living facility and is responsible for correcting cited deficiencies and ensuring that all minimum licensing requirements are met. The temporary manager must comply with all state and federal laws and regulations applicable to assisted living facilities. The temporary manager shall protect the health, safety, and welfare of the residents for the duration of the temporary management and shall perform all acts reasonably necessary to ensure residents' needs are met. The temporary management contract shall address the responsibility of the temporary manager to pay past due debts. The temporary manager's specific responsibilities may include, but are not limited to:
(a) Receiving and expending in a prudent and business-like manner all current revenues of the assisted living facility, provided that priority is given to debts and expenditures directly related to providing care and meeting residents' needs;
(b) Hiring and managing all consultants and employees and firing them for good cause;
(c) Making necessary purchases, repairs, and replacements, provided that such expenditures in excess of five thousand dollars by a temporary manager appointed by the department must be approved by the department;
(d) Entering into contracts necessary for the operation of the assisted living facility;
(e) Preserving resident trust funds and resident records; and
(f) Preparing all department-required reports, including a detailed monthly accounting of all expenditures and liabilities, which shall be sent to the department and the licensee.
(6) The licensee and department shall provide written notification immediately to all residents, resident representatives, interested family members, and the state long-term care ombuds program of the temporary management and the reasons for it. This notification shall include notice that residents may move from the assisted living facility without notifying the licensee or temporary manager in advance, and without incurring any charges, fees, or costs otherwise available for insufficient advance notice, during the temporary management period. The notification shall also inform residents and their families or representatives that the temporary management team will provide residents help with relocation and appropriate discharge planning and coordination if desired. The department shall provide assistance with relocation to residents who are department clients and may provide such assistance to other residents. The temporary manager shall meet regularly with staff, residents, residents' representatives, and families to inform them of the plans for and progress achieved in the correction of deficiencies, and of the plans for facility closure or continued operation.
(7) The department shall terminate temporary management:
(a) After sixty days unless good cause is shown to continue the temporary management. Good cause for continuing the temporary management exists when returning the assisted living facility to its former licensee would subject residents to a threat to health, safety, or welfare;
(b) When all residents are transferred and the assisted living facility is closed;
(c) When deficiencies threatening residents' health, safety, or welfare are eliminated and the former licensee agrees to department-specified conditions regarding the continued facility operation; or
(d) When a new licensee assumes control of the assisted living facility.
Nothing in this section precludes the department from revoking its approval of the temporary management or exercising its licensing enforcement authority under this chapter. The department's decision whether to approve or to revoke a temporary management arrangement is not subject to the administrative procedure act, chapter 34.05 RCW.
(8) The department shall indemnify, defend, and hold harmless any temporary manager appointed or approved under this section against claims made against the temporary manager for any actions by the temporary manager or its agents that do not amount to intentional torts or criminal behavior.
(9) The department may adopt rules implementing this section. In the development of rules or policies implementing this section, the department shall consult with residents and their representatives, resident advocates, financial professionals, assisted living facility providers, and organizations representing assisted living facilities.
[ 2013 c 23 s 12; 2012 c 10 s 31; 2007 c 162 s 1.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.

catchline: Temporary management.


title: RCW 18.20.430

text:
The assisted living facility temporary management account is created in the custody of the state treasurer. All receipts from civil penalties imposed under this chapter must be deposited into the account. Only the director or the director's designee may authorize expenditures from the account. The account is subject to allotment procedures under chapter 43.88 RCW, but an appropriation is not required for expenditures. Expenditures from the account may be used only for the protection of the health, safety, welfare, or property of residents of assisted living facilities found to be deficient. During the 2025-2027 fiscal biennium, the account may be expended for funding costs associated with the assisted living program. Uses of the account include, but are not limited to:
(1) Payment for the costs of relocation of residents to other facilities;
(2) Payment to maintain operation of an assisted living facility pending correction of deficiencies or closure, including payment of costs associated with temporary management authorized under this chapter;
(3) Reimbursement of residents for personal funds or property lost or stolen when the resident's personal funds or property cannot be recovered from the assisted living facility or third-party insurer; and
(4) The protection of the health, safety, welfare, and property of residents of assisted living facilities found to be noncompliant with licensing standards.
[ 2025 c 424 s 921; 2018 c 173 s 5; 2016 sp.s. c 36 s 912; 2012 c 10 s 32; 2007 c 162 s 2.]
Notes:
Effective date—2025 c 424: See note following RCW 9.46.100.
Findings—2018 c 173: See note following RCW 18.20.500.
Effective date—2016 sp.s. c 36: "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 [April 18, 2016]." [ 2016 sp.s. c 36 s 952.]
Application—2012 c 10: See note following RCW 18.20.010.

catchline: Assisted living facility temporary management account.


title: RCW 18.20.440

text:
(1) If an assisted living facility voluntarily withdraws from participation in a state medicaid program for residential care and services under chapter 74.39A RCW, but continues to provide services of the type provided by assisted living facilities, the facility's voluntary withdrawal from participation is not an acceptable basis for the transfer or discharge of residents of the facility (a) who were receiving medicaid on the day before the effective date of the withdrawal; or (b) who have been paying the facility privately for at least two years and who become eligible for medicaid within one hundred eighty days of the date of withdrawal.
(2) An assisted living facility that has withdrawn from the state medicaid program for residential care and services under chapter 74.39A RCW must provide the following oral and written notices to prospective residents. The written notice must be prominent and must be written on a page that is separate from the other admission documents. The notice shall provide that:
(a) The facility will not participate in the medicaid program with respect to that resident; and
(b) The facility may transfer or discharge the resident from the facility for nonpayment, even if the resident becomes eligible for medicaid.
(3) Notwithstanding any other provision of this section, the medicaid contract under chapter 74.39A RCW that exists on the day the facility withdraws from medicaid participation is deemed to continue in effect as to the persons described in subsection (1) of this section for the purposes of:
(a) Department payments for the residential care and services provided to such persons;
(b) Maintaining compliance with all requirements of the medicaid contract between the department and the facility; and
(c) Ongoing inspection, contracting, and enforcement authority under the medicaid contract, regulations, and law.
(4) Except as provided in subsection (1) of this section, this section shall not apply to a person who begins residence in a facility on or after the effective date of the facility's withdrawal from participation in the medicaid program for residential care and services.
(5) An assisted living facility that is providing residential care and services under chapter 74.39A RCW shall give the department and its residents sixty days' advance notice of the facility's intent to withdraw from participation in the medicaid program.
(6) Prior to admission to the facility, an assisted living facility participating in the state medicaid program for residential care and services under chapter 74.39A RCW must provide the following oral and written notices to prospective residents. The written notice must be prominent and must be written on a page that is separate from the other admission documents, and must provide that:
(a) In the future, the facility may choose to withdraw from participating in the medicaid program;
(b) If the facility withdraws from the medicaid program, it will continue to provide services to residents (i) who were receiving medicaid on the day before the effective date of the withdrawal; or (ii) who have been paying the facility privately for at least two years and who will become eligible for medicaid within one hundred eighty days of the date of withdrawal;
(c) After a facility withdraws from the medicaid program, it may transfer or discharge residents who do not meet the criteria described in this section for nonpayment, even if the resident becomes eligible for medicaid.
[ 2012 c 10 s 33; 2008 c 251 s 1.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.
Effective date—2008 c 251: "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 [March 28, 2008], except for *section 2 of this act which applies retroactively to September 1, 2007." [ 2008 c 251 s 3.]
*Reviser's note: Section 2 of this act was vetoed by the governor.

