title: RCW 70.41.235

text:
A hospital that provides health care services to the general public may not discriminate against a qualified doctor of osteopathic medicine and surgery licensed under chapter 18.57 RCW, who has applied to practice with the hospital, solely because that practitioner was board certified or eligible under an approved osteopathic certifying board instead of board certified or eligible respectively under an approved medical certifying board.
[ 1995 c 64 s 3.]

catchline: Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.


doc_type: statute

jurisdiction: wa

title: RCW 70.41.240

text:
The department of health shall compile and make available to the public information regarding medicare health care facility certification options available to hospitals licensed under this title that desire to convert to nonhospital health care facilities. The information provided shall include standards and requirements for certification and procedures for acquiring certification.
[ 1991 c 3 s 338; 1988 c 207 s 3.]
Notes:
Resources and staffing—1988 c 207: "The department of community development, department of trade and economic development, department of employment security, and department of social and health services are expected to use their present resources and staffing to carry out the requirements of this act." [ 1988 c 207 s 4.]

license: public-domain-government-work

rule_set: Revised Code of Washington

catchline: Information regarding conversion of hospitals to nonhospital health care facilities.

code: rcw

unit: section

court: Washington State Legislature


title: RCW 70.41.250

text:
(1) The legislature finds that the spiraling costs of health care continue to surmount efforts to contain them, increasing at approximately twice the inflationary rate. The causes of this phenomenon are complex. By making physicians and other health care providers with hospital admitting privileges more aware of the cost consequences of health care services for consumers, these providers may be inclined to exercise more restraint in providing only the most relevant and cost-beneficial hospital services, with a potential for reducing the utilization of those services. The requirement of the hospital to inform physicians and other health care providers of the charges of the health care services that they order may have a positive effect on containing health costs. Further, the option of the physician or other health care provider to inform the patient of these charges may strengthen the necessary dialogue in the provider-patient relationship that tends to be diminished by intervening third-party payers.
(2) The chief executive officer of a hospital licensed under this chapter and the superintendent of a state hospital shall establish and maintain a procedure for disclosing to physicians and other health care providers with admitting privileges the charges of all health care services ordered for their patients. Copies of hospital charges shall be made available to any physician and/or other health care provider ordering care in hospital inpatient/outpatient services. The physician and/or other health care provider may inform the patient of these charges and may specifically review them. Hospitals are also directed to study methods for making daily charges available to prescribing physicians through the use of interactive software and/or computerized information thereby allowing physicians and other health care providers to review not only the costs of present and past services but also future contemplated costs for additional diagnostic studies and therapeutic medications.
[ 1993 c 492 s 265.]
Notes:
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492: See RCW 43.72.910 through 43.72.915.

catchline: Cost disclosure to health care providers.


title: RCW 70.41.300

text:
"Cost-effective care" and "long-term care services," where used in RCW 70.41.310 and 70.41.320, shall have the same meaning as that given in *RCW 74.39A.008.
[ 1995 1st sp.s. c 18 s 4.]
Notes:
*Reviser's note: RCW 74.39A.008 was repealed by 1997 c 392 s 530.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Long-term care—Definitions.


title: RCW 70.41.310

text:
(1)(a) The department of social and health services, in consultation with hospitals and acute care facilities, shall promote the most appropriate and cost-effective use of long-term care services by developing and distributing to hospitals and other appropriate health care settings information on the various chronic long-term care programs that it administers directly or through contract. The information developed by the department of social and health services shall, at a minimum, include the following:
(i) An identification and detailed description of each long-term care service available in the state;
(ii) Functional, cognitive, and medicaid eligibility criteria that may be required for placement or admission to each long-term care service; and
(iii) A long-term care services resource manual for each hospital, that identifies the long-term care services operating within each hospital's patient service area. The long-term care services resource manual shall, at a minimum, identify the name, address, and telephone number of each entity known to be providing long-term care services; a brief description of the programs or services provided by each of the identified entities; and the name or names of a person or persons who may be contacted for further information or assistance in accessing the programs or services at each of the identified entities.
(b) The information required in (a) of this subsection shall be periodically updated and distributed to hospitals by the department of social and health services so that the information reflects current long-term care service options available within each hospital's patient service area.
(2) To the extent that a patient will have continuing care needs, once discharged from the hospital setting, hospitals shall, during the course of the patient's hospital stay, promote each patient's family member's and/or legal representative's understanding of available long-term care service discharge options by, at a minimum:
(a) Discussing the various and relevant long-term care services available, including eligibility criteria;
(b) Making available, to patients, their family members, and/or legal representative, a copy of the most current long-term care services resource manual;
(c) Responding to long-term care questions posed by patients, their family members, and/or legal representative;
(d) Assisting the patient, their family members, and/or legal representative in contacting appropriate persons or entities to respond to the question or questions posed; and
(e) Linking the patient and family to the local, state-designated aging and long-term care network to ensure effective transitions to appropriate levels of care and ongoing support.
[ 1995 1st sp.s. c 18 s 3.]
Notes:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Long-term care—Program information to be provided to hospitals—Information on options to be provided to patients.


title: RCW 70.41.320

text:
(1) Hospitals and acute care facilities shall:
(a) Work cooperatively with the department of social and health services, area agencies on aging, and local long-term care information and assistance organizations in the planning and implementation of patient discharges to long-term care services.
(b) Establish and maintain a system for discharge planning and designate a person responsible for system management and implementation.
(c) Establish written policies and procedures to:
(i) Identify patients needing further nursing, therapy, or supportive care following discharge from the hospital;
(ii) Subject to RCW 70.41.322, develop a documented discharge plan for each identified patient, including relevant patient history, specific care requirements, and date such follow-up care is to be initiated;
(iii) Coordinate with patient, family, caregiver, lay caregiver as provided in RCW 70.41.322, and appropriate members of the health care team which may include a long-term care worker or a home and community-based service provider. For the purposes of this subsection (1)(c)(iii), long-term care worker has the meaning provided in RCW 74.39A.009 and home and community-based service provider includes an adult family home as defined in RCW 70.128.010, an assisted living facility as defined in RCW 18.20.020, or a home care agency as defined in RCW 70.127.010;
(iv) Provide any patient, regardless of income status, written information and verbal consultation regarding the array of long-term care options available in the community, including the relative cost, eligibility criteria, location, and contact persons;
(v) Promote an informed choice of long-term care services on the part of patients, family members, and legal representatives;
(vi) Coordinate with the department and specialized case management agencies, including area agencies on aging and other appropriate long-term care providers, as necessary, to ensure timely transition to appropriate home, community residential, or nursing facility care; and
(vii) Inform the patient or his or her surrogate decision maker designated under RCW 7.70.065 if it is necessary to complete a valid disclosure authorization as required by state and federal laws governing health information privacy and security, including chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and related regulations, in order to allow disclosure of health care information, including the discharge plan, to an individual or entity that will be involved in the patient's care upon discharge, including a lay caregiver as defined in RCW 70.41.020, a long-term care worker as defined in RCW 74.39A.009, a home and community-based service provider such as an adult family home as defined in RCW 70.128.010, an assisted living facility as defined in RCW 18.20.020, or a home care agency as defined in RCW 70.127.010. If a valid disclosure authorization is obtained, the hospital may release information as designated by the patient for care coordination or other specified purposes.
(d) Work in cooperation with the department which is responsible for ensuring that patients eligible for medicaid long-term care receive prompt assessment and appropriate service authorization.
(2) In partnership with selected hospitals, the department of social and health services shall develop and implement pilot projects in up to three areas of the state with the goal of providing information about appropriate in-home and community services to individuals and their families early during the individual's hospital stay.
The department shall not delay hospital discharges but shall assist and support the activities of hospital discharge planners. The department also shall coordinate with home health and hospice agencies whenever appropriate. The role of the department is to assist the hospital and to assist patients and their families in making informed choices by providing information regarding home and community options.
In conducting the pilot projects, the department shall:
(a) Assess and offer information regarding appropriate in-home and community services to individuals who are medicaid clients or applicants; and
(b) Offer assessment and information regarding appropriate in-home and community services to individuals who are reasonably expected to become medicaid recipients within one hundred eighty days of admission to a nursing facility.
[ 2016 c 226 s 5; 1998 c 245 s 127; 1995 1st sp.s. c 18 s 5.]
Notes:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.

catchline: Long-term care—Patient discharge requirements for hospitals and acute care facilities—Pilot projects.


title: RCW 70.41.322

text:
(1) In addition to the requirements in RCW 70.41.320, hospital discharge policies must ensure that the discharge plan is appropriate for the patient's physical condition, emotional and social needs, and, if a lay caregiver is designated takes into consideration, to the extent possible, the lay caregiver's abilities as disclosed to the hospital.
(2) As part of a patient's individualized treatment plan, discharge criteria must include, but not be limited to, the following components:
(a) The details of the discharge plan;
(b) Hospital staff assessment of the patient's ability for self-care after discharge;
(c) An opportunity for the patient to designate a lay caregiver;
(d) Documentation of any designated lay caregiver's contact information;
(e) A description of aftercare tasks necessary to promote the patient's ability to stay at home;
(f) An opportunity for the patient and, if designated, the patient's lay caregiver to participate in the discharge planning;
(g) Instruction or training provided to the patient and, if designated, the patient's lay caregiver, prior to discharge, to perform aftercare tasks. Instruction or training may include education and counseling about the patient's medications, including dosing and proper use of medication delivery devices when applicable; and
(h) Notification to a lay caregiver, if designated, of the patient's discharge or transfer.
(3) In the event that a hospital is unable to contact a designated lay caregiver, the lack of contact may not interfere with, delay, or otherwise affect the medical care provided to the patient, or an appropriate discharge of the patient.
[ 2016 c 226 s 2.]


