Behavioral health response

AN ACT Relating to professionalizing first responders and co-1
responders through training and reimbursement for behavioral health 2
emergency response; amending RCW 18.71.205 and 71.24.905; adding new 3
sections to chapter 18.73 RCW; adding new sections to chapter 71.24 4
RCW; and creating a new section. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. (1) The legislature finds that:7
(a) The increased frequency of behavioral health emergencies in 8
the community results in increased 911 calls to fire, emergency 9
medical services, and law enforcement. First responders respond to 10
behavioral health emergencies related to drug overdoses, acute 11
suicidal behavior, acute crises, individuals requiring involuntary 12
treatment, and other situations in which there are concerns about 13
medical needs or safety; 14
(b) In addition to fire, emergency medical services, and law 15
enforcement responses to behavioral health calls, there are over 60 16
co-response teams currently operating across Washington to de-17
escalate situations, divert people from criminal justice and 18
emergency medical systems, and bring medical and behavioral health 19
care into the field to serve vulnerable populations;20
H-1075.1
HOUSE BILL 1809
State of Washington 69th Legislature 2025 Regular Session
By Representatives Nance, Griffey, Davis, Eslick, Farivar, Bernbaum,
Pollet, Macri, and Zahn
Read first time 02/03/25. Referred to Committee on Health Care &
Wellness.
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(c) There is a need for high acuity first response services for 1
people experiencing behavioral health emergencies to complement the 2
988 crisis line and behavioral health crisis response system. To help 3
address this need, 911 and 988 response systems must work together to 4
create a seamless crisis care delivery system for individuals in 5
crisis; and 6
(d) First responders and co-response teams in the 911 system 7
respond to behavioral health emergencies and other complex needs at 8
the nexus of health and behavioral health. First responders and co-9
responders are critical to the provision of medical care in the field 10
and ongoing case management and follow-up services, and they also 11
fill gaps in behavioral health crises when there are no mobile crisis 12
teams available. 13
(2) The legislature intends to: 14
(a) Provide high quality training and regional collaboration for 15
co-response service delivery to achieve better care and deliver 16
better outcomes for patients; 17
(b) Equip emergency medical services personnel with the training 18
they need to respond to behavioral health emergencies to save lives. 19
With the proper training, first responders will be better prepared 20
and more confident responding to behavioral health emergencies 21
leading to reduced burnout among these professionals; and22
(c) Develop funding strategies for first responders to better 23
respond to behavioral health emergencies and save taxpayer money. The 24
funding model will incentivize first responders to connect neighbors 25
in need to the right services which will reduce the dependence on 26
emergency departments as the default drop-off location for persons 27
experiencing a behavioral health crisis. By connecting persons in a 28
behavioral health crisis with therapy, counseling, rehabilitative 29
services, pharmacies, social workers, case workers, and shelters, 30
instead of reimbursing ambulances for trips to the emergency 31
department, communities will see a reduction in emergency department 32
overcrowding. 33
NEW SECTION. Sec. 2. A new section is added to chapter 18.73 34
RCW to read as follows: 35
(1) By January 1, 2027, the department shall adopt rules related 36
to the recognition of the behavioral health training in subsection 37
(2) of this section as an optional module that may be incorporated 38
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into ongoing training and evaluation programs available to emergency 1
medical technicians certified under this chapter. 2
(2) By July 1, 2026, the behavioral health crisis outreach 3
response and education center at the University of Washington shall 4
develop a nine-hour training course to instruct emergency medical 5
services personnel, including emergency medical technicians certified 6
under this chapter and physician's trained advanced emergency medical 7
technicians and paramedics certified under RCW 18.71.205, on 8
responding to behavioral health emergencies. The training must be 9
made available statewide in a format that allows for the course to be 10
taught completely in-person, completely online, or a hybrid format of 11
both in-person and online instruction. The training shall be 12
developed in a manner to allow it to be provided through ongoing 13
training and evaluation programs over the course of a three-year 14
period. 15
NEW SECTION. Sec. 3. A new section is added to chapter 18.73 16
RCW to read as follows: 17
(1) Beginning July 1, 2027, the secretary shall issue a 18
behavioral health endorsement to the certification of any emergency 19
medical technician certified under this chapter who demonstrates to 20
the secretary the successful completion of the training established 21
under subsection (2) of this section. 22
(2) By January 1, 2027, the behavioral health crisis outreach 23
response and education center at the University of Washington, in 24
consultation with the department, regional emergency medical services 25
and trauma care councils established under RCW 70.168.100, and 26
community and technical colleges, shall develop a course of 27
instruction to train emergency medical technicians identified in 28
subsection (1) of this section and physician's trained advanced 29
emergency medical technicians and paramedics certified under RCW 30
18.71.205 who are seeking a behavioral health endorsement under 31
either of those provisions. The course shall supplement the training 32
in section 2 of this act and shall include advanced instruction in 33
topics such as medical clearance for behavioral health patients, 34
overdose, crisis de-escalation, and suicide prevention.35
(3) The department and the behavioral health crisis outreach 36
