Washington Administrative Code

(1) A physician assistant must complete one hundred hours of continuing education every two years as required in chapter 246-12 WAC, Part 7, which may be audited for compliance at the discretion of the commission.(2) In lieu of one hundred hours of continuing medical education th…

(1) A licensed physician assistant must complete a one-time training in suicide assessment, treatment, and management. The training must be at least six hours in length and may be completed in one or more sessions.(2) The training must be completed by the end of the first full co…

(1) A physician assistant must complete two hours of health equity continuing education training every four years as described in WAC 246-12-800 through 246-12-830.(2) The two hours of health equity continuing education a physician assistant completes count toward meeting applica…

The physician assistant-surgical assistant (PASA) who is not eligible to take the NCCPA certifying exam shall:(1) Function only in the operating room as approved by the commission;(2) Only be allowed to close skin and subcutaneous tissue, placing suture ligatures, clamping, tying…

The following section applies to the physician assistant-surgical assistant (PASA) who is not eligible to take the NCCPA certification exam.(1) Responsibility of PASA. The PASA is responsible for performing only those tasks authorized by their participating physician(s) and withi…

(1) The following definitions apply throughout this section unless the context clearly requires otherwise.(a) "Patient" means a person who is receiving health care or treatment, or has received health care or treatment without a termination of the physician assistant-patient rela…

(1) A physician assistant commits unprofessional conduct if the physician assistant abuses a patient. A physician assistant abuses a patient when they:(a) Make statements regarding the patient's body, appearance, sexual history, or sexual orientation that have no legitimate medic…

The rules in WAC 246-918-800 through 246-918-935 govern the prescribing of opioids in the treatment of pain.The commission recognizes that principles of quality medical practice dictate that the people of the state of Washington have access to appropriate and effective pain relie…

WAC 246-918-800 through 246-918-935 do not apply to:(1) The treatment of patients with cancer-related pain;(2) The treatment of patients with sickle cell disease;(3) The provision of palliative, hospice, or other end-of-life care;(4) The provision of procedural medications;(5) Th…

The definitions apply to WAC 246-918-800 through 246-918-935 unless the context clearly requires otherwise.(1) "Aberrant behavior" means behavior that indicates current misuse, diversion, unauthorized use of alcohol or other controlled substances, or multiple early refills (renew…

(1) The physician assistant shall discuss with the patient the following information at the first issuance of a prescription for opioids and at the transition from acute to subacute, and subacute to chronic:(a) Risks associated with the use of opioids, including the risk of depen…

The physician assistant shall exercise their professional judgment in selecting appropriate treatment modalities for acute nonoperative, acute perioperative, subacute, or chronic pain including the use of multimodal pharmacologic and nonpharmacologic therapy as an alternative to …

(1) To prescribe an opioid in Washington state, a physician assistant licensed to prescribe opioids shall complete a one-time continuing education requirement regarding best practices in the prescribing of opioids or the opioid prescribing rules in this chapter. The continuing ed…

Prior to issuing an opioid prescription for acute nonoperative pain or acute perioperative pain, the physician assistant shall:(1) Conduct and document an appropriate history and physical examination, including screening for risk factors for overdose and severe postoperative pain…

The physician assistant shall comply with the requirements in this section when prescribing opioids for acute nonoperative pain.(1) The physician assistant should consider prescribing nonopioids as the first line of pain control in patients unless not clinically appropriate in ac…

The physician assistant shall comply with the requirements in this section when prescribing opioids for perioperative pain.(1) The physician assistant should consider prescribing nonopioids as the first line of pain control in patients unless not clinically appropriate in accorda…

The physician assistant shall comply with the requirements in this section when prescribing opioids for subacute pain.(1) Prior to issuing an opioid prescription for subacute pain, the physician assistant shall assess the rationale for continuing opioid therapy:(a) Conduct an app…

The physician assistant, having recognized the progression of a patient from the acute nonoperative or acute perioperative phase to the subacute phase shall develop an opioid treatment plan.(1) If tapering has not begun prior to the six- to twelve-week subacute phase, the physici…

When the patient enters the chronic pain phase, the patient shall be reevaluated as if presenting with a new disease. The physician assistant shall include in the patient's record:(1) An appropriate history including:(a) The nature and intensity of the pain;(b) The effect of pain…

The physician assistant, having recognized the progression of a patient from the subacute phase to the chronic phase, shall develop an opioid treatment plan as follows:(1) Treatment plan and objectives including:(a) Documentation of any medication prescribed;(b) Biologic specimen…

The physician assistant shall use a written agreement that outlines the patient's responsibilities for opioid therapy. This written agreement for treatment must include the following provisions:(1) The patient's agreement to provide samples for biological specimen testing when re…

(1) The physician assistant shall periodically review the course of treatment for chronic pain. The frequency of visits, biological testing, and PMP queries in accordance with the provisions of WAC 246-918-935, must be determined based on the patient's risk category:(a) For a hig…

Long-acting opioids should only be prescribed by a physician assistant who is familiar with its risks and use, and who is prepared to conduct the necessary careful monitoring. Special attention should be given to patients who are initiating such treatment. The physician assistant…

(1) The physician assistant shall consider referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic pain patients who are under eighteen years of age or who are potential high-risk …

A physician assistant is not required to consult with a pain management specialist as defined in WAC 246-918-895 when the physician assistant has documented adherence to all standards of practice as defined in WAC 246-918-855 through 246-918-875 and when one or more of the follow…

The physician assistant is exempt from the consultation requirement in WAC 246-918-880 if one or more of the following qualifications are met:(1) The physician assistant is a pain management specialist under WAC 246-918-895;(2) The physician assistant has successfully completed a…