title: RCW 70.41.324

text:
RCW 70.41.322 does not require a hospital to adopt discharge policies or criteria that:
(1) Delay a patient's discharge or transfer to another facility or to home; or
(2) Require the disclosure of protected health information to a lay caregiver without obtaining a patient's consent as required by state and federal laws governing health information privacy and security, including chapter 70.02 RCW and the federal health insurance portability and accountability act of 1996 and related regulations.
[ 2016 c 226 s 3.]

catchline: Discharge planning—Certain policies and criteria not required.


title: RCW 70.41.326

text:
Nothing in RCW 70.41.322 may be construed to:
(1) Interfere with the rights or duties of an agent operating under a valid health care directive under RCW 70.122.030;
(2) Interfere with designations made by a patient pursuant to a physician order for life-sustaining treatment under RCW 43.70.480;
(3) Interfere with the rights or duties of an authorized surrogate decision maker under RCW 7.70.065;
(4) Establish a new requirement to reimburse or otherwise pay for services performed by the lay caregiver for aftercare;
(5) Create a private right of action against a hospital or any of its directors, trustees, officers, employees, or agents, or any contractors with whom the hospital has a contractual relationship;
(6) Hold liable, in any way, a hospital, hospital employee, or any consultants or contractors with whom the hospital has a contractual relationship for the services rendered or not rendered by the lay caregiver to the patient at the patient's residence;
(7) Obligate a designated lay caregiver to perform any aftercare tasks for any patient;
(8) Require a patient to designate any individual as a lay caregiver as defined in RCW 70.41.020;
(9) Obviate the obligation of a health carrier as defined in RCW 48.43.005 or any other entity issuing health benefit plans to provide coverage required under a health benefit plan; and
(10) Impact, impede, or otherwise disrupt or reduce the reimbursement obligations of a health carrier or any other entity issuing health benefit plans.
[ 2016 c 226 s 4.]


title: RCW 70.41.330

text:
Every hospital shall post in conspicuous locations a notice of the department's hospital complaint toll-free telephone number. The form of the notice shall be approved by the department.
[ 2000 c 6 s 4.]

catchline: Hospital complaint toll-free telephone number.


title: RCW 70.41.340

text:
The department is authorized to adopt rules necessary to implement RCW 70.41.150, 70.41.155, and 70.41.330.
[ 2000 c 6 s 6.]

catchline: Investigation of hospital complaints—Rules.


title: RCW 70.41.350

text:
(1) Every hospital providing emergency care to a victim of sexual assault shall:
(a) Provide the victim with medically and factually accurate and unbiased written and oral information about emergency contraception;
(b) Orally inform each victim of sexual assault of her option to be provided emergency contraception at the hospital; and
(c) If not medically contraindicated, provide emergency contraception immediately at the hospital to each victim of sexual assault who requests it.
(2) The secretary, in collaboration with community sexual assault programs and other relevant stakeholders, shall develop, prepare, and produce informational materials relating to emergency contraception for the prevention of pregnancy in rape victims for distribution to and use in all emergency rooms in the state, in quantities sufficient to comply with the requirements of this section. The secretary, in collaboration with community sexual assault programs and other relevant stakeholders, may also approve informational materials from other sources for the purposes of this section. The informational materials must be clearly written and readily comprehensible in a culturally competent manner, as the secretary, in collaboration with community sexual assault programs and other relevant stakeholders, deems necessary to inform victims of sexual assault. The materials must explain the nature of emergency contraception, including that it is effective in preventing pregnancy, treatment options, and where they can be obtained.
(3) The secretary shall adopt rules necessary to implement this section.
[ 2002 c 116 s 3.]
Notes:
Findings—2002 c 116: "(1) The legislature finds that:
(a) Each year, over three hundred thousand women are sexually assaulted in the United States;
(b) Nationally, over thirty-two thousand women become pregnant each year as a result of sexual assault. Approximately fifty percent of these pregnancies end in abortion;
(c) Approximately thirty-eight percent of women in Washington are sexually assaulted over the course of their lifetime. This is twenty percent more than the national average;
(d) Only fifteen percent of sexual assaults in Washington are reported; however, even the numbers of reported attacks are staggering. For example, last year, two thousand six hundred fifty-nine rapes were reported in Washington, this is more than seven rapes per day.
(2) The legislature deems it essential that all hospital emergency rooms provide emergency contraception as a treatment option to any woman who seeks treatment as a result of a sexual assault." [ 2002 c 116 s 1.]

catchline: Emergency care provided to victims of sexual assault—Development of informational materials on emergency contraception—Rules.


title: RCW 70.41.360

text:
The department must respond to complaints of violations of RCW 70.41.350. The department shall convene a task force, composed of representatives from community sexual assault programs and other relevant stakeholders including advocacy agencies, medical agencies, and hospital associations, to provide input into the development and evaluation of the education materials and rule development. The task force shall expire on January 1, 2004.
[ 2002 c 116 s 4.]
Notes:
Findings—2002 c 116: See note following RCW 70.41.350.

catchline: Emergency care provided to victims of sexual assault—Department to respond to violations—Task force.


title: RCW 70.41.365

text:
Hospitals licensed under this chapter shall participate in the statewide sexual assault kit tracking system established in RCW 43.43.545 for the purpose of tracking the status of all sexual assault kits collected by or in the custody of hospitals and other entities contracting with hospitals. Hospitals shall begin full participation in the system according to the implementation schedule established by the Washington state patrol.
[ 2016 c 173 s 6.]
Notes:
Finding—Intent—2016 c 173: See note following RCW 43.43.545.

catchline: Statewide sexual assault kit tracking system—Participation by hospitals.


title: RCW 70.41.367

text:
(1) By July 1, 2020, any hospital that does not provide sexual assault evidence kit collection, or does not have appropriate providers available to provide sexual assault evidence kit collection at all times, shall develop a plan, in consultation with the local community sexual assault agency, to assist individuals with obtaining sexual assault evidence kit collection at a facility that provides such collection.
(2) Beginning July 1, 2020:
(a) If a hospital does not perform sexual assault evidence kit collection or does not have appropriate providers available, the hospital shall, within two hours of a request, provide notice to every individual who presents in the emergency department of the hospital and requests a sexual assault evidence kit collection that the hospital does not perform such collection or does not have appropriate providers available; and
(b) Pursuant to the plan required in subsection (1) of this section, if the hospital does not perform sexual assault evidence kit collection or does not have appropriate providers available, hospital staff must coordinate care with the local community sexual assault agency and assist the patient in finding a facility with an appropriate provider available.
(3) A hospital must notify individuals upon arrival who present in the emergency department of the hospital and request a sexual assault evidence kit collection that they may file a complaint with the department if the hospital fails to comply with subsection (2)(a) of this section.
[ 2019 c 250 s 1.]

catchline: Sexual assault evidence kit collection—Availability, plan, and notice requirements.


title: RCW 70.41.370

text:
The department shall investigate complaints of violations of RCW 18.79.350 and 18.79.360 by an employer. The department shall maintain records of all employers that have violated RCW 18.79.350 and 18.79.360.
[ 2003 c 258 s 8.]
Notes:
Severability—Effective date—2003 c 258: See notes following RCW 18.79.330.

catchline: Investigation of complaints of violations concerning nursing technicians.


title: RCW 70.41.380

text:
Hospitals shall have in place policies to assure that, when appropriate, information about unanticipated outcomes is provided to patients or their families or any surrogate decision makers identified pursuant to RCW 7.70.065. Notifications of unanticipated outcomes under this section do not constitute an acknowledgment or admission of liability, nor can the fact of notification, the content disclosed, or any and all statements, affirmations, gestures, or conduct expressing apology be introduced as evidence in a civil action.
[ 2005 c 118 s 1.]
Notes:
Policy to be in place beginning January 1, 2006—2005 c 118: "Beginning January 1, 2006, the department shall, during the survey of a hospital, ensure that the policy required in RCW 70.41.380 is in place." [ 2005 c 118 s 2.]

catchline: Notice of unanticipated outcomes.