catchline: Withdrawal from medicaid program—Notice—Duties.


title: RCW 18.20.500

text:
The department shall provide information to consumers about assisted living facilities. This information must be made available online and must include information related to site visits, substantiated inspection and complaint investigation reports, including any citation and remedy imposed, and a listing of licensed assisted living facilities by geographic location.
[ 2018 c 173 s 2.]
Notes:
Findings—2018 c 173: "The legislature finds that:
(1) Washington state is ranked number one in the nation in offering quality choices in its long-term services and supports system. Assisted living facilities are an important part of the state's long-term services and supports plan;
(2) Consumers should have access to current information about assisted living facilities to make informed choices;
(3) Washingtonians choose to live in assisted living facilities for many different reasons including safety, access to care, socialization, rehabilitation, and community;
(4) Deciding where to live and what kind of facility to live in are big decisions for potential residents and families. They deserve to have access to all information collected by the state to use in making their decisions. Providing transparency will allow for more informed consumer choices;
(5) Consumers already have access to information on nursing homes and adult family homes. This act would bring assisted living facilities in line with other settings; and
(6) Assisted living facilities need to be held accountable for the residents in their care and the fine structure should be reflective of that responsibility." [ 2018 c 173 s 1.]

catchline: Information for consumers.


title: RCW 18.20.510

text:
(1) The department shall facilitate a work group process to recommend quality metrics for assisted living facilities. The department shall keep a public record of comments submitted by stakeholders throughout the work group process.
(2) The work group shall consist of representatives from the department; assisted living provider associations; the long-term care ombuds; organizations with expertise in serving persons with mental health needs in an institutional setting, as selected by the department; organizations with expertise in serving persons with developmental disability needs in an institutional setting, as selected by the department; organizations with expertise in serving culturally diverse and non-English-speaking persons in an institutional setting, as selected by the department; health care professionals with experience caring for diverse and non-English-speaking patients, as selected by the department; licensed health care professionals with experience caring for geriatric patients, as selected by the department; and an Alzheimer's advocacy organization. The work group may solicit input from individuals with additional expertise, if necessary.
(3) The work group shall make an interim report by September 1, 2019, and final recommendations to the appropriate legislative committees by September 1, 2020, and shall include a dissent report if agreement is not achieved among stakeholders and the department.
(4) The work group must submit recommendations for a quality metric system, propose a process for monitoring and tracking performance, and recommend a process to inform consumers.
(5) The department shall include at least one meeting dedicated to review and analysis of other states with quality metric methodologies for assisted living and must include information on how well each state is achieving quality care outcomes. In addressing data metrics the work group shall consider whether the data that must be reported reflect and promote quality of care and whether reporting the data is unnecessarily burdensome upon assisted living facilities.
[ 2018 c 173 s 3.]
Notes:
Findings—2018 c 173: See note following RCW 18.20.500.

catchline: Work group—Quality metrics.


title: RCW 18.20.520

text:
The department must require an assisted living facility that is subject to a stop placement order or limited stop placement order under RCW 18.20.190 to publicly post in a conspicuous place at the facility a standardized notice that the department has issued a stop placement order or limited stop placement order for the facility. The standardized notice shall be developed by the department to include the date of the stop placement order or limited stop placement order, any conditions placed upon the facility's license, contact information for the department, contact information for the administrator or provider of the assisted living facility, and a statement that anyone may contact the department or the administrator or provider for further information. The notice must remain posted until the department has terminated the stop placement order or limited stop placement order.
[ 2021 c 159 s 2.]
Notes:
Findings—2021 c 159: "The legislature finds that:
(1) Residents in licensed long-term care facilities have been disproportionately impacted and isolated by the COVID-19 pandemic and over 50 percent of all COVID-19 deaths in Washington have been associated with long-term care facilities;
(2) According to a University of Washington report, social isolation creates a "double pandemic" that disrupts care and exacerbates the difficulties of dementia, depression, suicide risk, chronic health conditions, and other challenges faced by long-term care residents and providers;
(3) A "digital divide" exists in many parts of Washington, particularly for older adults of color with low incomes and those in rural communities;
(4) Residents with sensory limitations, mental illness, intellectual disabilities, dementia, cognitive limitations, traumatic brain injuries, or other disabilities may not be able to fully utilize digital tools which exacerbates their social isolation;
(5) Long-term care facilities already have the legal responsibility to care for their residents in a manner and in an environment that promotes the maintenance or enhancement of each resident's quality of life. A resident should have a safe, clean, comfortable, and homelike environment as detailed in chapter 70.129 RCW; and
(6) The COVID-19 pandemic has exposed systematic weaknesses in the state's long-term care system and there is a need to enact additional measures to protect and improve the health, safety, and quality of life of residents." [ 2021 c 159 s 1.]

catchline: Stop placement orders and limited stop placement orders.