response and education center at the University of Washington shall 37
collaborate to encourage regional emergency medical services and 38
trauma care councils established under RCW 70.168.100 and community 39
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and technical colleges to offer the course established in subsection 1
(2) of this section regularly and statewide. 2
(4) Obtaining a behavioral health endorsement under subsection 3
(1) of this section or RCW 18.71.205 is voluntary and not a 4
requirement for certification as an emergency medical technician or a 5
physician's trained advanced emergency medical technician and 6
paramedic. 7
Sec. 4. RCW 18.71.205 and 2022 c 136 s 4 are each amended to 8
read as follows: 9
(1) The secretary of the department of health shall prescribe:10
(a) Practice parameters, training standards for, and levels of, 11
physician's trained advanced emergency medical technicians and 12
paramedics; 13
(b) Minimum standards and performance requirements for the 14
certification and recertification of physician's trained advanced 15
emergency medical technicians and paramedics; and 16
(c) Procedures for provisional certification, certification, 17
recertification, and decertification of physician's trained advanced 18
emergency medical technicians and paramedics. 19
(2) Initial certification shall be for a period established by 20
the secretary pursuant to RCW 43.70.250 and 43.70.280.21
(3) Recertification shall be granted upon proof of continuing 22
satisfactory performance and education, and shall be for a period 23
established by the secretary pursuant to RCW 43.70.250 and 43.70.280. 24
By January 1, 2027, the department of health shall adopt rules 25
related to the recognition of the behavioral health training in 26
section 2 (2) of this act as an optional module that may be 27
incorporated into ongoing training and evaluation programs available 28
to physician's trained advanced emergency medical technicians and 29
paramedics.30
(4) As used in this chapter and chapter 18.73 RCW, "approved 31
medical program director" means a person who: 32
(a) Is licensed to practice medicine and surgery pursuant to this 33
chapter or osteopathic medicine and surgery pursuant to chapter 18.57 34
RCW; and 35
(b) Is qualified and knowledgeable in the administration and 36
management of emergency care and services; and 37
(c) Is so certified by the department of health for a county, 38
group of counties, or cities with populations over four hundred 39
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thousand in coordination with the recommendations of the local 1
medical community and local emergency medical services and trauma 2
care council. 3
(5) The uniform disciplinary act, chapter 18.130 RCW, governs 4
uncertified practice, the issuance and denial of certificates, and 5
the disciplining of certificate holders under this section. The 6
secretary shall be the disciplining authority under this section. 7
Disciplinary action shall be initiated against a person credentialed 8
under this chapter in a manner consistent with the responsibilities 9
and duties of the medical program director under whom such person is 10
responsible. 11
(6) Such activities of physician's trained advanced emergency 12
medical technicians and paramedics shall be limited to actions taken 13
under the express written or oral order of medical program directors 14
and shall not be construed at any time to include freestanding or 15
nondirected actions, for actions not presenting an emergency or life-16
threatening condition, except nonemergency activities performed 17
pursuant to subsection (7) of this section. 18
(7) Nothing in this section prohibits a physician's trained 19
advanced emergency medical technician or paramedic, acting under the 20
responsible supervision and direction of an approved medical program 21
director, from participating in a community assistance referral and 22
education services program established under RCW 35.21.930 if such 23
participation does not exceed the participant's training and 24
certification. 25
(8) Beginning July 1, 2027, the secretary shall issue a 26
behavioral health endorsement to the certification of any physician's 27
trained advanced emergency medical technician and paramedic certified 28
under this section who demonstrates to the secretary the successful 29
completion of the training established under section 3 (2) of this 30
act.31
NEW SECTION. Sec. 5. A new section is added to chapter 71.24 32
RCW to read as follows: 33
The authority shall require reimbursement under medical 34
assistance programs for fire departments and emergency medical 35
services providing behavioral health services under this chapter 36
through certified emergency medical technicians with a behavioral 37
health endorsement issued under section 3 of this act or certified 38
physician's trained advanced emergency medical technicians and 39
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paramedics with a behavioral health endorsement issued under RCW 1
18.71.205. 2
NEW SECTION. Sec. 6. A new section is added to chapter 71.24 3
RCW to read as follows: 4
(1) The authority, in collaboration with the behavioral health 5
administrative services organizations and the behavioral health 6
crisis outreach response and education center at the University of 7
Washington, shall establish a pilot project in four behavioral health 8
administrative services organizations. The pilot project must be 9
designed to develop best practices for coordinating responses to 10
behavioral health emergencies within the broader crisis response 11
continuum and develop billing strategies for fire agencies, emergency 12
medical service agencies, and law enforcement agencies that are not 13
endorsed mobile rapid response crisis teams under RCW 71.24.903 that 14
respond to behavioral health crisis situations. In addition, the 15
pilot project shall be designed to assess the types of behavioral 16
health training that are most relevant to first responders responding 17
to behavioral health emergencies. 18
(2) The pilot project shall be in effect between January 1, 2026, 19
and June 30, 2027. The authority shall select four behavioral health 20
