H-2216.1
HOUSE BILL 1907
State of Washington 68th Legislature 2024 Regular Session
By Representatives Tharinger, Riccelli, Reed, Ormsby, Callan,
Gregerson, and Reeves
Prefiled 12/07/23. Read first time 01/08/24. Referred to Committee
on Health Care & Wellness.
1 AN ACT Relating to creating a medical assistant-EMT
2 certification; amending RCW 18.360.010, 18.360.020, 18.360.030,
3 18.360.040, and 18.360.050; and reenacting and amending RCW
4 18.120.020 and 18.130.040.
5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
6 Sec. 1. RCW 18.360.010 and 2023 c 134 s 1 are each amended to
7 read as follows:
8 The definitions in this section apply throughout this chapter
9 unless the context clearly requires otherwise.
10 (1) "Administer" means the retrieval of medication, and its
11 application to a patient, as authorized in RCW 18.360.050.
12 (2) "Delegation" means direct authorization granted by a licensed
13 health care practitioner to a medical assistant to perform the
14 functions authorized in this chapter which fall within the scope of
15 practice of the health care provider and the training and experience
16 of the medical assistant.
17 (3) "Department" means the department of health.
18 (4) "Forensic phlebotomist" means a police officer, law
19 enforcement officer, or employee of a correctional facility or
20 detention facility, who is certified under this chapter and meets any
21 additional training and proficiency standards of his or her employer
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 1 to collect a venous blood sample for forensic testing pursuant to a
2 search warrant, a waiver of the warrant requirement, or exigent
3 circumstances.
4 (5) "Health care practitioner" means:
5 (a) A physician licensed under chapter 18.71 RCW;
6 (b) An osteopathic physician and surgeon licensed under chapter
7 18.57 RCW; or
8 (c) Acting within the scope of their respective licensure, a
9 podiatric physician and surgeon licensed under chapter 18.22 RCW, a
10 registered nurse or advanced registered nurse practitioner licensed
11 under chapter 18.79 RCW, a naturopath licensed under chapter 18.36A
12 RCW, a physician assistant licensed under chapter 18.71A RCW, or an
13 optometrist licensed under chapter 18.53 RCW.
14 (6) "Medical assistant-certified" means a person certified under
15 RCW 18.360.040 who assists a health care practitioner with patient
16 care, executes administrative and clinical procedures, and performs
17 functions as provided in RCW 18.360.050 under the supervision of the
18 health care practitioner.
19 (7) "Medical assistant-EMT" means a person registered under RCW
20 18.360.040 who also holds either an emergency medical technician
21 certification under RCW 18.73.081 or a paramedic certification under
22 RCW 18.71.205, and who performs functions as provided in RCW
23 18.360.050 under the supervision of a health care practitioner.
24 (8) "Medical assistant-hemodialysis technician" means a person
25 certified under RCW 18.360.040 who performs hemodialysis and other
26 functions pursuant to RCW 18.360.050 under the supervision of a
27 health care practitioner.
28 (((8))) (9) "Medical assistant-phlebotomist" means a person
29 certified under RCW 18.360.040 who performs capillary, venous, and
30 arterial invasive procedures for blood withdrawal and other functions
31 pursuant to RCW 18.360.050 under the supervision of a health care
32 practitioner.
33 (((9))) (10) "Medical assistant-registered" means a person
34 registered under RCW 18.360.040 who, pursuant to an endorsement by a
35 health care practitioner, clinic, or group practice, assists a health
36 care practitioner with patient care, executes administrative and
37 clinical procedures, and performs functions as provided in RCW
38 18.360.050 under the supervision of the health care practitioner.
39 (((10))) (11) "Secretary" means the secretary of the department
40 of health.
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 1 (((11))) (12)(a) "Supervision" means supervision of procedures
2 permitted pursuant to this chapter by a health care practitioner who
3 is physically present and is immediately available in the facility,
4 except as provided in (b) and (c) of this subsection.
5 (b) The health care practitioner does not need to be present
6 during procedures to withdraw blood, administer vaccines, or obtain
7 specimens for or perform diagnostic testing, but must be immediately
8 available.
9 (c) During a telemedicine visit, supervision over a medical
10 assistant assisting a health care practitioner with the telemedicine
11 visit may be provided through interactive audio and video
12 telemedicine technology.
13 Sec. 2. RCW 18.360.020 and 2017 c 336 s 15 are each amended to
14 read as follows:
15 (1) No person may practice as a medical assistant-certified,
16 medical assistant-hemodialysis technician, medical assistant-
17 phlebotomist, medical assistant-EMT, or forensic phlebotomist unless
18 he or she is certified under RCW 18.360.040.
19 (2) No person may practice as a medical assistant-registered
20 unless he or she is registered under RCW 18.360.040.
21 Sec. 3. RCW 18.360.030 and 2019 c 55 s 8 are each amended to
22 read as follows:
23 (1) The secretary shall adopt rules specifying the minimum
24 qualifications for a medical assistant-certified, medical assistant-
25 hemodialysis technician, medical assistant-phlebotomist, medical
26 assistant-EMT, and forensic phlebotomist.