title: RCW 18.20.525

text:
(1) Each assisted living facility shall develop and maintain a comprehensive disaster preparedness plan to be followed in the event of a disaster or emergency, including fires, earthquakes, floods, extreme heat, extreme cold, infectious disease outbreaks, loss of power or water, and other events that may require sheltering in place, evacuations, or other emergency measures to protect the health and safety of residents. The facility shall review the comprehensive disaster preparedness plan annually, update the plan as needed, and train all employees when they begin work in the facility on the comprehensive disaster preparedness plan and related staff procedures.
(2) The department shall adopt rules governing the comprehensive disaster preparedness plan. At a minimum, the rules must address: Timely communication with the residents' emergency contacts; timely communication with state and local agencies, long-term care ombuds, and developmental disabilities ombuds; contacting and requesting emergency assistance; on-duty employees' responsibilities; meeting residents' essential needs; procedures to identify and locate residents; and procedures to provide emergency information to provide for the health and safety of residents. In addition, the rules shall establish standards for maintaining personal protective equipment and infection control capabilities, as well as department inspection procedures with respect to the plans.
(3) For assisted living facilities certified as memory care facilities or memory care units under RCW 18.20.540, comprehensive disaster preparedness plans must specifically consider the needs of residents with dementia.
[ 2025 c 187 s 9; 2021 c 159 s 5.]
Notes:
Findings—Intent—Construction—Application—Requirements of chapter 70.129 RCW—2025 c 187: See notes following RCW 18.20.540.
Findings—2021 c 159: See note following RCW 18.20.520.

catchline: Disaster preparedness plan.


title: RCW 18.20.530

text:
(1) Beginning September 1, 2023, and annually thereafter, individuals that hold a multistate nurse license issued by a state other than Washington and are employed by assisted living facilities licensed under this chapter shall complete any demographic data surveys required by the board of nursing in rule as a condition of employment.
(2) Individuals that hold a multistate nurse license issued by a state other than Washington and are employed by assisted living facilities licensed under this chapter shall complete the suicide assessment, treatment, and management training required by RCW 43.70.442(5)(a) as a condition of employment.
(3) Assisted living facilities shall report to the board of nursing, within 30 days of employment, all nurses holding a multistate license issued by a state other than Washington and an attestation that the employees holding a multistate license issued by a state other than Washington have completed the tasks required under this section as a condition of employment.
(4) This section is subject to enforcement by the department.
[ 2023 c 123 s 28.]
Notes:
Short title—2023 c 123: See RCW 18.80.900.

catchline: Multistate nurse license—Conditions of employment.


