Ambulances/transport options

AN ACT Relating to transport of patients by ambulance to 1
facilities other than emergency departments; amending RCW 18.73.280, 2
48.43.121, 74.09.330, 70.168.015, and 70.168.100; reenacting and 3
amending RCW 18.71.210; and adding a new section to chapter 41.05 4
RCW. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
Sec. 1. RCW 18.73.280 and 2015 c 157 s 4 are each amended to 7
read as follows: 8
An ambulance service may transport patients to a ((nonmedical)) 9
facility other than an emergency department , such as an urgent care 10
clinic a mental health facility , or ((chemical dependency )) a 11
substance use disorder program, as authorized in regional emergency 12
medical services and trauma care plans under RCW 70.168.100.13
NEW SECTION. Sec. 2. A new section is added to chapter 41.05 14
RCW to read as follows: 15
A health plan offered to employees and their covered dependents 16
under this chapter issued or renewed on or after January 1, 2026, 17
shall provide coverage for ground ambulance transport to a facility 18
other than an emergency department, such as an urgent care clinic, a 19
H-1133.1
HOUSE BILL 1864
State of Washington 69th Legislature 2025 Regular Session
By Representatives Thomas, Griffey, Doglio, Parshley, Rule, Fosse,
Timmons, Farivar, Reed, Springer, Ramel, Nance, Cortes, Simmons,
Peterson, Macri, Street, Salahuddin, Obras, Pollet, Zahn, and Hill
Read first time 02/06/25. Referred to Committee on Health Care &
Wellness.
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mental health facility, or a substance use disorder program, in 1
accordance with RCW 18.73.280. 2
Sec. 3. RCW 48.43.121 and 2024 c 218 s 12 are each amended to 3
read as follows: 4
(1)(a) For health plans issued or renewed on or after January 1, 5
2025, a health carrier shall provide coverage for ground ambulance 6
transports to behavioral health emergency services providers for 7
enrollees who are experiencing an emergency medical condition as 8
defined in RCW 48.43.005. A health carrier may not require prior 9
authorization of ground ambulance services if a prudent layperson 10
acting reasonably would have believed that an emergency medical 11
condition existed. 12
(b) For a health plan issued or renewed on or after January 1, 13
2026, a health carrier shall provide coverage for ground ambulance 14
transport to a facility other than an emergency department, such as 15
an urgent care clinic, in accordance with RCW 18.73.280.16
(2) Coverage of ground ambulance transports ((to behavioral 17
health emergency services providers )) under subsection (1) of this 18
section may be subject to applicable in-network copayments, 19
coinsurance, and deductibles, as provided in chapter 48.49 RCW.20
Sec. 4. RCW 74.09.330 and 2015 c 157 s 6 are each amended to 21
read as follows: 22
The authority shall develop a reimbursement methodology for 23
ambulance services when transporting a medical assistance enrollee to 24
a facility other than an emergency department, such as an urgent care 25
clinic, mental health facility , or ((chemical dependency )) substance 26
use disorder program, in accordance with RCW 18.73.280 and the 27
applicable alternative facility procedures adopted under RCW 28
70.168.100. 29
Sec. 5. RCW 70.168.015 and 2015 c 157 s 2 are each amended to 30
read as follows: 31
As used in this chapter, the following terms have the meanings 32
indicated unless the context clearly requires otherwise.33
(1) "Cardiac" means acute coronary syndrome, an umbrella term 34
used to cover any group of clinical symptoms compatible with acute 35
myocardial ischemia, which is chest discomfort or other symptoms due 36
to insufficient blood supply to the heart muscle resulting from 37
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coronary artery disease. "Cardiac" also includes out-of-hospital 1
cardiac arrest, which is the cessation of mechanical heart activity 2
as assessed by emergency medical services personnel, or other acute 3
heart conditions. 4
(2) "Communications system" means a radio and landline network 5
which provides rapid public access, coordinated central dispatching 6
of services, and coordination of personnel, equipment, and facilities 7
in an emergency medical services and trauma care system.8
(3) "Department" means the department of health.9
(4) "Designated trauma care service" means a level I, II, III, 10
IV, or V trauma care service or level I, II, or III pediatric trauma 11
care service or level I, I-pediatric, II, or III trauma-related 12
rehabilitative service. 13
(5) "Designation" means a formal determination by the department 14
that hospitals or health care facilities are capable of providing 15
designated trauma care services as authorized in RCW 70.168.070.16
(6) "Emergency medical service" means medical treatment and care 17
that may be rendered at the scene of any medical emergency or while 18
transporting any patient in an ambulance to an appropriate medical 19
facility, including ambulance transportation between medical 20
facilities. 21
(7) "Emergency medical services and trauma care planning and 22
service regions" means geographic areas established by the department 23
under this chapter. 24
(8) "Emergency medical services and trauma care system plan" 25
