This bill reenacts and amends parts of chapter 18.360 RCW (including RCW 18.360.010 and RCW 18.360.050), amends RCW 18.360.060, and adds a new section to that chapter. It changes the scope-of-practice and procedural rules for several categories of medical assistants (medical assistant-certified, -registered, -phlebotomist, -hemodialysis technician, and medical assistant-EMT), specifying in statute which clinical, specimen collection, diagnostic testing, patient care, and limited medication administration tasks may be delegated by and performed under the supervision of specified health care practitioners. The department is authorized to update which CLIA-waived tests are allowed, and the secretary of health may adopt rules that further limit which drugs medical assistants may administer based on risk, drug class, or route. The new section permits a medical assistant-certified, under a standing written protocol and after required training, to enter and activate certain predefined orders in an order-entry system (for example routine immunizations, screening tests, routine lab monitoring, diagnostic imaging, specified therapeutic procedures, point-of-care and CLIA-waived tests, routine refills with no dose changes, referrals, perioperative order sets, and supportive device orders). Controlled substance orders may be entered but not activated by the assistant. Supervising practitioners must review and countersign any order entered and activated within 72 hours per facility policy. Employers must document training and make records available to the Department of Health, and the Department may adopt implementing rules. The bill clarifies supervision standards (generally requiring the practitioner to be physically present and immediately available, with specific exceptions such as certain blood draws, vaccine administration, specimen collection, and supervision by interactive audio/video telemedicine for intramuscular treatment of known or suspected syphilis). It also authorizes medical assistant-EMTs to establish and remove IV lines without administering medications, and addresses hemodialysis and phlebotomy duties with rulemaking authority for minimum standards. Some statutory text and cross-referenced subsections, the full amended language of RCW 18.360.050 and RCW 18.360.060, and the exact rule specifics are not included in the provided extracts, so those details are uncertain from the materials given.

If enacted, the law lets different categories of medical assistants take on more front-line clinical tasks and routine ordering that currently require a practitioner’s direct action. Certified medical assistants can enter and activate many routine orders (immunizations that don’t need clinical judgment, screening tests, repeat labs, imaging, point-of-care tests, routine refills, referrals, perioperative order sets and certain procedures) under standing written protocols after specific training, with the supervising practitioner required to review and countersign within 72 hours; they may enter but not activate controlled-substance orders. EMT, hemodialysis, phlebotomy, and registered medical assistants have clarified or expanded duties too (for example, EMT-MAs may place and remove IV lines without giving medications, and hemodialysis techs may administer drugs and oxygen under secretary rules), and the Department of Health can update which CLIA-waived tests are allowed and set drug or supervision limits. The most affected parties are health care facilities, supervising practitioners, and employers of medical assistants, who will likely save practitioner time and shift routine work to trained assistants but must create and maintain standing protocols, provide and document training, track countersignature timing, and be ready for Department of Health surveys; those compliance and training obligations will create administrative costs and potential liability if supervision or documentation requirements aren’t met. Important details that affect exact risk and cost—such as the specific drug restrictions the secretary will adopt, full text of the amended sections, and some referenced provisions—are not included here, so the scope of allowable medications and other operational limits remain uncertain.