title: RCW 18.20.540

text:
(1) After July 1, 2026, a person may not operate or maintain a memory care facility or memory care unit within this state without becoming certified under this section.
(2) To become certified by the department as a memory care facility or memory care unit, a licensed assisted living facility must:
(a) Have a valid, current license to operate the assisted living facility, as required under RCW 18.20.030;
(b) Not have a pattern of any of the following uncorrected or recurring significant enforcement actions prior to the date of application:
(i) Citations issued in areas related to resident harm or serious risk of harm, or actions or inactions resulting in serious disregard for resident health, safety, or deterioration of quality of care; or
(ii) Civil fines based on the department's determination of moderate or serious severity;
(c) Not have a stop placement, or any conditions on a license related to resident care or any license revocation or summary suspension actions prior to the date of application;
(d) Have permanent infrastructure that considers the specialized needs of residents with dementia including elements intended to prevent elopement;
(e) Have a staffing plan that provides staff levels in the memory care unit that is adequate to respond to the assessed sleeping and waking patterns and needs of residents, including awake staff 24 hours per day at a level that is adequate to respond to the needs of residents. This shall include:
(i) If residents are in separate buildings or cottages, at least one awake staff must be physically present in each building or cottage;
(ii) Maintaining staffing levels adequate to routinely provide assistance with eating, drinking, and cueing of eating and drinking, and occasionally provide all necessary physical assistance with eating for residents who require feeding assistance, including cutting up food into appropriate-sized pieces and helping the resident get food and liquid into their mouth. Nothing in this subsection (2)(e)(ii) shall be construed as requiring a memory care facility or memory care unit to provide total feeding assistance for an extended or indefinite period. Memory care facilities or memory care units are not required to provide or maintain feeding tubes or intravenous nutrition;
(f) Provide a physical building structure that has access sufficient to meet programming and daily activities as specified in subsection (3) of this section; and
(g) Have developed policies and procedures to:
(i) Plan for and respond appropriately to memory care facility or memory care unit residents who may wander;
(ii) Outline actions to be taken when a memory care resident is missing; and
(iii) Outline how consultative resources for residents will be obtained when needed for addressing resident behavioral challenges, outline the professional or professionals who will provide the consultation, and specify when and how the consultation will be utilized. Relevant professionals include, but are not limited to, clinical psychologists, psychiatrists, psychiatric nurse practitioners, and other specialists who are familiar with the care of persons with dementia.
(3) To maintain certification by the department as a memory care facility or memory care unit, a licensed assisted living facility shall:
(a) Comply with the plans and requirements outlined in subsection (2) of this section;
(b) Complete a full assessment of each resident receiving specialized care in the memory care facility or memory care unit, on a semiannual basis at a minimum, that considers the needs of residents with dementia;
(c) Ensure that each long-term care worker who works directly with memory care residents has at least six hours of continuing education per year related to dementia, including Alzheimer's disease. The six hours of continuing education per year may be part of other required training established in this chapter and chapter 18.88B RCW;
(d) Ensure that staff who work directly with memory care facility or memory care unit residents are familiar with the comprehensive disaster preparedness plan of the assisted living facility, as required under RCW 18.20.525. For an assisted living facility with a memory care certification, the comprehensive disaster preparedness plan must include the provisions specific to the needs of residents receiving certified memory care services with dementia;
(e) Provide programming that provides daily activities consistent with the functional abilities, interests, habits, and preferences of the individual residents. On a daily basis, except during the activation of the disaster preparedness plan, a memory care facility or memory care unit must:
(i) Provide residents access to:
(A) Opportunities for independent, self-directed activities;
(B) Individual activities in which a staff person or volunteer engages the resident in a planned or spontaneous activity of interest. Activities may include personal care activities that provide opportunities for purposeful and positive interactions; and
(C) Group activities;
(ii) Offer opportunities for activities that accommodate variations in a resident's mood, energy, and preferences. The memory care facility or memory care unit must make appropriate activities available based upon the resident's individual schedule and interests, such as providing access to staff support, food, and appropriate activities to residents who are awake at night;
(iii) Make available common areas that could be shared with other residents within the assisted living facility, at least one of which is outdoors, that vary by size and arrangement including, but not limited to: Various size furniture groupings that encourage social interaction; areas with environmental cues that may stimulate activity, such as a resident kitchen or workshop; areas with activity supplies and props to stimulate conversation; a garden area; and paths and walkways that encourage exploration and walking. These areas must accommodate and offer opportunities for individual or group activity;
(f) Have an outdoor area for residents that:
(i) Is accessible to residents without staff assistance;
(ii) Is surrounded by walls or fences tall enough to prevent typical elopement behaviors;
(iii) Has areas protected from direct sunlight and rain throughout the day;
(iv) Has walking surfaces that are firm, stable, slip-resistant, free from abrupt changes, and suitable for individuals using wheelchairs and walkers;
(v) Has suitable outdoor furniture;
(vi) Has plants that are not poisonous or toxic to humans;
(vii) Has areas for appropriate outdoor activities of interest to residents, such as walking paths, raised garden or flower beds, and bird feeders; and
(viii) During extreme weather events, is monitored or access can be restricted to ensure the health and well-being of the residents is not adversely impacted by their time outside; and
(g) Ensure that areas used by residents have a residential atmosphere and residents have opportunities for privacy, socialization, and safe walking and wandering behaviors, including:
(i) Encouraging residents' individualized spaces to be furnished or decorated with personal items based on resident needs and preferences; and
(ii) Ensuring residents have access to their own rooms at all times without staff assistance.
(4) To allow access to memory care throughout the state, the department may allow conditional exemptions to subsection (3)(f) of this section for locations operating in buildings constructed or originally licensed prior to July 1, 2025, where an outdoor space is located on a floor other than where the residents reside and an alternative viewing area was created in the memory care unit, as long as the viewing area:
(a) Is not obstructed by indoor furniture, storage areas, cleaning equipment, trash receptacles, snack food or drink tables, or other such encumbrances that would minimize access to the viewing area;
(b) Does not serve as a hallway or an additionally required community space such as a dining area or activity room;
(c) Does not house mobile health care services, such as home health, podiatrist, and dental services, or other purposes;
(d) Is a community space not within the residents' room; and
(e) Has windows that have an unobstructed and viewable height accessible by wheelchair.
(5) The department shall maintain a register of assisted living facilities that are certified as memory care facilities or memory care units and shall make this register available to the public and consumers.
(6) An assisted living facility must apply to the department to become certified, pay any fees including the initial certification and the annual certification fees, and provide any information as the department requires by rule to demonstrate the facility meets the requirements of subsection (2) of this section and any implementing rules. The department shall set initial and annual certification fees to be compensatory to the cost of the program.
(7) During the course of its regular licensing inspection activities, the department shall review whether a certified memory care facility or memory care unit continues to comply with requirements in this section.
(8) Any assisted living facility with a certified memory care facility or memory care unit that goes through a change of ownership shall submit an application for certification as a memory care facility at the same time that it applies for an assisted living facility license through a change of ownership proceeding.
(9) The department shall provide a current certification document to the memory care facility or memory care unit and require that the document is posted in a public area for residents, their families, and visitors to view upon entering the main entrance of the memory care facility or memory care unit.
(10) The department shall adopt rules to implement this section.
[ 2025 c 187 s 2.]
Notes:
Findings—Intent—2025 c 187: "(1) The legislature finds that:
(a) "Memory care" is not well-defined and has no standard definition in Washington. Memory care, however, is commonly understood to be a form of specialized care for people living with progressive memory loss or dementia. The term is most often applied to assisted living communities or other residential settings that offer specialized services and a specially designed environment that accommodates the needs of this population;
(b) A growing number of assisted living facilities use memory care in their names or their service descriptions and advertise themselves as providing memory care, Alzheimer's care, or dementia care. An informal study performed by the dementia action collaborative in 2021 found that there are approximately 237 assisted living facilities in Washington that advertise themselves as offering memory care or specialized dementia care, and that exact terminology and related available services varied. The use of the term "memory care" may mean that the whole building is devoted to the care of people living with dementia or that they offer a special unit or wing devoted solely to memory care; and
(c) The lack of a standard definition for memory care has resulted in differing physical environments and services from one facility to another. This situation makes it difficult for consumers and family members who are seeking or receiving care to understand the services and staffing currently offered and that can be expected as needs change over time.
(2) The legislature intends to create a memory care facility certification for licensed assisted living facilities, managed by the department of social and health services, to create a more standardized definition of memory care in Washington and help consumers make informed choices about receiving memory care services in assisted living facilities." [ 2025 c 187 s 1.]
Construction—Application—2025 c 187: "Nothing in this act is intended to prohibit assisted living facilities from providing care to residents with dementia in an assisted living setting without restricted egress, so long as the assisted living facility is not representing themselves out as a memory care facility, or otherwise representing to the public, clients, prospective clients, or the client or prospective client's representative that memory care is a specialty of the facility without certification outlined in section 2 of this act." [ 2025 c 187 s 10.]
Construction—Requirements of chapter 70.129 RCW—2025 c 187: "Nothing in this act shall be construed as replacing any requirements as outlined in chapter 70.129 RCW." [ 2025 c 187 s 11.]

catchline: Memory care facilities—Certification.


title: RCW 18.20.550

text:
The department shall adopt rules on how currently operating memory care facilities or memory care units applying for certification shall operate during the certification application process. These rules may include where the department may, at its sole discretion, grant conditional exemptions on a case-by-case basis for facilities operating before July 1, 2026, to prevent disruption of services or displacement of residents.
[ 2025 c 187 s 3.]
Notes:
Findings—Intent—Construction—Application—Requirements of chapter 70.129 RCW—2025 c 187: See notes following RCW 18.20.540.

catchline: Memory care facilities—Certification—Rule making.


title: RCW 18.20.560

text:
The legislature finds that the practices covered by RCW 18.20.540(1), the operation of a memory care facility without a certification, are matters vitally affecting the public interest for the purpose of applying the consumer protection act, chapter 19.86 RCW. A violation of this chapter is not reasonable in relation to the development and preservation of business and is an unfair or deceptive act in trade or commerce and an unfair method of competition for the purpose of applying the consumer protection act, chapter 19.86 RCW.
[ 2025 c 187 s 4.]
Notes:
Findings—Intent—Construction—Application—Requirements of chapter 70.129 RCW—2025 c 187: See notes following RCW 18.20.540.

catchline: Memory care facilities—Application of consumer protection act.