27 (a) The qualifications for a medical assistant-hemodialysis
28 technician must be equivalent to the qualifications for hemodialysis
29 technicians regulated pursuant to chapter 18.135 RCW as of January 1,
30 2012.
31 (b) The qualifications for a forensic phlebotomist must include
32 training consistent with the occupational safety and health
33 administration guidelines and must include between twenty and thirty
34 hours of work in a clinical setting with the completion of more than
35 one hundred successful venipunctures. The secretary may not require
36 more than ((forty)) 40 hours of classroom training for initial
37 training, which may include online preclass homework.
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 1 (c) The qualifications for a medical assistant-EMT must be
2 consistent with the qualifications for the emergency medical
3 technician certification pursuant to RCW 18.73.081 or the paramedic
4 certification pursuant to RCW 18.71.205. The secretary must ensure
5 that any person with an emergency medical technician or paramedic
6 certification is eligible for a medical assistant-EMT certification
7 with no additional training or examination requirements if the
8 certification for the emergency medical technician or a paramedic is
9 in good standing.
10 (2) The secretary shall adopt rules that establish the minimum
11 requirements necessary for a health care practitioner, clinic, or
12 group practice to endorse a medical assistant as qualified to perform
13 the duties authorized by this chapter and be able to file an
14 attestation of that endorsement with the department.
15 (((3) The Washington medical commission, the board of osteopathic
16 medicine and surgery, the podiatric medical board, the nursing care
17 quality assurance commission, the board of naturopathy, and the
18 optometry board shall each review and identify other specialty
19 assistive personnel not included in this chapter and the tasks they
20 perform. The department of health shall compile the information from
21 each disciplining authority listed in this subsection and submit the
22 compiled information to the legislature no later than December 15,
23 2012.))
24 Sec. 4. RCW 18.360.040 and 2023 c 134 s 2 are each amended to
25 read as follows:
26 (1)(a) The secretary shall issue a certification as a medical
27 assistant-certified to any person who has satisfactorily completed a
28 medical assistant training program approved by the secretary, passed
29 an examination approved by the secretary, and met any additional
30 qualifications established under RCW 18.360.030.
31 (b) The secretary shall issue an interim certification to any
32 person who has met all of the qualifications in (a) of this
33 subsection, except for the passage of the examination. A person
34 holding an interim permit possesses the full scope of practice of a
35 medical assistant-certified. The interim permit expires upon passage
36 of the examination and issuance of a certification, or after one
37 year, whichever occurs first, and may not be renewed.
38 (2)(a) The secretary shall issue a certification as a medical
39 assistant-hemodialysis technician to any person who meets the
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 1 qualifications for a medical assistant-hemodialysis technician
2 established under RCW 18.360.030.
3 (b) In order to allow sufficient time for the processing of a
4 medical assistant-hemodialysis technician certification, applicants
5 for that credential who have completed their training program are
6 allowed to continue to work at dialysis facilities, under the level
7 of supervision required for the training program, for a period of up
8 to 180 days after filing their application, to facilitate patient
9 continuity of care.
10 (3)(a) The secretary shall issue a certification as a medical
11 assistant-phlebotomist to any person who meets the qualifications for
12 a medical assistant-phlebotomist established under RCW 18.360.030.
13 (b) In order to allow sufficient time for the processing of a
14 medical assistant-phlebotomist certification, applicants for that
15 credential who have completed their training program are allowed to
16 work, under the level of supervision required for the training
17 program, for a period of up to 180 days after filing their
18 application, to facilitate access to services.
19 (4) The secretary shall issue a certification as a medical
20 assistant-EMT to any person who meets the qualifications for a
21 medical assistant-EMT established under RCW 18.360.030.
22 (5) The secretary shall issue a certification as a forensic
23 phlebotomist to any person who meets the qualifications for a
24 forensic phlebotomist established under RCW 18.360.030.
25 (((5))) (6)(a) The secretary shall issue a registration as a
26 medical assistant-registered to any person who has a current
27 endorsement from a health care practitioner, clinic, or group
28 practice.
29 (b) In order to be endorsed under this subsection (((5))) (6), a
30 person must:
31 (i) Be endorsed by a health care practitioner, clinic, or group
32 practice that meets the qualifications established under RCW
33 18.360.030; and
34 (ii) Have a current attestation of his or her endorsement to
35 perform specific medical tasks signed by a supervising health care
36 practitioner filed with the department. A medical assistant-
37 registered may only perform the medical tasks listed in his or her
38 current attestation of endorsement.
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 1 (c) A registration based on an endorsement by a health care
2 practitioner, clinic, or group practice is not transferable to
3 another health care practitioner, clinic, or group practice.