title: RCW 70.41.390

text:
(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
(a) "Lift team" means hospital employees specially trained to conduct patient lifts, transfers, and repositioning using lifting equipment when appropriate.
(b) "Safe patient handling" means the use of engineering controls, lifting and transfer aids, or assistive devices, by lift teams or other staff, instead of manual lifting to perform the acts of lifting, transferring, and repositioning health care patients and residents.
(c) "Musculoskeletal disorders" means conditions that involve the nerves, tendons, muscles, and supporting structures of the body.
(2) By February 1, 2007, each hospital must establish a safe patient handling committee either by creating a new committee or assigning the functions of a safe patient handling committee to an existing committee. The purpose of the committee is to design and recommend the process for implementing a safe patient handling program. At least half of the members of the safe patient handling committee shall be frontline nonmanagerial employees who provide direct care to patients unless doing so will adversely affect patient care.
(3) By December 1, 2007, each hospital must establish a safe patient handling program. As part of this program, a hospital must:
(a) Implement a safe patient handling policy for all shifts and units of the hospital. Implementation of the safe patient handling policy may be phased-in with the acquisition of equipment under subsection (4) of this section;
(b) Conduct a patient handling hazard assessment. This assessment should consider such variables as patient-handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas;
(c) Develop a process to identify the appropriate use of the safe patient handling policy based on the patient's physical and medical condition and the availability of lifting equipment or lift teams. The policy shall include a means to address circumstances under which it would be medically contraindicated to use lifting or transfer aids or assistive devices for particular patients;
(d) Conduct an annual performance evaluation of the program to determine its effectiveness, with the results of the evaluation reported to the safe patient handling committee. The evaluation shall determine the extent to which implementation of the program has resulted in a reduction in musculoskeletal disorder claims and days of lost work attributable to musculoskeletal disorder caused by patient handling, and include recommendations to increase the program's effectiveness; and
(e) When developing architectural plans for constructing or remodeling a hospital or a unit of a hospital in which patient handling and movement occurs, consider the feasibility of incorporating patient handling equipment or the physical space and construction design needed to incorporate that equipment at a later date.
(4) By January 30, 2010, each hospital must complete, at a minimum, acquisition of their choice of: (a) One readily available lift per acute care unit on the same floor unless the safe patient handling committee determines a lift is unnecessary in the unit; (b) one lift for every ten acute care available inpatient beds; or (c) equipment for use by lift teams. Hospitals must train staff on policies, equipment, and devices at least annually.
(5) Nothing in this section precludes lift team members from performing other duties as assigned during their shift.
(6) A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement.
[ 2006 c 165 s 2.]
Notes:
Findings—2006 c 165: "The legislature finds that:
(1) Patients are not at optimum levels of safety while being lifted, transferred, or repositioned manually. Mechanical lift programs can reduce skin tears suffered by patients by threefold. Nurses, thirty-eight percent of whom have previous back injuries, can drop patients if their pain thresholds are triggered.
(2) According to the bureau of labor statistics, hospitals in Washington have a nonfatal employee injury incidence rate that exceeds the rate of construction, agriculture, manufacturing, and transportation.
(3) The physical demands of the nursing profession lead many nurses to leave the profession. Research shows that the annual prevalence rate for nursing back injury is over forty percent and many nurses who suffer a back injury do not return to nursing. Considering the present nursing shortage in Washington, measures must be taken to protect nurses from disabling injury.
(4) Washington hospitals have made progress toward implementation of safe patient handling programs that are effective in decreasing employee injuries. It is not the intent of this act to place an undue financial burden on hospitals." [ 2006 c 165 s 1.]

catchline: Safe patient handling.


title: RCW 70.41.400

text:
(1) Prior to or upon discharge, a hospital must furnish each patient receiving inpatient services a written statement providing a list of physician groups and other professional partners that commonly provide care for patients at the hospital and from whom the patient may receive a bill, along with contact phone numbers for those groups. The statement must prominently display a phone number that a patient can call for assistance if the patient has any questions about any of the bills they receive after discharge that relate to their hospital stay.
(2)(a) Hospitals, physician groups, and other professional partners may not furnish information relating to a medical debt as defined in RCW 19.16.100 to a consumer credit reporting agency. A medical debt is void and unenforceable if a hospital, physician group, or professional partner violates this subsection (2)(a).
(b) A violation of (a) of this subsection is deemed a violation of the law governing the license of the hospital, physician group, or professional partner.
(3) The legislature finds that the practices covered by this section are matters vitally affecting the public interest for the purpose of applying the consumer protection act, chapter 19.86 RCW. A violation of this section 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.
(4) This section does not apply to any hospital owned or operated by a health maintenance organization under chapter 48.46 RCW when providing prepaid health care services to enrollees of the health maintenance organization or any of its wholly owned subsidiary carriers.
[ 2025 c 145 s 5; 2006 c 60 s 2.]
Notes:
Findings—Intent—2006 c 60: "The legislature finds that the implementation of health information technologies in hospitals, including electronic medical records, has the potential to significantly reduce cost, improve patient outcomes, and simplify the administration of health care. Further, the legislature finds that the number of and complexity of the bills that result from a hospital stay can be confusing to patients. Therefore, it is the intent of the legislature to encourage hospitals to design the implementation of health information technologies so as to allow the hospital to provide the patient, prior to or upon discharge, clearly understandable information about the services provided during the hospital stay, and the bills the patient is likely to receive related to each of those services. Recognizing that complete implementation of the technologies required to achieve this goal will take a number of years, the legislature intends to require that hospitals immediately begin working toward the goal by compiling and communicating information to assist patients in understanding their bills." [ 2006 c 60 s 1.]

catchline: Patient billing—Medical debt reporting prohibition—Application of consumer protection act—Exceptions.


title: RCW 70.41.410

text:
The definitions in this section apply throughout this section, RCW 70.41.420, and 70.41.425 unless the context clearly requires otherwise.
(1) "Hospital" has the same meaning as defined in RCW 70.41.020, and also includes state hospitals as defined in RCW 72.23.010.
(2) "Hospital staffing committee" means the committee established by a hospital under RCW 70.41.420.
(3) "Intensity" means the level of patient need for nursing care, as determined by the nursing assessment.
(4) "Nursing assistant-certified" means an individual certified under chapter 18.88A RCW who provides direct care to patients.
(5) "Nursing staff" means registered nurses, licensed practical nurses, nursing assistants-certified, and unlicensed assistive nursing personnel providing direct patient care.
(6) "Patient care staff" means a person who is providing direct care or supportive services to patients but who is not:
(a) Nursing staff as defined in this section;
(b) A physician licensed under chapter 18.71 or 18.57 RCW;
(c) A physician's assistant licensed under chapter 18.71A RCW; or
(d) An advanced registered nurse practitioner licensed under *RCW 18.79.250, unless working as a direct care registered nurse.
(7) "Patient care unit" means any unit or area of the hospital that provides patient care by registered nurses.
(8) "Reasonable efforts" means that the employer exhausts and documents all of the following but is unable to obtain staffing coverage:
(a) Seeks individuals to consent to work additional time from all available qualified staff who are working;
(b) Contacts qualified employees who have made themselves available to work additional time;
(c) Seeks the use of per diem staff; and
(d) When practical, seeks personnel from a contracted temporary agency when such staffing is permitted by law or an applicable collective bargaining agreement, and when the employer regularly uses a contracted temporary agency.
(9) "Registered nurse" means an individual licensed as a nurse under chapter 18.79 RCW who provides direct care to patients.
(10) "Skill mix" means the experience of, and number and relative percentages of, nursing and patient care staff.
(11) "Unforeseeable emergent circumstance" means:
(a) Any unforeseen declared national, state, or municipal emergency;
(b) When a hospital disaster plan is activated;
(c) Any unforeseen disaster or other catastrophic event that substantially affects or increases the need for health care services; or
(d) When a hospital is diverting patients to another hospital or hospitals for treatment.
[ 2023 c 114 s 2; 2008 c 47 s 2.]
Notes:
*Reviser's note: RCW 18.79.250 was amended by 2024 c 239 s 13, changing "advanced registered nurse practitioner" to "advanced practice registered nurse," effective June 30, 2027.
Effective date—2023 c 114: "Except for sections 1, 3, 15, and 16 of this act, this act takes effect July 1, 2024." [ 2023 c 114 s 17.]
Findings—Intent—2008 c 47: "(1) The legislature finds that:
(a) Research evidence demonstrates that registered nurses play a critical role in patient safety and quality of care. The ever-worsening shortage of nurses available to provide care in acute care hospitals has necessitated multiple strategies to generate more nurses and improve the recruitment and retention of nurses in hospitals; and
(b) Evidence-based nurse staffing that can help ensure quality and safe patient care while increasing nurse satisfaction in the work environment is key to solving an urgent public health issue in Washington state. Hospitals and nursing organizations recognize a mutual interest in patient safety initiatives that create a healthy environment for nurses and safe care for patients.
(2) In order to protect patients and to support greater retention of registered nurses, and to promote evidence-based nurse staffing, the legislature intends to establish a mechanism whereby direct care nurses and hospital management shall participate in a joint process regarding decisions about nurse staffing." [ 2008 c 47 s 1.]
PDF
RCW 70.41.410
Hospital staffing committee—Definitions. (Effective June 30, 2027.)
The definitions in this section apply throughout this section and RCW 70.41.420 and 70.41.425 unless the context clearly requires otherwise.
(1) "Hospital" has the same meaning as defined in RCW 70.41.020, and also includes state hospitals as defined in RCW 72.23.010.
(2) "Hospital staffing committee" means the committee established by a hospital under RCW 70.41.420.
(3) "Intensity" means the level of patient need for nursing care, as determined by the nursing assessment.
(4) "Nursing assistant-certified" means an individual certified under chapter 18.88A RCW who provides direct care to patients.
(5) "Nursing staff" means registered nurses, licensed practical nurses, nursing assistants-certified, and unlicensed assistive nursing personnel providing direct patient care.
(6) "Patient care staff" means a person who is providing direct care or supportive services to patients but who is not:
(a) Nursing staff as defined in this section;
(b) A physician licensed under chapter 18.71 or 18.57 RCW;
(c) A physician's assistant licensed under chapter 18.71A RCW; or
(d) An advanced practice registered nurse licensed under RCW 18.79.250, unless working as a direct care registered nurse.
(7) "Patient care unit" means any unit or area of the hospital that provides patient care by registered nurses.
(8) "Reasonable efforts" means that the employer exhausts and documents all of the following but is unable to obtain staffing coverage:
(a) Seeks individuals to consent to work additional time from all available qualified staff who are working;
(b) Contacts qualified employees who have made themselves available to work additional time;
(c) Seeks the use of per diem staff; and
(d) When practical, seeks personnel from a contracted temporary agency when such staffing is permitted by law or an applicable collective bargaining agreement, and when the employer regularly uses a contracted temporary agency.
(9) "Registered nurse" means an individual licensed as a nurse under chapter 18.79 RCW who provides direct care to patients.
(10) "Skill mix" means the experience of, and number and relative percentages of, nursing and patient care staff.
(11) "Unforeseeable emergent circumstance" means:
(a) Any unforeseen declared national, state, or municipal emergency;
(b) When a hospital disaster plan is activated;
(c) Any unforeseen disaster or other catastrophic event that substantially affects or increases the need for health care services; or
(d) When a hospital is diverting patients to another hospital or hospitals for treatment.
[ 2025 c 58 s 5133; 2023 c 114 s 2; 2008 c 47 s 2.]
Notes:
Effective date—2025 c 58 ss 5058-5170: See note following RCW 7.68.030.
Explanatory note—2025 c 58: See note following RCW 1.16.050.
Effective date—2023 c 114: "Except for sections 1, 3, 15, and 16 of this act, this act takes effect July 1, 2024." [ 2023 c 114 s 17.]
Findings—Intent—2008 c 47: "(1) The legislature finds that:
(a) Research evidence demonstrates that registered nurses play a critical role in patient safety and quality of care. The ever-worsening shortage of nurses available to provide care in acute care hospitals has necessitated multiple strategies to generate more nurses and improve the recruitment and retention of nurses in hospitals; and
(b) Evidence-based nurse staffing that can help ensure quality and safe patient care while increasing nurse satisfaction in the work environment is key to solving an urgent public health issue in Washington state. Hospitals and nursing organizations recognize a mutual interest in patient safety initiatives that create a healthy environment for nurses and safe care for patients.
(2) In order to protect patients and to support greater retention of registered nurses, and to promote evidence-based nurse staffing, the legislature intends to establish a mechanism whereby direct care nurses and hospital management shall participate in a joint process regarding decisions about nurse staffing." [ 2008 c 47 s 1.]