title: RCW 18.20.900

text:
If any part, or parts, of this chapter shall be held unconstitutional, the remaining provisions shall be given full force and effect, as completely as if the part held unconstitutional had not been included herein, if any such remaining part can then be administered for the purpose of establishing and maintaining standards for assisted living facilities.
[ 2012 c 10 s 34; 1957 c 253 s 20.]
Notes:
Application—2012 c 10: See note following RCW 18.20.010.

catchline: Severability—1957 c 253.


title: RCW 18.20.901

text:
For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to marital relationships and married persons, and references to dissolution of marriage shall apply equally to state registered domestic partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict with federal law. Where necessary to implement chapter 521, Laws of 2009, gender-specific terms such as husband and wife used in any statute, rule, or other law shall be construed to be gender neutral, and applicable to individuals in state registered domestic partnerships.
[ 2009 c 521 s 45.]

catchline: Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.


title: RCW 18.200.005

text:
It is the intent of the legislature that this act accomplish the following: Safeguard public health, safety, and welfare; protect the public from being mislead by unethical, ill-prepared, unscrupulous, and unauthorized persons; assure the highest degree of professional conduct on the part of orthotists and prosthetists; and assure the availability of orthotic and prosthetic services of high quality to persons in need of the services. The purpose of this act is to provide for the regulation of persons offering orthotic and prosthetic services to the public.
[ 1997 c 285 s 1.]

catchline: Intent—Purpose—1997 c 285.


title: RCW 18.200.010

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Advisory committee" means the orthotics and prosthetics advisory committee.
(2) "Department" means the department of health.
(3) "Secretary" means the secretary of health or the secretary's designee.
(4) "Orthotics" means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation. With basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct deformity or to improve the safety and efficiency of mobility or locomotion, or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patient's tissues and to assure proper fit and function of the orthotic device by periodic evaluation.
(5) "Orthotist" means a person licensed to practice orthotics under this chapter.
(6) "Orthosis" means a custom-fabricated, definitive brace or support that is designed for long-term use. Except for the treatment of scoliosis, orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: Commercially available knee orthoses used following injury or surgery; spastic muscle tone-inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; custom-made, leather wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; arch supports, also known as foot orthotics; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the secretary, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility. Prefabricated orthoses, also known as custom-fitted, or off-the-shelf, are devices that are manufactured as commercially available stock items for no specific patient. Direct-formed orthoses are devices formed or shaped during the molding process directly on the patient's body or body segment. Custom-fabricated orthoses, also known as custom-made orthoses, are devices designed and fabricated, in turn, from raw materials for a specific patient and require the generation of an image, form, or mold that replicates the patient's body or body segment and, in turn, involves the rectification of dimensions, contours, and volumes to achieve proper fit, comfort, and function for that specific patient.
(7) "Prosthetics" means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, aligning, adjusting, or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patient's body or body segment and that requires rectification of dimensions, contours, and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize the function, stability, and safety of the patient. The practice of prosthetics includes providing continuing patient care in order to assess the prosthetic device's effect on the patient's tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.
(8) "Prosthetist" means a person who is licensed to practice prosthetics under this chapter.
(9) "Prosthesis" means a definitive artificial limb that is alignable or articulated, or, in lower extremity applications, capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, fingers or toes, dental appliances, ostomy products, devices such as artificial breasts, eyelashes, wigs, or other devices as determined by the secretary that do not have a significant impact on the musculoskeletal functions of the body. In the lower extremity of the body, the term prosthesis does not include prostheses required for amputations distal to and including the transmetatarsal level. In the upper extremity of the body, the term prosthesis does not include prostheses that are provided to restore function for amputations distal to and including the carpal level.
(10) "Authorized health care practitioner" means licensed physicians, physician's assistants, osteopathic physicians, chiropractors, naturopaths, podiatric physicians and surgeons, dentists, and *advanced registered nurse practitioners.
[ 1997 c 285 s 2.]
Notes:
*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.

catchline: Definitions.


title: RCW 18.200.020

text:
An orthotist or prosthetist may only provide treatment utilizing new orthoses or prostheses for which the orthotist or prosthetist is licensed to do so, and only under an order from or referral by an authorized health care practitioner. A consultation and periodic review by an authorized health care practitioner is not required for evaluation, repair, adjusting, or servicing of orthoses by a licensed orthotist and servicing of prostheses by a licensed prosthetist. Nor is an authorized health care practitioner's order required for maintenance of an orthosis or prosthesis to the level of its original prescription for an indefinite period of time if the order remains appropriate for the patient's medical needs.
Orthotists and prosthetists must refer persons under their care to authorized health care practitioners if they have reasonable cause to believe symptoms or conditions are present that require services beyond the scope of their practice or for which the prescribed orthotic or prosthetic treatment is contraindicated.
[ 1997 c 285 s 3.]

catchline: Treatment limits.


title: RCW 18.200.030

text:
No person may represent himself or herself as a licensed orthotist or prosthetist, use a title or description of services, or engage in the practice of orthotics or prosthetics without applying for licensure, meeting the required qualifications, and being licensed by the department of health, unless otherwise exempted by this chapter.
A person not licensed with the secretary must not represent himself or herself as being so licensed and may not use in connection with his or her name the words or letters "L.O.," "L.P.," or "L.P.O.," or other letters, words, signs, numbers, or insignia indicating or implying that he or she is either a licensed orthotist or a licensed prosthetist, or both. No person may practice orthotics or prosthetics without first having a valid license. The license must be posted in a conspicuous location at the person's worksite.
[ 1997 c 285 s 4.]

catchline: Use of title—Prohibited without license—Posting of license.


title: RCW 18.200.040

text:
Nothing in this chapter shall be construed to prohibit or restrict:
(1) The practice by individuals listed under RCW 18.130.040 and performing services within their authorized scopes 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 orthotic or prosthetic 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, if the person is designated by a title that clearly indicates the person's status as a student or trainee;
(4) A person fulfilling the supervised residency or internship experience requirements described in RCW 18.200.070, if the activities and services constitute a part of the experience necessary to meet the requirements of this chapter; or
(5) A person from performing orthotic or prosthetic services in this state if: (a) The services are performed for no more than ninety working days; and (b) the person is licensed in another state or has met commonly accepted standards for the practice of orthotics or prosthetics as determined by the secretary.
[ 1997 c 285 s 5.]

catchline: Practices not limited by chapter.