A pain management specialist shall meet one or more of the following qualifications:(1) If a physician assistant must have a delegation agreement with a physician pain management specialist and meet the educational requirements and practice requirements listed below:(a) A minimum…

Not all chronic pain patients will need their opioid prescriptions tapered. Relying on medical decision making and patient-centered treatment, the physician assistant shall consider tapering or referral for a substance use disorder evaluation when:(1) The patient requests;(2) The…

(1) When a patient receiving chronic opioid pain medications changes to a new physician assistant, it is normally appropriate for the new physician assistant to initially maintain the patient's current opioid doses. Over time, the physician assistant may evaluate if any tapering …

(1) Children or adolescent patients. In the treatment of pain for children or adolescent patients, the physician assistant shall treat pain in a manner equal to that of an adult but must account for the weight of the patient and adjust the dosage prescribed accordingly.(2) Pregna…

(1) When providing episodic care for a patient who the physician assistant knows is being treated with opioids for chronic pain, such as for emergency or urgent care, the physician assistant, or their designee, shall review the PMP and document their review and any concerns.(2) A…

(1) The physician assistant shall not knowingly prescribe opioids in combination with the following medications without documentation of medical decision making:(a) Benzodiazepines;(b) Barbiturates;(c) Sedatives;(d) Carisoprodol; or(e) Nonbenzodiazepine hypnotics.(2) If, because …

(1) Where practicable, the physician assistant providing acute nonoperative pain or acute perioperative pain treatment to a patient who is known to be receiving MAT medications shall prescribe opioids when appropriate for pain relief either in consultation with a MAT prescribing …

The opioid prescribing physician assistant shall confirm or provide a current prescription for naloxone when opioids are prescribed to a high-risk patient.[Statutory Authority: RCW 18.71.017, 18.71.800, 18.71A.800 and 2017 c 297. WSR 18-23-061, § 246-918-930, filed 11/16/18, effe…

(1) The physician assistant shall register to access the PMP or demonstrate proof of having assured access to the PMP if they prescribe Schedule II-V medications in Washington state.(2) The physician assistant is permitted to delegate performance of a required PMP query to an aut…

(1) Licenses must be renewed every two years on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.(2) The applicant or licensee must pay the following nonrefundable fees:Title of FeeFeePhysician assistants:Original application Application$50.00 UW HEAL-WA surc…

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Applicant" is an individual who has completed the application form and has paid the application fee.(2) "Commission" means the Washington medical commission.(3) "Emerg…

The commission's official mailing address is:Washington Medical CommissionDepartment of HealthP.O. Box 47866Olympia, WA 98504-7866[Statutory Authority: RCW 18.71.017 and 18.130.050. WSR 20-22-003, § 246-919-020, filed 10/21/20, effective 11/21/20. Statutory Authority: RCW 18.71.0…

Regular commission meetings shall be held at least four times yearly. Additional regular or special meetings may be called at the discretion of the chair or by a quorum of the commission.[Statutory Authority: RCW 18.71.017. WSR 04-04-067, § 246-919-110, filed 2/2/04, effective 3/…

An application for a license may not be withdrawn after the commission determines that grounds exist for denial of the license or for the issuance of a conditional license. Applications that are subject to investigation for unprofessional conduct or impaired practice may not be w…

For the purposes of RCW 18.71.055, the commission approves medical schools accredited by the Liaison Committee on Medical Education.[Statutory Authority: RCW 18.71.017 and 18.130.050. WSR 20-22-003, § 246-919-320, filed 10/21/20, effective 11/21/20. Statutory Authority: RCW 18.71…

(1) Postgraduate medical training means clinical training approved by the commission in general medicine or surgery, or a specialty or subspecialty in the field of medicine or surgery as recognized by the American Board of Medical Specialties listed in the 2017-2018 ABMS Board Ce…

All graduates of medical schools outside the United States, Canada, or Puerto Rico must satisfy one of the following requirements:(1) Held a full and unrestricted license to practice medicine in another state prior to 1958;(2) Obtained a certificate with an indefinite status gran…

(1) The commission may issue a limited physician and surgeon clinical experience license to an applicant who does not qualify for licensure under RCW 18.71.050 or chapter 18.71B RCW and who does meet the requirements established in RCW 18.71.095(6) for the purpose of gaining clin…

(1) The commission accepts the United States Medical Licensing Examination (USMLE) as the examination for licensure.(2) The minimal passing scores for each component of any approved examination combination shall be a score of seventy-five as defined by the examining authority.(3)…

(1) The commission may accept certain examinations as a basis for licensure. These examinations include USMLE, Federation Licensure Examination (FLEX), National Boards Examination (NBE), or those given by the other states, or territories of the United States. Those who have taken…

The commission will accept the Federation Licensing Examination (FLEX) weighted average of 75 reported from the Federation of State Medical Boards. All FLEX scores must be submitted directly from the Federation of State Medical Boards. FLEX scores reported by other states will no…

(1) The commission may require an applicant to pass the Special Purpose Examination (SPEX) or any other examination deemed appropriate. An applicant may be required to take an examination when the commission has concerns with the applicant's ability to practice competently for re…

(1) An applicant who holds an unrestricted, active license in another state with licensing standards substantially equivalent to those in Washington may apply for a temporary practice permit authorizing the applicant to practice as a physician in Washington.(2) The commission wil…

The commission conducts background checks on applicants to assure safe patient care. Completion of a national criminal background check may require additional time. The commission may issue a temporary practice permit when the applicant has met all other licensure requirements, e…