catchline: Hospital staffing committee—Definitions. (Effective until June 30, 2027.)


title: RCW 70.41.420

text:
(1) By January 1, 2024, each hospital shall establish a hospital staffing committee, either by creating a new committee or assigning the functions of the hospital staffing committee to an existing nurse staffing committee.
(2) Hospital staffing committees must be comprised of:
(a) At least 50 percent of the voting members of the hospital staffing committee shall be nursing staff, who are nonsupervisory and nonmanagerial, currently providing direct patient care. The selection of the nursing staff shall be according to the collective bargaining representative or representatives if there is one or more at the hospital. If there is no collective bargaining representative, the members of the hospital staffing committee who are nursing staff providing direct patient care shall be selected by their peers.
(b) 50 percent of the members of the hospital staffing committee shall be determined by the hospital administration and shall include but not be limited to the chief financial officer, the chief nursing officers, and patient care unit directors or managers or their designees.
(3) Participation in the hospital staffing committee by a hospital employee shall be on scheduled work time and compensated at the appropriate rate of pay. Hospital staffing committee members shall be relieved of all other work duties during meetings of the committee. Additional staffing relief must be provided if necessary to ensure committee members are able to attend hospital staffing committee meetings.
(4) Primary responsibilities of the hospital staffing committee shall include:
(a) Development and oversight of an annual patient care unit and shift-based hospital staffing plan, based on the needs of patients, to be used as the primary component of the staffing budget. The hospital staffing committee shall use a uniform format or form, created by the department in consultation with the advisory committee established in RCW 43.70.855 and the department of labor and industries, for complying with the requirement to submit the annual staffing plan. The uniform format or form must allow for variations in service offerings, facility design, and other differences between hospitals, but must allow patients and the public to clearly understand and compare staffing plans. Hospitals may include a description of additional resources available to support unit-level patient care and a description of the hospital, including the size and type of facility. Factors to be considered in the development of the plan should include, but are not limited to:
(i) Census, including total numbers of patients on the unit on each shift and activity such as patient discharges, admissions, and transfers;
(ii) Patient acuity level, intensity of care needs, and the type of care to be delivered on each shift;
(iii) Skill mix;
(iv) Level of experience and specialty certification or training of nursing and patient care staff providing care;
(v) The need for specialized or intensive equipment;
(vi) The architecture and geography of the patient care unit, including but not limited to placement of patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
(vii) Staffing guidelines adopted or published by national nursing professional associations, specialty nursing organizations, and other health professional organizations;
(viii) Availability of other personnel and patient care staff supporting nursing services on the unit; and
(ix) Compliance with the terms of an applicable collective bargaining agreement, if any, and relevant state and federal laws and rules, including those regarding meal and rest breaks and use of overtime and on-call shifts;
(b) Semiannual review of the staffing plan against patient need and known evidence-based staffing information, including the nursing sensitive quality indicators collected by the hospital; and
(c) Review, assessment, and response to staffing variations or complaints presented to the committee.
(5) In addition to the factors listed in subsection (4)(a) of this section, hospital finances and resources must be taken into account in the development of the hospital staffing plan.
(6)(a) The committee shall produce the hospital's annual hospital staffing plan.
(b) The committee shall propose by a 50 percent plus one vote a draft of the hospital's annual staffing plan which must be delivered to the hospital's chief executive officer or their designee by July 1, 2024, and annually thereafter.
(c) The chief executive officer or their designee must provide written feedback to the hospital staffing committee on the proposed annual staffing plan. The feedback must:
(i) Identify those elements of the proposed staffing plan the chief executive officer requests to be changed to address elements identified by the chief executive officer, including subsection (4)(a) of this section, that could cause the chief executive officer concern regarding financial feasibility, concern regarding temporary or permanent closure of units, or patient care risk; and
(ii) Provide a status report on implementation of the staffing plan including nursing sensitive quality indicators collected by the hospital, patient surveys, and recruitment and retention efforts, including the hospital's success over the previous six months in filling approved open positions for employees covered by the staffing plan.
(d) The committee must review and consider any feedback required under (c)(i) of this subsection prior to approving by a 50 percent plus one vote a revised hospital staffing plan to provide to the chief executive officer.
(e) If this revised proposed staffing plan is not adopted by the hospital, the most recent of the following remains in effect:
(i) The staffing plan that was in effect January 1, 2023; or
(ii) The staffing plan last approved by a 50 percent plus one vote of a duly constituted hospital staffing committee and adopted by the hospital, in accordance with all standards under this section.
(f) Beginning January 1, 2025, each hospital shall submit its final staffing plan to the department and thereafter on an annual basis and at any time in between that the plan is updated.
(7)(a) Beginning July 1, 2025, each hospital shall implement the staffing plan and assign nursing staff to each patient care unit in accordance with the plan except in instances of unforeseeable emergent circumstances.
(b) Each hospital shall document when a patient care unit nursing staff assignment is out of compliance with the adopted hospital staffing plan. For purposes of this subsection, out of compliance means the number of patients assigned to the nursing staff exceeds the patient care unit assignment as directed by the nurse staffing plan. The hospital must adopt written policies and procedures under this subsection no later than October 1, 2024.
(i) Each hospital must report to the department on a semiannual basis the accurate percentage of nurse staffing assignments where the assignment in a patient care unit is out of compliance with the adopted nurse staffing plan. Beginning in 2026, semiannual reports are due on July 31st and January 31st each year. The first report is due January 31, 2026, and must cover the last six months of 2025.
(ii) Beginning July 1, 2025, if a hospital is in compliance for less than 80 percent of the nurse staffing assignment in a month, the hospital must, within seven calendar days following the end of the month in which the hospital was out of compliance, report to the department regarding lack of compliance with the nurse staffing patient care unit assignments in the hospital staffing plan.
(iii) The department must develop a form or forms for the report to be made under this subsection by October 1, 2024. The form must include a checkbox for either cochair of the hospital staffing committee to indicate their belief that the validity of the report should be investigated by the department. If the checkbox on the form has been checked, the department may initiate an investigation as to the validity of the semiannual report under (b)(i) of this subsection.
(iv) This subsection (7)(b) does not apply to:
(A) Hospitals certified as critical access hospitals;
(B) Hospitals with fewer than 25 acute care licensed beds;
(C) Hospitals certified by the centers for medicare and medicaid services as sole community hospitals that are not owned or operated by a health system that owns or operates more than one acute hospital licensed under chapter 70.41 RCW; and
(D) Hospitals located on an island operating within a public hospital district in Skagit county.
(c) A nursing staff may report to the hospital staffing committee any variations where the nursing staff assignment in a patient care unit is not in accordance with the adopted staffing plan and may make a complaint to the committee based on the variations.
(d) Shift-to-shift adjustments in staffing levels required by the plan may be made by the appropriate hospital personnel overseeing patient care operations. If nursing staff on a patient care unit objects to a shift-to-shift adjustment, the nursing staff may submit the complaint to the hospital staffing committee.
(e) Hospital staffing committees shall develop a process to examine and respond to data submitted under (c) and (d) of this subsection, including the ability to determine if a specific complaint is resolved or dismissing a complaint based on unsubstantiated data. All written complaints submitted to the hospital staffing committee must be reviewed by the staffing committee, regardless of what format the complainant uses to submit the complaint.
(f) In the event of an unforeseeable emergent circumstance lasting for 15 days or more, the hospital incident command shall report within 30 days to the cochairs of the hospital staffing committee an assessment of the staffing needs arising from the unforeseeable emergent circumstance and the hospital's plan to address those identified staffing needs. Upon receipt of the report, the hospital staffing committee shall convene to develop a contingency staffing plan to address the needs arising from the unforeseeable emergent circumstance. The hospital's deviation from its staffing plan may not be in effect for more than 90 days without the review of the hospital staffing committee. Within 90 days of an initial deviation under this section the hospital must report to the department the basis for the deviation and must report to the department again once the deviation under this section is no longer in effect.
(g) A direct care registered nurse or direct care nursing assistant-certified may not be assigned by hospitals to a nursing unit or clinical area unless that nurse has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area. The hospital must adopt written policies and procedures under this subsection no later than July 1, 2025.
(8) Each hospital shall post, in a public area on each patient care unit, the staffing plan and the staffing schedule for that shift on that unit, as well as the relevant clinical staffing for that shift. The staffing plan and current staffing levels must also be made available to patients and visitors upon request. The hospital must also post in a public area on each patient care unit any corrective action plan relevant to that patient care unit as required under RCW 70.41.425(4).
(9) A hospital may not retaliate against or engage in any form of intimidation or otherwise take any adverse action against:
(a) An employee for performing any duties or responsibilities in connection with the hospital staffing committee; or
(b) An employee, patient, or other individual who notifies the hospital staffing committee or the hospital administration of his or her concerns on nurse staffing.
(10) This section is not intended to create unreasonable burdens on critical access hospitals under 42 U.S.C. Sec. 1395i-4. Critical access hospitals may develop flexible approaches to accomplish the requirements of this section that may include but are not limited to having hospital staffing committees work by videoconference, telephone, or email.
(11) By July 1, 2024, the hospital staffing committee shall file with the department a charter that must include, but is not limited to:
(a) A process for electing cochairs and their terms;
(b) Roles, responsibilities, and processes by which the hospital staffing committee functions, including which patient care staff job classes will be represented on the committee as nonvoting members, how many members will serve on the committee, processes to ensure adequate quorum and ability of committee members to attend, and processes for replacing members who do not regularly attend;
(c) Schedule for monthly meetings with more frequent meetings as needed that ensures committee members have 30 days' notice of meetings;
(d) Processes by which all staffing complaints will be reviewed, investigated, and resolved, noting the date received as well as initial, contingent, and final disposition of complaints and corrective action plan where applicable;
(e) Processes by which complaints will be resolved within 90 days of receipt, or longer with majority approval of the committee, and processes to ensure the complainant receives a letter stating the outcome of the complaint;
(f) Processes for attendance by any employee, and a labor representative if requested by the employee, who is involved in a complaint;
(g) Processes for the hospital staffing committee to conduct quarterly reviews of: Staff turnover rates including new hire turnover rates during first year of employment; anonymized aggregate exit interview data on an annual basis; and hospital plans regarding workforce development;
(h) Standards for hospital staffing committee approval of meeting documentation including meeting minutes, attendance, and actions taken;
(i) Policies for retention of meeting documentation for a minimum of three years and consistent with each hospital's document retention policies;
(j) Processes for the hospital to provide the hospital staffing committee with information regarding patient complaints involving staffing made to the hospital through the patient grievance process required under 42 C.F.R. 482.13(a)(2); and
(k) Processes for how the information from the reports required under subsection (7) of this section will be used to inform the development and semiannual review of the staffing plan.
(12) The department and the department of labor and industries must provide technical assistance to hospital staffing committees to assist with compliance with this section. Technical assistance may not be provided during an inspection, or during the time between when an investigation of a hospital has been initiated and when such investigation is resolved.
[ 2023 c 114 s 3; 2017 c 249 s 2; 2008 c 47 s 3.]
Notes:
Findings—Short title—2017 c 249: See notes following RCW 70.41.425.
Findings—Intent—2008 c 47: See note following RCW 70.41.410.