title: RCW 18.200.050

text:
In addition to other authority provided by law, the secretary has the authority to:
(1) Adopt rules under chapter 34.05 RCW necessary to implement this chapter;
(2) Establish administrative procedures, administrative requirements, and fees in accordance with RCW 43.70.250 and 43.70.280. All fees collected under this section must be credited to the health professions account as required under RCW 43.70.320;
(3) Register applicants, issue licenses to applicants who have met the education, training, and examination requirements for licensure, and deny licenses to applicants who do not meet the minimum qualifications, except that proceedings concerning the denial of credentials based upon unprofessional conduct or impairment are governed by the uniform disciplinary act, chapter 18.130 RCW;
(4) Hire clerical, administrative, investigative, and other staff as needed to implement this chapter and hire individuals licensed under this chapter to serve as examiners for any practical examinations;
(5) Determine minimum education requirements and evaluate and designate those educational programs from which graduation will be accepted as proof of eligibility to take a qualifying examination for applicants for licensure;
(6) Establish the standards and procedures for revocation of approval of education programs;
(7) Utilize or contract with individuals or organizations having expertise in the profession or in education to assist in the evaluations;
(8) Prepare and administer, or approve the preparation and administration of, examinations for applicants for licensure;
(9) Determine whether alternative methods of training are equivalent to formal education, and establish forms, procedures, and criteria for evaluation of an applicant's alternative training to determine the applicant's eligibility to take any qualifying examination;
(10) Determine which jurisdictions have licensing requirements equivalent to those of this state and issue licenses without examinations to individuals licensed in those jurisdictions;
(11) Define and approve any experience requirement for licensing;
(12) Implement and administer a program for consumer education;
(13) Adopt rules implementing continuing competency requirements for renewal of the license and relicensing;
(14) Maintain the official department records of all applicants and licensees;
(15) Establish by rule the procedures for an appeal of an examination failure;
(16) Establish requirements and procedures for an inactive license; and
(17) With the advice of the advisory committee, the secretary may recommend collaboration with health professions, boards, and commissions to develop appropriate referral protocols.
[ 1997 c 285 s 6.]

catchline: Secretary's authority.


title: RCW 18.200.060

text:
(1) The secretary has the authority to appoint an advisory committee to further the purposes of this chapter. The secretary may consider the persons who are recommended for appointment by the orthotic and prosthetic associations of the state. The committee is composed of five members, one member initially appointed for a term of one year, two for a term of two years, and two for a term of three years. Subsequent appointments are for terms of three years. No person may serve as a member of the committee for more than two consecutive terms. Members of the advisory committee must be residents of this state. The committee is composed of three individuals licensed in the category designated and engaged in rendering services to the public. Two members must at all times be holders of licenses for the practice of either prosthetics or orthotics, or both, in this state, except for the initial members of the advisory committee, all of whom must fulfill the requirements for licensure under this chapter. One member must be a practicing orthotist. One member must be a practicing prosthetist. One member must be licensed by the state as a physician licensed under chapter 18.57 or 18.71 RCW, specializing in orthopedic medicine or surgery or physiatry. Two members must represent the public at large and be unaffiliated directly or indirectly with the profession being credentialed but, to the extent possible, be consumers of orthotic and prosthetic services. The two members appointed to the advisory committee representing the public at large must have an interest in the rights of consumers of health services and must not be or have been a licensee of a health occupation committee or an employee of a health facility, nor derive his or her primary livelihood from the provision of health services at any level of responsibility.
(2) The secretary may remove any member of the advisory committee for cause as specified by rule. In the case of a vacancy, the secretary shall appoint a person to serve for the remainder of the unexpired term.
(3) The advisory committee may provide advice on matters specifically identified and requested by the secretary, such as applications for licenses.
(4) The advisory committee may be requested by the secretary to approve an examination required for licensure under this chapter.
(5) The advisory committee may be requested by the secretary to review and monitor the exemptions to requirements of certain orthoses and prostheses in this chapter and recommend to the secretary any statutory changes that may be needed to properly protect the public.
(6) The advisory committee, at the request of the secretary, may recommend rules in accordance with the administrative procedure act, chapter 34.05 RCW, relating to standards for appropriateness of orthotic and prosthetic care.
(7) The advisory committee shall meet at the times and places designated by the secretary and hold meetings during the year as necessary to provide advice to the secretary. The committee may elect a chair and a vice chair. A majority of the members currently serving constitute a quorum.
(8) Each member of an advisory committee shall be reimbursed for travel expenses as authorized in RCW 43.03.050 and 43.03.060. In addition, members of the committees shall be compensated in accordance with RCW 43.03.240 when engaged in the authorized business of their committees.
(9) The secretary, members of advisory committees, or individuals acting on their behalf are immune from suit in any action, civil or criminal, based on any credentialing or disciplinary proceedings or other official acts performed in the course of their duties.
[ 2022 c 240 s 30; 1997 c 285 s 7.]


title: RCW 18.200.070

text:
(1) An applicant must file a written application on forms provided by the department showing to the satisfaction of the secretary, in consultation with the advisory committee, that the applicant meets the following requirements:
(a) The applicant possesses a baccalaureate degree with coursework appropriate for the profession approved by the secretary, or possesses equivalent training as determined by the secretary pursuant to subsections (3) and (5) of this section;
(b) The applicant has the amount of formal training, including the hours of classroom education and clinical practice, in areas of study as the secretary deems necessary and appropriate;
(c) The applicant has completed a clinical internship or residency in the professional area for which a license is sought in accordance with the standards, guidelines, or procedures for clinical internships or residencies inside or outside the state as established by the secretary, or that are otherwise substantially equivalent to the standards commonly accepted in the fields of orthotics and prosthetics as determined by the secretary pursuant to subsections (3) and (5) of this section. The secretary must set the internship as at least one year.
(2) An applicant for licensure as either an orthotist or prosthetist must pass all written and practical examinations that are required and approved by the secretary in consultation with the advisory committee.
(3) The standards and requirements for licensure established by the secretary must be substantially equal to the standards commonly accepted in the fields of orthotics and prosthetics.
(4) An applicant failing to make the required grade in the first examination may take up to three subsequent examinations as the applicant desires upon prepaying a fee, determined by the secretary under RCW 43.70.250, for each subsequent examination. Upon failing four examinations, the secretary may invalidate the original application and require remedial education before the person may take future examinations.
(5) The secretary may waive some of the education, examination, or experience requirements of this section if the secretary determines that the applicant meets alternative standards, established by the secretary through rule, that are substantially equivalent to the requirements in subsections (1) and (2) of this section.
[ 1997 c 285 s 8.]


