Prior Authorization Requirements For Providers Prescribing Buprenorphine-Containing Products

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Health plans and state and school employee plans must cover at least one FDA-approved opioid agonist, antagonist and partial agonist without prior authorization. WASH. REV. CODE ANN. § 48.43.760; WASH. REV. CODE ANN. §41.05.525

Upon initiation or renewal of Medicaid managed care plan, a managed health care system may not impose prior authorization on at least one FDA-approved opioid antagonist, agonist and partial agonist. WASH. REV. CODE ANN. 74.09.645

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Education Required for Addiction Counselor Credentialing

Washington credentials one type of addiction counselor. A Substance Use Disorder Professional requires, at minimum, an associate degree and accrual of 2,500 hours of supervised experience. A higher-level degree can substitute the number of hours (i.e. a person with a bachelor’s degree needs 2,000 hours). Wash. Rev. Code §18.205.030 and Wash. Admin. Code §246-811 and Washington State Department of Health

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Licensed Professional Counselor Ability to Diagnose

Mental health counselors may apply the principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups and organizations for the purpose of treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes, but is not limited to, the assessment, diagnosis and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health. Wash. Rev. Code §18.225.010

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Peer Support Specialist Certification or Credentialing Authority

The certification standards and procedures for peer counselors are developed and administered by the Washington State Department of Social and Health Services. The standards include requirements for peer specialist qualifications, core competencies, training and examination, renewal, revocation and supervision.

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Certified Nurse Midwife Practice Authority

Full independent practice and prescriptive authority and the NM must practice with their scope of practice.

The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure. Wash. Admin. Code §246-840-300

A NM may prescribe prescription drugs and Schedules II-V controlled substances. Wash. Rev. Code §18.79.050

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Nurse Practitioner Practice Authority

Full independent practice and prescriptive authority and the NP must practice with their scope of practice.

The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure. Wash. Admin. Code §246-840-300

An NP may prescribe prescription drugs and Schedules II-V controlled substances. Wash. Rev. Code §18.79.050

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Nurse Practitioner Authority to Sign POLST Forms

NPs are authorized to sign portable orders for life-sustaining treatment forms as a qualified emergency services personnel. Rev. Code Wa. Ann. §43.70.480

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Nurse Practitioner as a Primary Care Provider

NPs are recognized in state policy as primary care providers. Primary care provider means a general practice physician, family practitioner, internist, pediatrician, osteopath, naturopath, physician assistant, osteopathic physician assistant and advanced registered nurse practitioner. Wash. Rev. Code §74.09.010(18)

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Authority to perform ophthalmic procedures

Washington allows the removal of lumps and bumps by an optometrist.

(1) The practice of optometry is defined as the examination of the human eye, the examination and ascertaining any defects of the human vision system, and the analysis of the process of vision. The practice of optometry may include, but not necessarily be limited to, the following:

  • (i) Removal of nonpenetrating foreign bodies, debridement of tissue, epilation of misaligned eyelashes, placement of punctual or lacrimal plugs, including devices containing pharmaceutical agents
    implanted in the lacrimal system, dilation and irrigation of the lacrimal system, nonlaser light therapy, and placement of biologic
    membranes.

 Wash. Rev. Code §18.53.010

 

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Injectable Authority

The practice of optometry may include the following advanced procedures:
(i) Common complication of the lids, lashes, and lacrimal systems;
(ii) Chalazion management, including injection and excision;
(iii) Injections, including intramuscular injections of epinephrine and subconjunctival and subcutaneous injections of medications;
(iv) Management of lid lesions, including intralesional injection of medications;
(v) Preoperative and postoperative care related to these procedures;
(vi) Use of topical and injectable anesthetics; and
(vii) Eyelid surgery, excluding any cosmetic surgery or surgery requiring the use of general anesthesia. Wash. Rev. Code §18.53.010

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Prescription of controlled substances

Optometrists may prescribe Schedule III-V controlled substances and Schedule II controlled substances containing hydrocodone combinations. Wash. Rev. Code §18.53.010

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Dental Hygienists with Direct Access

Dental hygienists who work for a health care facility or senior center can provide their services without the supervision of a dentist if they meet certain experience requirements, enter into a written agreement with a licensed dentist who will provide off-site supervision, and they refer the treated patients to a dentist for dental planning and treatment. Wash. Rev. Code §18.29.056

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Dental Therapists

Dental health aide therapists may provide preventive services in practice settings on tribal reservations and operated by an Indian health program. A dental health aide therapist must practice under the supervision of a dentist. Wash. Rev. Code §70.350

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Practice of Teledentistry

Teledentistry may be delivered though through live video and store-and-forward modalities. WA State Health Care Authority, Medicaid Provider, Dental-Related Services, pg. 83

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Administration of COVID-19 Vaccine

Washington has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act does allow pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

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Prescription Adaptation

Washington does not allow pharmacists to modify prescriptions.

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Prescription of Hormonal Contraceptives

Washington allows pharmacists to prescribe hormonal contraceptives if they enter into a collaborative practice agreement with a practitioner who has the appropriate prescriptive authority. Washington Laws, 1979

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Prescription of Tobacco Cessation Aids

Washington does not allow pharmacists to prescribe tobacco cessation aids.

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Supervision Requirements (Practice and Prescriptive Authority)

Supervision by a physician required for practice and prescriptive authority.

A PA may practice medicine in this state to the extent permitted by the practice agreement. […] PAs may provide services that they are competent to perform based on their education, training and experience and that are consistent with their practice agreement. The supervising physician and the PA shall determine which procedures may be performed and the supervision under which the procedure is performed. PAs may practice in any area of medicine or surgery as long as the practice is not beyond the supervising physician’s own scope of expertise and clinical practice and the practice agreement. WASH. REV. CODE § 18.71A.030

A PA may prescribe, order, administer and dispense legend drugs and Schedule II, III, IV, or V controlled substances consistent with the scope of practice in an approved practice agreement filed with the commission provided: (a) The PA has an active DEA registration; and (b) All prescriptions comply with state and federal prescription regulations. WASH. ADMIN. CODE § 246-918-035

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Number of PAs Supervised

Statute limits the number of PAs a physician may supervise.

A physician may supervise no more than 10 PAs. A physician may petition the commission for a waiver of this limit. WASH. REV. CODE § 18.71A.120(6)-(7)

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Chart Co-Signatures

Chart co-signatures may be determined at the practice level.

A physician is not required to countersign orders written in a patient’s clinical record or an official form by a PA with whom the physician has a practice agreement. WASH. REV. CODE § 18.71A.090(2

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Adaptable Proximity Requirements

Statute allows adaptable proximity.

Supervision shall not be construed to necessarily require the personal presence of the supervising physician or physicians at the place where services are rendered. WASH. REV. CODE § 18.71A.020(2)(b)(ii)

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Scope of Practice Determination

PA’s may provide services within their competency and are based on their education, training and experience consistent with a delegation agreement. The supervising physician and the PA determine which procedures may be performed.  Wash. Rev. Code §18.71A.30 and Wash. Rev. Code §18.71A.060

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