catchline: Hospital staffing committee.


title: RCW 70.41.425

text:
(1)(a) The department shall investigate a complaint submitted under this section for violation of RCW 70.41.420 following receipt of a complaint with documented evidence of failure to:
(i) Form or establish a hospital staffing committee;
(ii) Conduct a semiannual review of a staffing plan;
(iii) Submit a staffing plan on an annual basis and any updates; or
(iv)(A) Follow the nursing staff assignments in a patient care unit in violation of RCW 70.41.420(7) (c) or (d).
(B) Based on their formal agreement required under RCW 70.41.428 and 49.12.485, the department and the department of labor and industries shall investigate complaints under this subsection (1)(a)(iv). The departments may only investigate a complaint under this subsection (1)(a)(iv) for violations of RCW 70.41.420(7) (c) or (d), that were submitted to the hospital staffing committee and remain unresolved for 60 days after receipt by the hospital staffing committee, excluding complaints determined by the hospital staffing committee to be resolved or dismissed.
(b) The department and the department of labor and industries may investigate and take appropriate enforcement action without any complaint if either department discovers data in the course of an investigation or inspection suggesting any violation of RCW 70.41.420.
(c) After an investigation conducted under (a) of this subsection, if the department and the department of labor and industries, pursuant to their formal agreement under RCW 70.41.428 and 49.12.485, determine that there has been multiple unresolved violations of RCW 70.41.420(7) (c) and (d) of a similar nature within 30 days prior to the receipt of the complaint by the department, the department shall require the hospital to submit for their approval a corrective plan of action within 45 days of the presentation of findings from the department to the hospital.
(d) Hospitals will not be found in violation of RCW 70.41.420 if it has been determined, following an investigation, that:
(i) There were unforeseeable emergent circumstances and the process under RCW 70.41.420(7)(f) has been followed, if applicable;
(ii) The hospital, after consultation with the hospital staffing committee, documents that the hospital has made reasonable efforts to obtain and retain staffing to meet required personnel assignments but has been unable to do so; or
(iii) Per documentation provided by the hospital, an individual admission of a patient in need of critical care to sustain their life or prevent disability received from another hospital caused the staffing plan violation alleged in the complaint.
(2)(a) The department shall review each hospital staffing plan submitted by a hospital to ensure it is received by the appropriate deadline and is completed on the department-issued staffing plan form.
(b) The hospital must complete all applicable portions of the staffing plan form. The department may determine that a hospital has failed to timely submit its staffing plan if the staffing plan form is incomplete.
(3) Beginning January 1, 2027, the department shall review all reports submitted under RCW 70.41.420(7)(b)(i) to ensure:
(a) The forms are received by the appropriate deadline;
(b) The forms are completed on the department-issued form; and
(c) The checkbox under RCW 70.41.420(7)(b)(iii) has not been checked.
(4) Beginning January 1, 2027, the department, in consultation with the department of labor and industries, must require a hospital to submit for their approval a corrective plan of action within 45 calendar days of a report to the department under RCW 70.41.420(7)(b)(ii) of this section or after an investigation under RCW 70.41.420(7)(b)(iii) of this section finds that the hospital is not in compliance.
(5)(a) Pursuant to their formal agreement under RCW 70.41.428 and 49.12.485 the department and the department of labor and industries must review and approve a hospital's proposed corrective plan of action under subsection (1)(c) or (4) of this section. As necessary, the department will require the hospital to revise the plan for it to adequately address issues identified by the department and the department of labor and industries prior to approving the plan.
(b) The department may review any corrective plan of action under subsection (1)(c) or (4) of this section that adversely impact provision of health care services or patient safety, and may require revisions to the corrective plan of action to ensure patient safety is maintained.
(c) A corrective plan of action may include, but is not limited to, the following elements:
(i) Exercising efforts to obtain additional staff;
(ii) Implementing actions to improve staffing plan variation or shift-to-shift adjustment planning;
(iii) Delaying the addition of new services or procedure areas;
(iv) Requiring minimum staffing standards;
(v) Reducing hospital beds or services; or
(vi) Closing the hospital emergency department to ambulance transport, except for patients in need of critical care to sustain their life or prevent disability.
(d) A corrective plan of action must be of a duration long enough to demonstrate the hospital's ability to sustain compliance with the requirements of this section.
(e) In the event that the hospital follows a corrective plan of action under this subsection but remains in compliance for less than 80 percent of the nurse staffing assignments in the month following completion of the corrective plan of action, the hospital is required to submit a revised corrective plan of action with new elements that are likely to produce a minimum of 80 percent compliance with the nurse staffing assignments in a month.
(6)(a) In the event that a hospital fails to submit a staffing plan, staffing committee charter, or a corrective plan of action by the relevant deadline, the department may take administrative action with penalties up to $10,000 per 30 days of failure to comply.
(b)(i) In the event that a hospital submits but fails to follow a corrective plan of action required under subsection (1)(c) or (4) of this section, the department of labor and industries may impose a civil penalty of $50,000 per 30 days. Civil penalties apply until the hospital begins to follow a corrective plan of action that has been approved by the department. Revenue from these fines must be deposited into the supplemental pension fund established under RCW 51.44.033.
(ii) If the department of labor and industries finds a violation after an investigation pursuant to subsection (1)(a)(iv)(B) of this section or assesses or imposes any penalty pursuant to this section, the employer may appeal the department's finding or assessment of penalties according to the procedures under RCW 49.12.145 through 49.12.149.
(7)(a) As resources allow, the department must make records of any civil penalties and administrative actions or license suspensions or revocations imposed on hospitals, or any notices of resolution under this section available to the public.
(b) The department must post hospital staffing plans, hospital staffing committee charters, and the semiannual compliance reports required under RCW 70.41.420 on its website.
(8) Nothing in this section shall be construed to preclude the ability to otherwise submit a complaint to the department for failure to follow RCW 70.41.420.
[ 2023 c 114 s 4; 2017 c 249 s 3.]
Notes:
Effective date—2023 c 114: See note following RCW 70.41.410.
Findings—2017 c 249: "The legislature finds that:
(1) Research demonstrates that registered nurses play a critical role in improving patient safety and quality of care;
(2) Appropriate staffing of hospital personnel including registered nurses available for patient care assists in reducing errors, complications, and adverse patient care events and can improve staff safety and satisfaction and reduce incidences of workplace injuries;
(3) Health care professional, technical, and support staff comprise vital components of the patient care team, bringing their particular skills and services to ensuring quality patient care;
(4) Assuring sufficient staffing of hospital personnel, including registered nurses, is an urgent public policy priority in order to protect patients and support greater retention of registered nurses and safer working conditions; and
(5) Steps should be taken to promote evidence-based nurse staffing and increase transparency of health care data and decision making based on the data." [ 2017 c 249 s 1.]
Short title—2017 c 249: "This act may be known and cited as the Washington state patient safety act." [ 2017 c 249 s 5.]