title: RCW 18.200.080

text:
The secretary may grant a license without an examination for those applicants who have practiced full time for five of the six years prior to *the effective date of this act and who have provided comprehensive orthotic or prosthetic, or orthotic and prosthetic, services in an established practice. This section applies only to those individuals who apply within one year of *the effective date of this act.
[ 1997 c 285 s 9.]
Notes:
*Reviser's note: 1997 c 285 has two different effective dates. The effective date for sections 1 through 5 and 8 through 12 is December 1, 1998, and the effective date for the remainder of the act is July 27, 1997.

catchline: Licensure without examination.


title: RCW 18.200.090

text:
An applicant holding a license in another state or a territory of the United States may be licensed to practice in this state without examination if the secretary determines that the other jurisdiction's credentialing standards are substantially equivalent to the standards in this jurisdiction.
[ 1997 c 285 s 10.]

catchline: Reciprocity.


title: RCW 18.200.100

text:
The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of licenses, unauthorized practice, and the discipline of persons licensed under this chapter. The secretary is the disciplining authority under this chapter.
[ 1997 c 285 s 11.]

catchline: Application of uniform disciplinary act.


title: RCW 18.200.900

text:
This chapter is known and may be cited as the orthotics and prosthetics practice act.
[ 1997 c 285 s 12.]

catchline: Short title.


title: RCW 18.200.902

text:
Sections 1 through 5 and 8 through 12 of this act take effect December 1, 1998.
[ 1997 c 285 s 16.]

catchline: Effective date—1997 c 285 ss 1-5 and 8-12.


title: RCW 18.205.010

text:
The legislature recognizes substance use disorder professionals as discrete health professionals. Substance use disorder professional certification serves the public interest.
[ 2019 c 444 s 1; 1998 c 243 s 1.]

catchline: Substance use disorder professional certification.


title: RCW 18.205.020

text:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Agency" means (a) a community behavioral health agency or facility operated, licensed, or certified by the state of Washington; (b) a federally recognized Indian tribe located within the state; (c) a county; (d) a federally qualified health center; or (e) a hospital.
(2) "Certification" means a voluntary process recognizing an individual who qualifies by examination and meets established educational prerequisites, and which protects the title of practice.
(3) "Co-occurring disorder specialist" means an individual possessing an enhancement that certifies the individual to provide substance use disorder counseling subject to the practice limitations under RCW 18.205.105.
(4) "Committee" means the substance use disorder professional certification advisory committee established under this chapter.
(5) "Core competencies of substance use disorder counseling" means competency in the nationally recognized knowledge, skills, and attitudes of professional practice, including assessment and diagnosis of substance use disorders, substance use disorder treatment planning and referral, patient and family education in the disease of substance use disorders, individual and group counseling, relapse prevention counseling, and case management, all oriented to assist individuals with substance use disorder in their recovery.
(6) "Counseling" means employing any therapeutic techniques including, but not limited to, social work, mental health counseling, marriage and family therapy, and hypnotherapy, for a fee, that offer, assist, or attempt to assist an individual or individuals in the amelioration or adjustment of mental, emotional, or behavioral problems, and includes therapeutic techniques to achieve sensitivity and awareness of self and others and the development of human potential. For the purposes of this chapter, nothing may be construed to imply that the practice of hypnotherapy is necessarily limited to counseling.
(7) "Department" means the department of health.
(8) "Health profession" means a profession providing health services regulated under the laws of this state.
(9) "Recovery" means a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery often involves achieving remission from active substance use disorder.
(10) "Secretary" means the secretary of health or the secretary's designee.
(11) "Substance use disorder counseling" means employing the core competencies of substance use disorder counseling to assist or attempt to assist individuals with substance use disorder in their recovery.
(12) "Substance use disorder professional" means an individual certified in substance use disorder counseling under this chapter.
(13) "Substance use disorder professional trainee" means an individual working toward the education and experience requirements for certification as a substance use disorder professional.
[ 2019 c 444 s 2; 2008 c 135 s 15; 1998 c 243 s 2.]
Notes:
Reviser's note: The definitions in this section have been alphabetized pursuant to RCW 1.08.015(2)(k).
Effective date—2008 c 135 ss 1, 2, 7-9, and 11-19: See note following RCW 18.19.020.


title: RCW 18.205.030

text:
No person may represent oneself as a certified substance use disorder professional, certified substance use disorder professional trainee, or co-occurring disorder specialist or use any title or description of services of a certified substance use disorder professional, certified substance use disorder professional trainee, or co-occurring disorder specialist without applying for certification, meeting the required qualifications, and being certified by the department of health, unless otherwise exempted by this chapter.
[ 2019 c 444 s 3; 2008 c 135 s 16; 2000 c 171 s 41; 1998 c 243 s 3.]
Notes:
Effective date—2008 c 135 ss 1, 2, 7-9, and 11-19: See note following RCW 18.19.020.

catchline: Title or description of services.


title: RCW 18.205.050

text:
Nothing in this chapter shall 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 the 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.
[ 1998 c 243 s 5.]

catchline: Practice not prohibited or restricted by chapter.


title: RCW 18.205.060

text:
In addition to any other authority provided by law, the secretary has the authority to:
(1) Adopt rules under chapter 34.05 RCW necessary to implement this chapter, in consultation with the committee;
(2) Establish all certification, examination, and renewal fees in accordance with RCW 43.70.250;
(3) Establish forms and procedures necessary to administer this chapter;
(4) Issue certificates to applicants who have met the education, training, and examination requirements for certification and to deny certification to applicants who do not meet the minimum qualifications, except that proceedings concerning the denial of certification based upon unprofessional conduct or impairment shall be governed by the uniform disciplinary act, chapter 18.130 RCW;
(5) Hire clerical, administrative, investigative, and other staff as needed to implement this chapter, and hire individuals certified under this chapter to serve as examiners for any practical examinations;
(6) Determine minimum education requirements and evaluate and designate those educational programs that will be accepted as proof of eligibility to take a qualifying examination for applicants for certification;
(7) Prepare, grade, and administer, or determine the nature of, and supervise the grading and administration of, examinations for applicants for certification;
(8) Determine whether alternative methods of training are equivalent to formal education, and establish forms, procedures, and criteria for evaluation of an applicant's alternative training to determine the applicant's eligibility to take any qualifying examination;
(9) Determine which states have credentialing requirements equivalent to those of this state, and issue certificates to individuals credentialed in those states without examinations;
(10) Define and approve any experience requirement for certification;
(11) Implement and administer a program for consumer education;
(12) Adopt rules implementing a continuing competency program;
(13) Maintain the official department record of all applicants and certificated individuals;
(14) Establish by rule the procedures for an appeal of an examination failure; and
(15) Establish disclosure requirements.
[ 1998 c 243 s 6.]

