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Understanding the Regulatory Process

Understanding the Regulatory Process

In a typical year, the WSMA tracks a dozen or more rules and submits comments on a wide array of issues impacting medicine to various regulatory bodies, including the Washington Medical Commission, the Department of Health, the Health Care Authority, the Office of the Insurance Commissioner, Labor & Industries, and the Department of Licensing. While our Olympia team has an intimate understanding of how the process works and a strong grasp on how a proposal will impact your practice, we are not clinicians; your feedback is critical to help guide our approach.

How It Works

For all the attention given to the legislative process, rules quietly written by bureaucrats carry the same force of law as those written by elected officials.

In Washington state, language from bills that pass the Legislature and are signed into law by the governor is added to the Revised Code of Washington (RCW), the compendium of all state laws in force. Legislative language will contain specific concepts and goals, while often directing regulatory agencies and departments to fill in the details through rulemaking.

Lawmakers do this for several reasons, including a hesitancy to place complicated policy (think about the ever-evolving practice of medicine) in the RCW because it is so difficult to update; you have to pass another law. Deferring to regulatory bodies provides flexibility.

It also offers a more deliberate and comprehensive policymaking arena that facilitates expert input through a process not subject to the pressures and time constraints of the legislative session. Plus, regulatory bodies have the authority to conduct emergency rulemaking any time of year (not just when the Legislature is in session) to address issues that arise or when required to advance the agency's objectives.

The Administrative Procedures Act (APA) outlines how the rulemaking process must be conducted in our state. In short, an agency or department must release a "preproposal statement of inquiry," officially referred to as a CR-101, which is a "heads up" to the public that they intend to write a rule. The second step, the CR-102, includes draft language and an opportunity to comment. The CR-103 is the final, adopted rule. Once finalized, rules are added to the Washington Administrative Code (similar to the RCW, the WAC catalogues all state regulations).

How You Can Help

Each year, the WSMA tracks a dozen or more rules and submits comments on a wide array of issues impacting medicine. For example, in 2017, the Legislature passed House Bill 1427, which directs relevant boards and commissions to write opioid rules for the professions they regulate. We worked on the bill while it was under consideration by the Legislature and participated in every stage of the rulemaking. We were successful in many of our goals, but only because we solicited feedback from WSMA members and urged them to submit their thoughts to the state or endorse our comprehensive comment letter. The APA requires that each comment be considered during the rulemaking process; in short, your feedback matters.

The WSMA will alert members of opportunities to participate in rulemaking in its various email communications. For a comprehensive look at all rules being monitored by the WSMA, contact the policy department at or 360.352.4848.

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