means a statewide plan that identifies statewide emergency medical 26
services and trauma care objectives and priorities and identifies 27
equipment, facility, personnel, training, and other needs required to 28
create and maintain a statewide emergency medical services and trauma 29
care system. The plan also includes a plan of implementation that 30
identifies the state, regional, and local activities that will 31
create, operate, maintain, and enhance the system. The plan is 32
formulated by incorporating the regional emergency medical services 33
and trauma care plans required under this chapter. The plan shall be 34
updated every two years and shall be made available to the state 35
board of health in sufficient time to be considered in preparation of 36
the biennial state health report required in RCW 43.20.050.37
(9) "Emergency medical services medical program director" means a 38
person who is an approved program director as defined by RCW 39
18.71.205(4). 40
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(10) "Facility patient care protocols" means the written 1
procedures adopted by the medical staff that direct the care of the 2
patient. These procedures shall be based upon the assessment of the 3
patients' medical needs. The procedures shall follow minimum 4
statewide standards for trauma care services. 5
(11) "Hospital" means a facility licensed under chapter 70.41 6
RCW, or comparable health care facility operated by the federal 7
government or located and licensed in another state.8
(12) "Level I-pediatric rehabilitative services" means 9
rehabilitative services as established in RCW 70.168.060. Facilities 10
providing level I-pediatric rehabilitative services provide the same 11
services as facilities authorized to provide level I rehabilitative 12
services except these services are exclusively for children under the 13
age of fifteen years. 14
(13) "Level I pediatric trauma care services" means pediatric 15
trauma care services as established in RCW 70.168.060. Hospitals 16
providing level I services shall provide definitive, comprehensive, 17
specialized care for pediatric trauma patients and shall also provide 18
ongoing research and health care professional education in pediatric 19
trauma care. 20
(14) "Level I rehabilitative services" means rehabilitative 21
services as established in RCW 70.168.060. Facilities providing level 22
I rehabilitative services provide rehabilitative treatment to 23
patients with traumatic brain injuries, spinal cord injuries, 24
complicated amputations, and other diagnoses resulting in functional 25
impairment, with moderate to severe impairment or complexity. These 26
facilities serve as referral facilities for facilities authorized to 27
provide level II and III rehabilitative services. 28
(15) "Level I trauma care services" means trauma care services as 29
established in RCW 70.168.060. Hospitals providing level I services 30
shall have specialized trauma care teams and provide ongoing research 31
and health care professional education in trauma care.32
(16) "Level II pediatric trauma care services" means pediatric 33
trauma care services as established in RCW 70.168.060. Hospitals 34
providing level II services shall provide initial stabilization and 35
evaluation of pediatric trauma patients and provide comprehensive 36
general medicine and surgical care to pediatric patients who can be 37
maintained in a stable or improving condition without the specialized 38
care available in the level I hospital. Complex surgeries and 39
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research and health care professional education in pediatric trauma 1
care activities are not required. 2
(17) "Level II rehabilitative services" means rehabilitative 3
services as established in RCW 70.168.060. Facilities providing level 4
II rehabilitative services treat individuals with musculoskeletal 5
trauma, peripheral nerve lesions, lower extremity amputations, and 6
other diagnoses resulting in functional impairment in more than one 7
functional area, with moderate to severe impairment or complexity.8
(18) "Level II trauma care services" means trauma care services 9
as established in RCW 70.168.060. Hospitals providing level II 10
services shall be similar to those provided by level I hospitals, 11
although complex surgeries and research and health care professional 12
education activities are not required to be provided.13
(19) "Level III pediatric trauma care services" means pediatric 14
trauma care services as established in RCW 70.168.060. Hospitals 15
providing level III services shall provide initial evaluation and 16
stabilization of patients. The range of pediatric trauma care 17
services provided in level III hospitals are not as comprehensive as 18
level I and II hospitals. 19
(20) "Level III rehabilitative services" means rehabilitative 20
services as established in RCW 70.168.060. Facilities providing level 21
III rehabilitative services provide treatment to individuals with 22
musculoskeletal injuries, peripheral nerve injuries, uncomplicated 23
lower extremity amputations, and other diagnoses resulting in 24
functional impairment in more than one functional area but with 25
minimal to moderate impairment or complexity. 26
(21) "Level III trauma care services" means trauma care services 27