title: RCW 70.41.428

text:
By July 1, 2024, the department and the department of labor and industries must jointly establish a formal agreement that identifies the roles of each of the two agencies with respect to the oversight and enforcement of RCW 70.41.420 (4)(a) and (12) and 70.41.425 (1), (4), (5), (6)(b), and (7), as follows:
(1) To the extent feasible, provide for oversight and enforcement actions by a single agency, and must include measures to avoid multiple citations for the same violation; and
(2) Include provisions that allow for data sharing, including hospital staffing plans, reports submitted under RCW 70.41.420(7), and hospital staffing committee complaints submitted to the department.
[ 2023 c 114 s 5.]
Notes:
Effective date—2023 c 114: See note following RCW 70.41.410.

catchline: Hospital staffing committee—Oversight.


title: RCW 70.41.430

text:
(1) Each hospital licensed under this chapter shall, by January 1, 2023, adopt a policy regarding prevention and control of the transmission of pathogens of epidemiological concern. The policy shall, at a minimum, contain the following elements:
(a) A facility risk assessment to identify pathogens of epidemiological concern that considers elements such as the probability of occurrence as determined via surveillance, potential impact, and measures the hospital has implemented to mitigate the risk to patients, health care workers, and visitors; and
(b) Appropriate evidence-based procedures and intervention strategies to identify and help prevent patients from transmitting pathogens of epidemiological concern to other patients and health care workers.
(2) A hospital that has identified through appropriate testing a patient who has a pathogen of epidemiological concern that is required to be reported to the national healthcare safety network of the United States centers for disease control and prevention shall report the event as required by the United States centers for medicare and medicaid services.
(3) For the purposes of this section "pathogens of epidemiological concern" means infectious agents that have one or more of the following characteristics:
(a) A propensity for transmission within health care facilities based on published reports from the centers for disease control and prevention and the occurrence of temporal or geographic clusters of two or more patients;
(b) Antimicrobial resistance implications;
(c) Association with serious clinical disease or increased morbidity and mortality; or
(d) A newly discovered or reemerging pathogen.
[ 2022 c 207 s 2; 2009 c 244 s 1.]
Notes:
Finding—2022 c 207: "The legislature finds that a singular focus on methicillin-resistant staphylococcus aureus does not reflect the reality that there are many more pathogens of epidemiological concern. Modernization of state law is needed. Hospitals must prepare and respond effectively to pathogens of epidemiological concern within their facilities through a broad facility risk assessment that identifies pathogens of epidemiological concern that pose risks to patients, health care workers, and visitors. Department of health oversight and surveys will ensure risk assessments are appropriate and current. Lab identified pathogens must be reported to the national healthcare safety network of the United States centers for disease control and prevention pursuant to requirements from the centers for medicare and medicaid services." [ 2022 c 207 s 1.]

catchline: Prevention and control of the transmission of pathogens of epidemiological concern—Policy adoption—Reporting—Definitions.


title: RCW 70.41.440

text:
(1) A hospital shall report to a local law enforcement authority as soon as reasonably possible, taking into consideration a patient's emergency care needs, when the hospital provides treatment for a bullet wound, gunshot wound, or stab wound to a patient. A hospital shall establish a written policy to identify the person or persons responsible for making the report.
(2) The report required under subsection (1) of this section must include the following information, if known:
(a) The name, residence, sex, and age of the patient;
(b) Whether the patient has received a bullet wound, gunshot wound, or stab wound; and
(c) The name of the health care provider providing treatment for the bullet wound, gunshot wound, or stab wound.
(3) Nothing in this section shall limit a person's duty to report under RCW 26.44.030 or 74.34.035.
(4) Any bullets, clothing, or other foreign objects that are removed from a patient for whom a hospital is required to make a report pursuant to subsection (1) of this section shall be preserved and kept in custody in such a way that the identity and integrity thereof are reasonably maintained until the bullets, clothing, or other foreign objects are taken into possession by a law enforcement authority or the hospital's normal period for retention of such items expires, whichever occurs first.
(5) Any hospital or person who in good faith, and without gross negligence or willful or wanton misconduct, makes a report required by this section, cooperates in an investigation or criminal or judicial proceeding related to such report, or maintains bullets, clothing, or other foreign objects, or provides such items to a law enforcement authority as described in subsection (4) of this section, is immune from civil or criminal liability or professional licensure action arising out of or related to the report and its contents or the absence of information in the report, cooperation in an investigation or criminal or judicial proceeding, and the maintenance or provision to a law enforcement authority of bullets, clothing, or other foreign objects under subsection (4) of this section.
(6) The physician-patient privilege described in RCW 5.60.060(4), the registered nurse-patient privilege described in RCW 5.62.020, and any other health care provider-patient privilege created or recognized by law are not a basis for excluding as evidence in any criminal proceeding any report, or information contained in a report made under this section.
(7) All reporting, preservation, or other requirements of this section are secondary to patient care needs and may be delayed or compromised without penalty to the hospital or person required to fulfill the requirements of this section.
(8) If the patient states his or her injury is the result of domestic violence, the hospital shall follow its established processes to inform the patient of resources to assure the safety of the patient and his or her family.
[ 2013 c 252 s 1; 2009 c 359 s 2.]

catchline: Duty to report violent injuries—Preservation of evidence—Immunity—Privilege.


title: RCW 70.41.450

text:
Hospitals licensed under this chapter shall post a sign in patient registration areas containing at least the following language: "Information about the estimated charges of your hospital services is available upon request. Please do not hesitate to ask for information."
[ 2009 c 529 s 2.]

catchline: Estimated charges of hospital services—Notice.


title: RCW 70.41.460

text:
As a condition of licensure, a hospital must contract with the department of corrections pursuant to RCW 72.10.030.
[ 2012 c 237 s 3.]

catchline: Contract with department of corrections.