administrative services organizations to be the pilot project sites. 21
The authority shall select behavioral health administrative services 22
organizations on both sides of the Cascade crest. The authority must 23
select sites that either have integrated 911 and 988 response 24
capacity or have plans to integrate 911 and 988 response capacity.25
(3) By July 1, 2027, the authority or its designee shall submit a 26
report to the governor and the relevant committees of the legislature 27
with a summary of the pilot project and its results, including best 28
practices developed under subsection (1) of this section and 29
recommendations for local, regional, and statewide implementation of 30
the best practices. 31
NEW SECTION. Sec. 7. A new section is added to chapter 71.24 32
RCW to read as follows: 33
(1) The behavioral health administrative services organizations 34
and the behavioral health crisis outreach response and education 35
center at the University of Washington, in consultation with the 36
authority, shall establish a program to administer a co-response 37
education training academy resulting in a certification in best 38
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crisis response practices in three behavioral health administrative 1
services organizations with a significant co-response footprint. The 2
co-response education training academy shall be expanded to all 10 3
behavioral health administrative services organizations by 2027 and 4
provide openings for other regional crisis and mobile response teams. 5
The behavioral health administrative services organizations shall 6
promote the training academy available to local co-response and 7
crisis teams in their regions. The certification shall be optional 8
and may not serve as an additional requirement for licensure for 9
first responders or licensed human services professionals.10
(2) The behavioral health crisis outreach response and education 11
center at the University of Washington may provide grants to small 12
and rural co-response programs for staff to attend the training to 13
offset increased costs associated with sending staff to training.14
Sec. 8. RCW 71.24.905 and 2022 c 232 s 2 are each amended to 15
read as follows: 16
(1) Subject to the availability of amounts appropriated for this 17
specific purpose, the behavioral health crisis outreach response and 18
education center at the University of Washington ((shall)), in 19
consultation and collaboration with the co-responder outreach 20
alliance and other stakeholders as appropriate in the field of co-21
response, shall: 22
(a) ((Establish regular opportunities for police, fire, emergency 23
medical services, peer counselors, and behavioral health personnel 24
working in co-response to convene for activities such as training, 25
exchanging information and best practices around the state and 26
nationally, and providing the University of Washington with 27
assistance with activities described in this section;28
(b) Subject to the availability of amounts appropriated for this 29
specific purpose, administer a small budget to help defray costs for 30
training and professional development, which may include expenses 31
related to attending or hosting site visits with experienced co-32
response teams;33
(c))) Develop an assessment to be provided to the governor and 34
legislature by June 30, ((2023)) 2026, and annually thereafter , 35
describing and analyzing the following: 36
(i) Existing capacity and shortfalls across the state in co-37
response teams and the co-response workforce and of emergency medical 38
technicians and physician's trained advanced emergency medical 39
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technicians or paramedics operating with a behavioral health 1
endorsement to their certification under section 3 of this act or RCW 2
18.71.205; 3
(ii) Current alignment of co-response teams with cities, 4
counties, behavioral health administrative services organizations, 5
and call centers; distribution among ((police)) law enforcement , 6
fire, and EMS-based co-response models; and desired alignment;7
(iii) Current funding strategies for co-response teams and 8
identification of ((federal)) promising funding opportunities;9
(iv) Current data systems utilized and an assessment of their 10
effectiveness for use by co-responders, program planners, and 11
policymakers; 12
(v) Current training practices and identification of future state 13
training practices; 14
(vi) Alignment with designated crisis responder activities;15
(vii) Recommendations concerning best practices to prepare co-16
responders to achieve objectives and meet future state crisis system 17
needs, including those of the 988 system; 18
(viii) Recommendations to align co-responder activities with 19
efforts to reform ways in which persons experiencing a behavioral 20
health crisis interact with the criminal justice ((system)) and 21
emergency medical systems; and 22
(ix) Assessment of training and educational needs for current and 23
future co-responder workforce; 24
(((d) Beginning in calendar year 2023, begin development of model 25
training curricula for individuals participating in co-response 26
teams; and27
(e) Beginning in calendar year 2023, host))28
(b) Host an annual statewide conference that draws state and 29
national ((co-responders)) crisis responders from both 911 and 988 30
systems. The behavioral health crisis outreach response and education 31
center at the University of Washington shall collaborate with 32
stakeholders to increase the capacity of the annual conference to 33
make it available to crisis responders across a variety of programs.34
(2) Stakeholders in the field of co-response may include, but are 35
not limited to, an association representing co-responders in 36
Washington, the Washington association of designated crisis 37
responders; state associations representing police, fire, and 38
emergency medical services personnel; the Washington council on 39
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behavioral health; the state ((enhanced)) 911 system; 988 crisis call 1
centers; and the peer workforce alliance. 2
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