as established in RCW 70.168.060. The range of trauma care services 28
provided by level III hospitals are not as comprehensive as level I 29
and II hospitals. 30
(22) "Level IV trauma care services" means trauma care services 31
as established in RCW 70.168.060. 32
(23) "Level V trauma care services" means trauma care services as 33
established in RCW 70.168.060. Facilities providing level V services 34
shall provide stabilization and transfer of all patients with 35
potentially life-threatening injuries. 36
(24) "Patient care procedures" means written operating guidelines 37
adopted by the regional emergency medical services and trauma care 38
council, in consultation with local emergency medical services and 39
trauma care councils, emergency communication centers, and the 40
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emergency medical services medical program director, in accordance 1
with minimum statewide standards. The patient care procedures shall 2
identify the level of medical care personnel to be dispatched to an 3
emergency scene, procedures for triage of patients, the level of 4
trauma care facility, mental health facility, or ((chemical 5
dependency)) substance use disorder program, or other nonemergency 6
department facility, such as an urgent care clinic, to first receive 7
the patient, and the name and location of other trauma care 8
facilities, mental health facilities, or ((chemical dependency )) 9
substance use disorder programs to receive the patient should an 10
interfacility transfer be necessary. Procedures on interfacility 11
transfer of patients shall be consistent with the transfer procedures 12
required in chapter 70.170 RCW. 13
(25) "Pediatric trauma patient" means trauma patients known or 14
estimated to be less than fifteen years of age. 15
(26) "Prehospital" means emergency medical care or transportation 16
rendered to patients prior to hospital admission or during 17
interfacility transfer by licensed ambulance or aid service under 18
chapter 18.73 RCW, by personnel certified to provide emergency 19
medical care under chapters 18.71 and 18.73 RCW, or by facilities 20
providing level V trauma care services as provided for in this 21
chapter. 22
(27) "Prehospital patient care protocols" means the written 23
procedures adopted by the emergency medical services medical program 24
director that direct the out-of-hospital emergency care of the 25
emergency patient which includes the trauma patient. These procedures 26
shall be based upon the assessment of the patients' medical needs and 27
the treatment to be provided for serious conditions. The procedures 28
shall meet or exceed statewide minimum standards for trauma and other 29
prehospital care services. 30
(28) "Rehabilitative services" means a formal program of 31
multidisciplinary, coordinated, and integrated services for 32
evaluation, treatment, education, and training to help individuals 33
with disabling impairments achieve and maintain optimal functional 34
independence in physical, psychosocial, social, vocational, and 35
avocational realms. Rehabilitation is indicated for the trauma 36
patient who has sustained neurologic or musculoskeletal injury and 37
who needs physical or cognitive intervention to return to home, work, 38
or society. 39
(29) "Secretary" means the secretary of the department of health.40
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(30) "Trauma" means a major single or multisystem injury 1
requiring immediate medical or surgical intervention or treatment to 2
prevent death or permanent disability. 3
(31) "Trauma care system" means an organized approach to 4
providing care to trauma patients that provides personnel, 5
facilities, and equipment for effective and coordinated trauma care. 6
The trauma care system shall: Identify facilities with specific 7
capabilities to provide care, triage trauma victims at the scene, and 8
require that all trauma victims be sent to an appropriate trauma 9
facility. The trauma care system includes prevention, prehospital 10
care, hospital care, and rehabilitation. 11
(32) "Triage" means the sorting of patients in terms of 12
disposition, destination, or priority. Triage of prehospital trauma 13
victims requires identifying injury severity so that the appropriate 14
care level can be readily assessed according to patient care 15
guidelines. 16
(33) "Verification" means the identification of prehospital 17
providers who are capable of providing verified trauma care services 18
and shall be a part of the licensure process required in chapter 19
18.73 RCW. 20
(34) "Verified trauma care service" means prehospital service as 21
provided for in RCW 70.168.080, and identified in the regional 22
emergency medical services and trauma care plan as required by RCW 23
70.168.100. 24
Sec. 6. RCW 70.168.100 and 2015 c 157 s 3 are each amended to 25
read as follows: 26
Regional emergency medical services and trauma care councils are 27
established. The councils: 28
(1) By June 1990, shall begin the development of regional 29
emergency medical services and trauma care plans to:30
(a) Assess and analyze regional emergency medical services and 31
trauma care needs; 32
(b) Identify personnel, agencies, facilities, equipment, 33
training, and education to meet regional and local needs;34