title: RCW 70.41.470

text:
(1) As of January 1, 2013, each hospital that is recognized by the internal revenue service as a 501(c)(3) nonprofit entity must make its federally required community health needs assessment widely available to the public and submit it to the department within fifteen days of submission to the internal revenue service. Following completion of the initial community health needs assessment, each hospital in accordance with the internal revenue service shall complete and make widely available to the public and submit to the department an assessment once every three years. The department must post the information submitted to it pursuant to this subsection on its website.
(2)(a) Unless contained in the community health needs assessment under subsection (1) of this section, a hospital subject to the requirements under subsection (1) of this section shall make public and submit to the department a description of the community served by the hospital, including both a geographic description and a description of the general population served by the hospital; and demographic information such as leading causes of death, levels of chronic illness, and descriptions of the medically underserved, low-income, and minority, or chronically ill populations in the community.
(b)(i) Beginning July 1, 2022, a hospital, other than a hospital designated by medicare as a critical access hospital or sole community hospital, that is subject to the requirements under subsection (1) of this section must annually submit to the department an addendum which details information about activities identified as community health improvement services with a cost of $5,000 or more. The addendum must include the type of activity, the method in which the activity was delivered, how the activity relates to an identified community need in the community health needs assessment, the target population for the activity, strategies to reach the target population, identified outcome metrics, the cost to the hospital to provide the activity, the methodology used to calculate the hospital's costs, and the number of people served by the activity. If a community health improvement service is administered by an entity other than the hospital, the other entity must be identified in the addendum.
(ii) Beginning July 1, 2022, a hospital designated by medicare as a critical access hospital or sole community hospital that is subject to the requirements under subsection (1) of this section must annually submit to the department an addendum which details information about the 10 highest cost activities identified as community health improvement services. The addendum must include the type of activity, the method in which the activity was delivered, how the activity relates to an identified community need in the community health needs assessment, the target population for the activity, strategies to reach the target population, identified outcome metrics, the cost to the hospital to provide the activity, the methodology used to calculate the hospital's costs, and the number of people served by the activity. If a community health improvement service is administered by an entity other than the hospital, the other entity must be identified in the addendum.
(iii) The department shall require the reporting of demographic information about participant race, ethnicity, any disability, gender identity, preferred language, and zip code of primary residency. The department, in consultation with interested entities, may revise the required demographic information according to an established six-year review cycle about participant race, ethnicity, disabilities, gender identity, preferred language, and zip code of primary residence that must be reported under (b)(i) and (ii) of this subsection (2). At a minimum, the department's consultation process shall include community organizations that provide community health improvement services, communities impacted by health inequities, health care workers, hospitals, and the governor's interagency coordinating council on health disparities. The department shall establish a six-year cycle for the review of the information requested under this subsection (2)(b)(iii).
(iv) The department shall provide guidance on participant data collection and the reporting requirements under this subsection (2)(b). The guidance shall include a standard form for the reporting of information under this subsection (2)(b). The standard form must allow for the reporting of community health improvement services that are repeated within a reporting period to be combined within the addendum as a single project with the number of instances of the services listed. The department must develop the guidelines in consultation with interested entities, including an association representing hospitals in Washington, labor unions representing workers who work in hospital settings, and community health board associations. The department must post the information submitted to it pursuant to this subsection (2)(b) on its website.
(3)(a) Each hospital subject to the requirements of subsection (1) of this section shall make widely available to the public a community benefit implementation strategy within one year of completing its community health needs assessment. In developing the implementation strategy, hospitals shall consult with community-based organizations and stakeholders, and local public health jurisdictions, as well as any additional consultations the hospital decides to undertake. Unless contained in the implementation strategy under this subsection (3)(a), the hospital must provide a brief explanation for not accepting recommendations for community benefit proposals identified in the assessment through the stakeholder consultation process, such as excessive expense to implement or infeasibility of implementation of the proposal.
(b) Implementation strategies must be evidence-based, when available; or development and implementation of innovative programs and practices should be supported by evaluation measures.
(4) When requesting demographic information under subsection (2)(b) of this section, a hospital must inform participants that providing the information is voluntary. If a hospital fails to report demographic information under subsection (2)(b) of this section because a participant refused to provide the information, the department may not take any action against the hospital for failure to comply with reporting requirements or other licensing standards on that basis.
(5) For the purposes of this section, the term "widely available to the public" has the same meaning as in the internal revenue service guidelines.
[ 2021 c 162 s 5; 2012 c 103 s 1.]

catchline: Information to be made widely available by certain hospitals—Community health needs assessment—Description of community served—Community benefit implementation strategy.


title: RCW 70.41.480

text:
(1) The legislature finds that high quality, safe, and compassionate health care services for patients of Washington state must be available at all times. The legislature further finds that there is a need for patients being released from hospital emergency departments to maintain access to emergency medications when community or hospital pharmacy services are not available, including medication for opioid overdose reversal and for the treatment for opioid use disorder as appropriate, human immunodeficiency virus postexposure prophylaxis drugs, anti-infectives, and drugs that come prepackaged by the manufacturer. It is the intent of the legislature to accomplish this objective by allowing practitioners with prescriptive authority to prescribe limited amounts of prepackaged emergency medications to patients being discharged from hospital emergency departments when access to community or outpatient hospital pharmacy services is not otherwise available.
(2) A hospital may allow a practitioner to prescribe prepackaged emergency medications and allow a practitioner or a registered nurse licensed under chapter 18.79 RCW to distribute prepackaged emergency medications to patients being discharged from a hospital emergency department in the following circumstances:
(a) During times when community or outpatient hospital pharmacy services are not available within 15 miles within Washington by road;
(b) When, in the judgment of the practitioner and consistent with hospital policies and procedures, a patient has no reasonable ability to reach the local community or outpatient pharmacy; or
(c) When a patient is identified as needing human immunodeficiency virus postexposure prophylaxis drugs or therapies.
(3) A hospital may only allow this practice if the director of the hospital pharmacy, in collaboration with appropriate hospital medical staff, develops policies and procedures regarding the following:
(a) Development of a list, preapproved by the pharmacy director, of the types of emergency medications to be prepackaged and distributed;
(b) Assurances that emergency medications to be prepackaged pursuant to this section are prepared by a pharmacist or under the supervision of a pharmacist licensed under chapter 18.64 RCW;
(c) Development of specific criteria under which emergency prepackaged medications may be prescribed and distributed consistent with the limitations of this section;
(d) Assurances that any practitioner authorized to prescribe prepackaged emergency medication or any nurse authorized to distribute prepackaged emergency medication is trained on the types of medications available and the circumstances under which they may be distributed;
(e) Procedures to require practitioners intending to prescribe prepackaged emergency medications pursuant to this section to maintain a valid prescription either in writing or electronically in the patient's records prior to a medication being distributed to a patient;
(f) Establishment of a limit of no more than a 48 hour supply of emergency medication as the maximum to be dispensed to a patient, except when:
(i) Community or hospital outpatient pharmacy services will not be available within 48 hours;
(ii) Anti-infectives or human immunodeficiency virus postexposure prophylaxis drugs or therapies are required; or
(iii) Drugs or therapies are packaged directly by the manufacturer in quantities larger than a 48-hour supply that cannot be altered to limit the quantity to a 48-hour supply;
(g) Assurances that prepackaged emergency medications will be kept in a secure location in or near the emergency department in such a manner as to preclude the necessity for entry into the pharmacy; and
(h) Assurances that nurses or practitioners will distribute prepackaged emergency medications to patients only after a practitioner has counseled the patient on the medication.
(4) The delivery of a single dose of medication for immediate administration to the patient is not subject to the requirements of this section.
(5) Nothing in this section restricts the authority of a practitioner in a hospital emergency department to distribute opioid overdose reversal medication under RCW 69.41.095.
(6) A practitioner or a nurse in a hospital emergency department must dispense or distribute opioid overdose reversal medication in compliance with RCW 70.41.485.
(7) Except as permitted for human immunodeficiency virus postexposure prophylaxis or opioid overdose reversal drugs or therapies, nothing in this section permits a hospital to bill separately from the bundled payment for drugs or therapies dispensed pursuant to this section.
(8) For purposes of this section:
(a) "Emergency medication" means any medication commonly prescribed to emergency department patients, including those drugs, substances or immediate precursors listed in schedules II through V of the uniform controlled substances act, chapter 69.50 RCW, as now or hereafter amended;
(b) "Distribute" means the delivery of a drug or device other than by administering or dispensing;
(c) "Manufacturer" has the same meaning as provided in RCW 18.64.011;
(d) "Opioid overdose reversal medication" has the same meaning as provided in RCW 69.41.095;
(e) "Practitioner" means any person duly authorized by law or rule in the state of Washington to prescribe drugs as defined in RCW 18.64.011; and
(f) "Nurse" means a registered nurse or licensed practical nurse as defined in chapter 18.79 RCW.
[ 2025 c 213 s 1; 2024 c 251 s 2; 2022 c 25 s 1; 2021 c 273 s 2; 2019 c 314 s 18; 2015 c 234 s 1.]
Notes:
Effective date—2024 c 251: See note following RCW 70.41.495.
Effective date—2022 c 25: "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 11, 2022]." [ 2022 c 25 s 2.]
Effective date—2021 c 273 ss 2-4: "Sections 2 through 4 of this act take effect January 1, 2022." [ 2021 c 273 s 14.]
Findings—Intent—2021 c 273: "(1) The legislature finds that:
(a) Opioid use disorder is a treatable brain disease from which people recover;
(b) Individuals living with opioid use disorder are at high risk for fatal overdose;
(c) Overdose deaths are preventable with lifesaving opioid overdose reversal medications like naloxone;
(d) Just as individuals with life-threatening allergies should carry an EpiPen, individuals with opioid use disorder should carry opioid overdose reversal medication;
(e) There are 53,000 individuals in Washington enrolled in apple health, Washington's medicaid program, that have a diagnosis of opioid use disorder and yet there are alarmingly few medicaid claims for opioid overdose reversal medication; and
(f) Most of the opioid overdose reversal medication distributed in Washington is currently paid for with flexible federal and state dollars and distributed in bulk, rather than appropriately billed to a patient's insurance. Those finite flexible funds should instead be used for nonmedicaid eligible expenses or for opioid overdose reversal medication distributed in nonmedicaid eligible settings or to nonmedicaid eligible persons. The state's current methods for acquisition and distribution of opioid overdose reversal medication are not sustainable and insufficient to reach all Washingtonians living with opioid use disorder.
(2) Therefore, it is the intent of the legislature to increase access for all individuals with opioid use disorder to opioid overdose reversal medication so that if they experience an overdose, they will have a second chance. As long as there is breath, there is hope for recovery." [ 2021 c 273 s 1.]
Declaration—2019 c 314: See note following RCW 18.22.810.
Effective date—2015 c 234 s 1: "Section 1 of 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 [May 11, 2015]." [ 2015 c 234 s 5.]