4 (d) An applicant for registration as a medical assistant-
5 registered who applies to the department within seven days of
6 employment by the endorsing health care practitioner, clinic, or
7 group practice may work as a medical assistant-registered for up to
8 sixty days while the application is processed. The applicant must
9 stop working on the sixtieth day of employment if the registration
10 has not been granted for any reason.
11 (((6))) (7) A certification issued under subsections (1) through
12 (3) of this section is transferable between different practice
13 settings. A certification under subsection (4) of this section is
14 transferable between hospitals licensed under chapter 70.41 RCW. A
15 certification under subsection (((4))) (5) of this section is
16 transferable between law enforcement agencies.
17 Sec. 5. RCW 18.360.050 and 2023 c 134 s 3 are each amended to
18 read as follows:
19 (1) A medical assistant-certified may perform the following
20 duties delegated by, and under the supervision of, a health care
21 practitioner:
22 (a) Fundamental procedures:
23 (i) Wrapping items for autoclaving;
24 (ii) Procedures for sterilizing equipment and instruments;
25 (iii) Disposing of biohazardous materials; and
26 (iv) Practicing standard precautions.
27 (b) Clinical procedures:
28 (i) Performing aseptic procedures in a setting other than a
29 hospital licensed under chapter 70.41 RCW;
30 (ii) Preparing of and assisting in sterile procedures in a
31 setting other than a hospital under chapter 70.41 RCW;
32 (iii) Taking vital signs;
33 (iv) Preparing patients for examination;
34 (v) Capillary blood withdrawal, venipuncture, and intradermal,
35 subcutaneous, and intramuscular injections; and
36 (vi) Observing and reporting patients' signs or symptoms.
37 (c) Specimen collection:
38 (i) Capillary puncture and venipuncture;
39 (ii) Obtaining specimens for microbiological testing; and
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 1 (iii) Instructing patients in proper technique to collect urine
2 and fecal specimens.
3 (d) Diagnostic testing:
4 (i) Electrocardiography;
5 (ii) Respiratory testing; and
6 (iii)(A) Tests waived under the federal clinical laboratory
7 improvement amendments program on July 1, 2013. The department shall
8 periodically update the tests authorized under this subsection (1)(d)
9 based on changes made by the federal clinical laboratory improvement
10 amendments program; and
11 (B) Moderate complexity tests if the medical assistant-certified
12 meets standards for personnel qualifications and responsibilities in
13 compliance with federal regulation for nonwaived testing.
14 (e) Patient care:
15 (i) Telephone and in-person screening limited to intake and
16 gathering of information without requiring the exercise of judgment
17 based on clinical knowledge;
18 (ii) Obtaining vital signs;
19 (iii) Obtaining and recording patient history;
20 (iv) Preparing and maintaining examination and treatment areas;
21 (v) Preparing patients for, and assisting with, routine and
22 specialty examinations, procedures, treatments, and minor office
23 surgeries;
24 (vi) Maintaining medication and immunization records; and
25 (vii) Screening and following up on test results as directed by a
26 health care practitioner.
27 (f)(i) Administering medications. A medical assistant-certified
28 may only administer medications if the drugs are:
29 (A) Administered only by unit or single dosage, or by a dosage
30 calculated and verified by a health care practitioner. For purposes
31 of this section, a combination or multidose vaccine shall be
32 considered a unit dose;
33 (B) Limited to legend drugs, vaccines, and Schedule III-V
34 controlled substances as authorized by a health care practitioner
35 under the scope of his or her license and consistent with rules
36 adopted by the secretary under (f)(ii) of this subsection; and
37 (C) Administered pursuant to a written order from a health care
38 practitioner.
39 (ii) A medical assistant-certified may not administer
40 experimental drugs or chemotherapy agents. The secretary may, by
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 1 rule, further limit the drugs that may be administered under this
2 subsection (1)(f). The rules adopted under this subsection must limit
3 the drugs based on risk, class, or route.
4 (g) Intravenous injections. A medical assistant-certified may
5 establish intravenous lines for diagnostic or therapeutic purposes,
6 without administering medications, under the supervision of a health
7 care practitioner, and administer intravenous injections for
8 diagnostic or therapeutic agents under the direct visual supervision
9 of a health care practitioner if the medical assistant-certified
10 meets minimum standards established by the secretary in rule. The
11 minimum standards must be substantially similar to the qualifications
12 for category D and F health care assistants as they exist on July 1,
13 2013.
14 (h) Urethral catheterization when appropriately trained.
15 (2) A medical assistant-hemodialysis technician may perform
16 hemodialysis when delegated and supervised by a health care
17 practitioner. A medical assistant-hemodialysis technician may also
18 administer drugs and oxygen to a patient when delegated and
19 supervised by a health care practitioner and pursuant to rules
20 adopted by the secretary.
21 (3) A medical assistant-phlebotomist may perform:
22 (a) Capillary, venous, or arterial invasive procedures for blood
23 withdrawal when delegated and supervised by a health care
24 practitioner and pursuant to rules adopted by the secretary;
25 (b) Tests waived under the federal clin