(c) Identify specific activities necessary to meet statewide 35
standards and patient care outcomes and develop a plan of 36
implementation for regional compliance; 37
(d) Establish and review agreements with regional providers 38
necessary to meet state standards; 39
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(e) Establish agreements with providers outside the region to 1
facilitate patient transfer; 2
(f) Include a regional budget; 3
(g) Establish the number and level of facilities to be designated 4
which are consistent with state standards and based upon availability 5
of resources and the distribution of trauma within the region;6
(h) Identify the need for and recommend distribution and level of 7
care of prehospital services to assure adequate availability and 8
avoid inefficient duplication and lack of coordination of prehospital 9
services within the region; 10
(i) Identify procedures to allow for the appropriate transport of 11
patients to facilities other than emergency departments, such as 12
urgent care clinics, mental health facilities , or ((chemical 13
dependency)) substance use disorder programs, as informed by RCW 14
18.73.280 and the alternative facility guidelines adopted under RCW 15
70.168.170; and 16
(j) Include other specific elements defined by the department;17
(2) By June 1991, shall begin the submission of the regional 18
emergency medical services and trauma care plan to the department;19
(3) Shall advise the department on matters relating to the 20
delivery of emergency medical services and trauma care within the 21
region; 22
(4) Shall provide data required by the department to assess the 23
effectiveness of the emergency medical services and trauma care 24
system; 25
(5) May apply for, receive, and accept gifts and other payments, 26
including property and service, from any governmental or other public 27
or private entity or person, and may make arrangements as to the use 28
of these receipts, including any activities related to the design, 29
maintenance, or enhancements of the emergency medical services and 30
trauma care system in the region. The councils shall report in the 31
regional budget the amount, source, and purpose of all gifts and 32
payments. 33
Sec. 7. RCW 18.71.210 and 2015 c 157 s 5 and 2015 c 93 s 4 are 34
each reenacted and amended to read as follows: 35
(1) No act or omission of any physician's trained advanced 36
emergency medical technician and paramedic, as defined in RCW 37
18.71.200, or any emergency medical technician or first responder, as 38
defined in RCW 18.73.030, done or omitted in good faith while 39
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rendering emergency medical service under the responsible supervision 1
and control of a licensed physician or an approved medical program 2
director or delegate (s) to a person who has suffered illness or 3
bodily injury shall impose any liability upon: 4
(a) The physician's trained advanced emergency medical technician 5
and paramedic, emergency medical technician, or first responder;6
(b) The medical program director; 7
(c) The supervising physician(s); 8
(d) Any hospital, the officers, members of the staff, nurses, or 9
other employees of a hospital; 10
(e) Any training agency or training physician(s);11
(f) Any licensed ambulance service; or 12
(g) Any federal, state, county, city, or other local governmental 13
unit or employees of such a governmental unit. 14
(2) This section shall apply to an act or omission committed or 15
omitted in the performance of the actual emergency medical procedures 16
and not in the commission or omission of an act which is not within 17
the field of medical expertise of the physician's trained advanced 18
emergency medical technician and paramedic, emergency medical 19
technician, or first responder, as the case may be.20
(3) This section shall apply also to emergency medical 21
technicians, advanced emergency medical technicians, paramedics, and 22
medical program directors participating in a community assistance 23
referral and education services program established under RCW 24
35.21.930. 25
(((3))) (4) This section shall apply also, as to the entities and 26
personnel described in subsection (1) of this section, to any act or 27
omission committed or omitted in good faith by such entities or 28
personnel in rendering services at the request of an approved medical 29
program director in the training of emergency medical service 30
personnel for certification or recertification pursuant to this 31
chapter. 32
(((4))) (5) This section shall apply also, as to the entities and 33
personnel described in subsection (1) of this section, to any act or 34
omission committed or omitted in good faith by such entities or 35
personnel involved in the transport of patients to facilities other 36
than emergency departments, such as urgent care clinics, mental 37
health facilities , or ((chemical dependency )) substance use disorder 38
programs, in accordance with applicable alternative facility 39
procedures adopted under RCW 70.168.100. 40
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(((5))) (6) This section shall not apply to any act or omission 1
which constitutes either gross negligence or willful or wanton 2
misconduct. 3
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