catchline: Authority of secretary.


title: RCW 18.205.070

text:
The secretary shall keep an official record of all proceedings. A part of the record shall consist of a register of all applicants for certification under this chapter and the results of each application.
[ 1998 c 243 s 7.]

catchline: Official record of proceedings.


title: RCW 18.205.080

text:
(1) The secretary shall appoint a substance use disorder certification advisory committee to further the purposes of this chapter. The committee shall be composed of seven members, one member initially appointed for a term of one year, three for a term of two years, and three for a term of three years. Subsequent appointments shall be for terms of three years. No person may serve as a member of the committee for more than two consecutive terms. Members of the committee shall be residents of this state. The committee shall be composed of four certified substance use disorder professionals; one substance use disorder treatment program director; one physician licensed under chapter 18.71 or 18.57 RCW who is certified in addiction medicine or a licensed or certified mental health practitioner; and one member of the public who has received substance use disorder counseling.
(2) The secretary may remove any member of the committee for cause as specified by rule. In the case of a vacancy, the secretary shall appoint a person to serve for the remainder of the unexpired term.
(3) The committee shall meet at the times and places designated by the secretary and shall hold meetings during the year as necessary to provide advice to the director. The committee may elect a chair and a vice chair. A majority of the members currently serving shall constitute a quorum.
(4) Each member of the committee shall be reimbursed for travel expenses as authorized in RCW 43.03.050 and 43.03.060. In addition, members of the committee shall be compensated in accordance with RCW 43.03.240 when engaged in the authorized business of the committee.
(5) The director of the health care authority, or his or her designee, shall serve as an ex officio member of the committee.
(6) The secretary, members of the committee, or individuals acting on their behalf are immune from suit in any action, civil or criminal, based on any certification or disciplinary proceedings or other official acts performed in the course of their duties.
[ 2019 c 444 s 4; 2018 c 201 s 9007; 1998 c 243 s 8.]
Notes:
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.

catchline: Substance use disorder certification advisory committee—Composition—Terms.


title: RCW 18.205.090

text:
(1) The secretary shall issue a certificate to any applicant who demonstrates to the secretary's satisfaction that the following requirements have been met:
(a) Completion of:
(i) An educational program approved by the secretary;
(ii) An apprenticeship program reviewed by the substance use disorder certification advisory committee, approved by the secretary, and registered and approved under chapter 49.04 RCW; or
(iii) Alternate training that meets established criteria;
(b) Successful completion of an approved examination, based on core competencies of substance use disorder counseling; and
(c) Successful completion of an experience requirement that establishes fewer hours of experience for applicants with higher levels of relevant education. In meeting any experience requirement established under this subsection, the secretary may not require more than one thousand five hundred hours of experience in substance use disorder counseling for applicants who are licensed under chapter 18.83 RCW or under chapter 18.79 RCW as *advanced registered nurse practitioners.
(2) The secretary shall establish by rule what constitutes adequate proof of meeting the criteria.
(3) Applicants are subject to the grounds for denial of a certificate or issuance of a conditional certificate under chapter 18.130 RCW.
(4) Certified substance use disorder professionals shall not be required to be registered under chapter 18.19 RCW or licensed under chapter 18.225 RCW.
(5) As of July 28, 2019, a person certified under this chapter holding the title of chemical dependency professional is considered to hold the title of substance use disorder professional until such time as the person's present certification expires or is renewed.
[ 2021 c 165 s 2; 2019 c 444 s 5; 2001 c 251 s 30; 1998 c 243 s 9.]
Notes:
*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.
Rules—2021 c 165: See note following RCW 18.205.095.
Severability—2001 c 251: See RCW 18.225.900.

catchline: Certification requirements.


title: RCW 18.205.095

text:
(1) The secretary shall issue a trainee certificate to any applicant who demonstrates to the satisfaction of the secretary that he or she is working toward the education and experience requirements in RCW 18.205.090.
(2) A trainee certified under this section shall submit to the secretary for approval a declaration, in accordance with rules adopted by the department, which shall be updated with the trainee's annual renewal, that he or she is actively pursuing the experience requirements under RCW 18.205.090 and is enrolled in:
(a) An approved education program; or
(b) An apprenticeship program reviewed by the substance use disorder certification advisory committee, approved by the secretary, and registered and approved under chapter 49.04 RCW.
(3) A trainee certified under this section may practice only under the supervision of a certified substance use disorder professional. The first 50 hours of any face-to-face client contact must be under direct observation. All remaining experience must be under supervision in accordance with rules adopted by the department.
(4) A certified substance use disorder professional trainee provides substance use disorder assessments, counseling, and case management and can provide clinical services to patients consistent with his or her education, training, and experience as approved by his or her supervisor.
(5) A person whose trainee certification was not renewed due to the person exceeding the four-renewal limit in place prior to June 6, 2024, shall be treated as if the person's certification expired. The secretary shall allow such a person to return the person's trainee certification to active status pursuant to standard rules and procedures in place for returning an expired credential to active status.
(6) Applicants are subject to denial of a certificate or issuance of a conditional certificate for the reasons set forth in chapter 18.130 RCW.
(7) A person certified under this chapter holding the title of chemical dependency professional trainee is considered to hold the title of substance use disorder professional trainee until such time as the person's present certification expires or is renewed.
[ 2024 c 371 s 13. Prior: 2021 c 165 s 1; 2021 c 57 s 1; 2019 c 444 s 6; 2008 c 135 s 18.]
Notes:
Rule making—2024 c 371 ss 1-16: See note following RCW 18.83.020.
Rules—2021 c 165: "The department of health may adopt any rules necessary to implement this act." [ 2021 c 165 s 5.]
Effective date—2021 c 57: "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 [April 16, 2021]." [ 2021 c 57 s 3.]
Effective date—2008 c 135 ss 1, 2, 7-9, and 11-19: See note following RCW 18.19.020.

catchline: Certification requirements—Trainees.