catchline: Findings—Intent—Authority to prescribe prepackaged emergency medications—Definitions.


title: RCW 70.41.485

text:
(1) A hospital shall provide a person who presents to an emergency department with symptoms of an opioid overdose, opioid use disorder, or other adverse event related to opioid use with opioid overdose reversal medication upon discharge, unless the treating practitioner determines in their clinical and professional judgment that dispensing or distributing opioid overdose reversal medication is not appropriate or the practitioner has confirmed that the patient already has opioid overdose reversal medication. If the hospital dispenses or distributes opioid overdose reversal medication it must provide directions for use.
(2) The opioid overdose reversal medication may be dispensed with technology used to dispense medications.
(3) A person who is provided opioid overdose reversal medication under this section must be provided information and resources about medication for opioid use disorder and harm reduction strategies and services which may be available, such as substance use disorder treatment services and substance use disorder peer counselors. This information should be available in all languages relevant to the communities that the hospital serves.
(4) The labeling requirements of RCW 69.41.050 and 18.64.246 do not apply to opioid overdose reversal medications dispensed or distributed in accordance with this section.
(5) Until the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 is operational:
(a) If the patient is enrolled in a medical assistance program under chapter 74.09 RCW, the hospital must bill the patient's medicaid benefit for the patient's opioid overdose reversal medication utilizing the appropriate billing codes established by the health care authority. This billing must be separate from and in addition to the payment for the other services provided during the hospital visit.
(b) If the patient has available health insurance coverage other than medical assistance under chapter 74.09 RCW, the hospital must bill the patient's health plan for the cost of the opioid overdose reversal medication.
(c) For patients who are not enrolled in medical assistance and do not have any other available insurance coverage, the hospital must bill the health care authority for the cost of the patient's opioid overdose reversal medication.
(6) This section does not prohibit a hospital from dispensing opioid overdose reversal medication to a patient at no cost to the patient out of the hospital's prepurchased supply.
(7) Nothing in this section prohibits or modifies a hospital's ability or responsibility to bill a patient's health insurance or to provide financial assistance as required by state or federal law.
(8) A hospital, its employees, and its practitioners are immune from suit in any action, civil or criminal, or from professional or other disciplinary action, for action or inaction in compliance with this section.
(9) For purposes of this section:
(a) "Opioid overdose reversal medication" has the meaning provided in RCW 69.41.095.
(b) "Practitioner" has the meaning provided in RCW 18.64.011.
[ 2021 c 273 s 3.]
Notes:
Effective date—2021 c 273 ss 2-4: See note following RCW 70.41.480.
Findings—Intent—2021 c 273: See note following RCW 70.41.480.

catchline: Opioid overdose reversal medications—Distribution—Labeling—Liability.


title: RCW 70.41.490

text:
(1) The legislature recognizes that in order for hospitals to ensure drugs are accessible to patients and the public to meet hospital and community health care needs, certain transfers of drugs must be authorized between hospitals and their affiliated or related companies under common ownership and control of the corporate entity and for emergency medical reasons.
(2) A licensed hospital pharmacy is permitted, without a wholesaler license, to:
(a) Engage in intracompany sales, being defined as any transaction or transfer between any division, subsidiary, parent company, affiliated company, or related company under common ownership and control of the corporate entity, unless the transfer occurs between a wholesale distributor and a health care entity or practitioner; and
(b) Sell, purchase, or trade a drug or offer to sell, purchase, or trade a drug for emergency medical reasons. For the purposes of this subsection, "emergency medical reasons" includes transfers of prescription drugs to alleviate a temporary shortage, except that the gross dollar value of the transfers may not exceed five percent of the total prescription drug sale revenue of either the transferor or transferee pharmacy during any twelve consecutive month period.
[ 2015 c 234 s 2.]

catchline: Authorization for certain transfers of drugs between hospitals and their affiliated companies.


title: RCW 70.41.495

text:
(1) A hospital must adopt a policy and have procedures in place, that conform with the guidelines issued by the centers for disease control and prevention, for the dispensing of human immunodeficiency virus postexposure prophylaxis drugs or therapies.
(2) This policy must ensure that hospital staff dispense or deliver as defined in RCW 18.64.011 to a patient, with a patient's informed consent, a 28-day supply of human immunodeficiency virus postexposure prophylaxis drugs or therapies following the patient's possible exposure to human immunodeficiency virus, unless medically contraindicated, inconsistent with accepted standards of care, or inconsistent with centers for disease control and prevention guidelines. When available, hospitals shall dispense or deliver generic human immunodeficiency virus postexposure prophylaxis drugs or therapies.
(3) Nothing in this section shall be construed to alter the coverage for reimbursement of postexposure prophylaxis drugs through:
(a) The crime victims' compensation program, established in chapter 7.68 RCW, for drugs dispensed or delivered to sexual assault victims; or
(b) The industrial insurance act for drugs dispensed or delivered to a worker exposed to the human immunodeficiency virus through the course of employment.
[ 2024 c 251 s 1.]
Notes:
Effective date—2024 c 251: "This act takes effect January 1, 2025." [ 2024 c 251 s 6.]

catchline: Human immunodeficiency virus postexposure prophylaxis drugs and therapies—Policies—Coverage.


title: RCW 70.41.500

text:
A hospital that provides a parent with a positive prenatal or postnatal diagnosis of Down syndrome shall provide the parent with the information prepared by the department under RCW 43.70.738 at the time the hospital provides the parent with the Down syndrome diagnosis.
[ 2016 c 70 s 9.]

catchline: Down syndrome—Parent information.


title: RCW 70.41.510

text:
If the insurance commissioner reports to the department that he or she has cause to believe that a hospital has engaged in a pattern of violations of RCW 48.49.020 or 48.49.030 or has violated RCW 48.43.732, and the report is substantiated after investigation, the department may levy a fine upon the hospital in an amount not to exceed one thousand dollars per violation and take other formal or informal disciplinary action as permitted under the authority of the department.
[ 2025 c 389 s 5; 2019 c 427 s 18.]
Notes:
Finding—Intent—2025 c 389: See note following RCW 48.43.732.
Findings—Intent—Effective date—2019 c 427: See RCW 48.49.003 and 48.49.900.

catchline: Pattern of balance billing protection act violations by hospital—Fines and disciplinary action.


title: RCW 70.41.520

text:
(1) Every hospital must submit to the department its policies related to access to care regarding:
(a) Admission;
(b) End-of-life care and the death with dignity act, chapter 70.245 RCW;
(c) Nondiscrimination; and
(d) Reproductive health care.
(2) The department shall post a copy of the policies received under subsection (1) of this section on its website.
(3) If a hospital makes changes to any of the policies listed under subsection (1) of this section, it must submit a copy of the changed policy to the department within thirty days after the hospital approves the changes.
(4) A hospital must post a copy of the policies provided to the department under subsection (1) of this section and the forms required under subsection (5) of this section to the hospital's own website in a location where the policies are readily accessible to the public without a required login or other restriction.
(5)(a) The department shall, in consultation with stakeholders including a hospital association and patient advocacy groups, develop two simple and clear forms to be submitted by hospitals along with the policies required in subsection (1) of this section. One form must provide the public with specific information about which reproductive health care services are and are not generally available at each hospital. The other form must provide the public with specific information about which end-of-life services are and are not generally available at each hospital. Each form must include contact information for the hospital in case patients have specific questions about services available at the hospital.
(b) The department shall provide the form required in this subsection related to end-of-life care and the death with dignity act, chapter 70.245 RCW, by November 1, 2023. Hospitals shall submit the completed form to the department within 60 days of the form being provided.
[ 2023 c 38 s 18; 2019 c 399 s 4.]
Notes:
Findings—Short title—2019 c 399: See notes following RCW 74.09.875.
Recommendations—Preexposure and postexposure prophylaxis financial support awareness—2019 c 399: See note following RCW 48.43.072.

catchline: Access to care policies for admission, nondiscrimination, and reproductive health care—Requirement to submit, post on website, and use department-created form.


title: RCW 70.41.530

text:
A hospital that is an originating site or distant site for audio-only telemedicine may not charge a facility fee.
[ 2022 c 126 s 1.]

catchline: Audio-only telemedicine—Facility fees.


title: RCW 70.41.540

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 hospitals 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 hospitals 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) Hospitals 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 24.]
Notes:
Short title—2023 c 123: See RCW 18.80.900.

catchline: Multistate nurse license—Conditions of employment.